THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient, considering red flags and risk factors.

The competent candidate should:

• Establish rapport and conduct an empathetic, patient-centred consultation, addressing concerns about vision and neurological conditions.
• Clarify the presenting complaint, exploring the onset, duration, and progression of symptoms, including the nature of the abnormal eye sensation (e.g., gritty, burning, foreign body sensation).
• Identify associated symptoms:
  • Blurred vision
  • Photophobia
  • Eye redness or discharge
  • Neurological symptoms (numbness, tingling, weakness, dizziness, coordination issues)
  • Headache, facial pain, recent viral illness
• Explore red flags suggestive of serious conditions such as multiple sclerosis (MS), herpes simplex keratitis, optic neuritis, or trigeminal neuralgia.
• Obtain past medical history, including autoimmune diseases, neurological conditions, diabetes, or previous eye disorders.
• Review family history (e.g., MS in a maternal aunt).
• Assess lifestyle factors, including screen time, exposure to dry environments, and eye strain.
• Ask about medications and allergies, including contact lens use, eye drops, or any recent skincare products.
• Provide empathetic reassurance while explaining the need for further assessment.

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Task 2: Discuss the differential diagnoses and explain potential causes of her abnormal eye sensation.

The competent candidate should:

• Explain that abnormal eye sensations can result from benign conditions or serious underlying pathology, requiring careful evaluation.
• Discuss common benign causes:
  • Dry eye syndrome – exacerbated by screen time, air-conditioning, and reduced blinking.
  • Corneal abrasion – though less likely without trauma.
  • Allergic conjunctivitis – usually associated with itching and watering.
• Explain more serious conditions:
  • Herpes simplex keratitis – foreign body sensation, blurred vision, possible history of cold sores.
  • Optic neuritis (linked to MS) – blurry vision, eye pain, colour desaturation.
  • Trigeminal neuralgia – sharp facial pain or tingling alongside eye discomfort.
  • Migraine aura – transient vision changes without permanent damage.
• Highlight her family history of MS, which warrants further neurological assessment.
• Use patient-friendly language and avoid medical jargon to ensure understanding.

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Task 3: Outline an appropriate management plan, including necessary investigations and referrals.

The competent candidate should:

• Explain the need for further assessment, tailored to the differential diagnoses.
• Consider first-line investigations:
  • Fluorescein staining – to rule out corneal abrasions or ulceration.
  • Ophthalmoscopy/slit lamp exam – to assess keratitis, uveitis, or optic nerve involvement.
  • Neurological assessment – to check for MS-related symptoms (reflexes, coordination, sensory changes).
  • MRI brain/orbits – if neurological causes (optic neuritis, MS) are suspected.
• Initiate symptomatic management:
  • Artificial tears and warm compresses for dry eye syndrome.
  • Avoidance of triggers (screen overuse, air-conditioning, allergens).
  • Antiviral eye drops if herpetic keratitis is suspected.
• Arrange urgent ophthalmology referral if:
  • Vision loss worsens.
  • Pain increases significantly.
  • Neurological symptoms develop.
• Provide clear follow-up instructions, scheduling a review within one to two weeks.

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Task 4: Provide preventive health advice regarding eye care and lifestyle modifications.

The competent candidate should:

• Educate on eye hygiene:
  • Blink more often when using screens.
  • Use humidifiers if in dry environments.
• Discuss lifestyle modifications:
  • 20-20-20 rule – every 20 minutes, take a 20-second break and look 20 feet away.
  • Hydration and omega-3 intake for eye health.
• Advise on MS risk awareness, encouraging regular check-ups if neurological symptoms develop.
• Encourage routine eye exams, especially if symptoms persist.

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SUMMARY OF A COMPETENT ANSWER

• Thorough history-taking, identifying red flags and risk factors for serious eye and neurological conditions.
• Clear and structured differential diagnosis, distinguishing between benign and serious causes.
• Logical management plan, including relevant investigations and specialist referrals.
• Preventive health advice, addressing lifestyle factors and risk reduction.
• Patient-centred communication, ensuring clarity, empathy, and reassurance.

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PITFALLS

• Failing to recognise red flag symptoms, such as vision loss, neurological deficits, or worsening pain.
• Dismissing patient concerns about MS without addressing family history and risk factors.
• Not considering a broad differential diagnosis, including neurological, autoimmune, and infectious causes.
• Neglecting to arrange appropriate follow-up or specialist referral, delaying diagnosis of serious conditions.
• Over-reassuring the patient without adequate investigation, potentially missing significant pathology.
• Using excessive medical jargon, leading to poor patient understanding and increased anxiety.

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REFERENCES

• RACGP Guidelines – Eye Health in General Practice
• GP Exams – Eye sensation abnormal

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MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare, and the full impact of their illness experience on their lives.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured and thorough history to identify red flags.
2.2 Interprets findings to differentiate between benign and serious causes of eye sensation abnormalities.

3. Diagnosis, Decision-Making and Reasoning

3.1 Generates a differential diagnosis for abnormal eye sensations.
3.2 Identifies alarm symptoms suggestive of serious conditions.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan for eye sensation abnormalities.
4.2 Provides appropriate referrals and follow-up based on risk stratification.

5. Preventive and Population Health

5.1 Discusses appropriate preventive eye care and risk factor modification.

6. Professionalism

6.1 Respects patient autonomy and confidentiality when discussing health concerns.

7. General Practice Systems and Regulatory Requirements

7.1 Refers appropriately under Medicare guidelines for ophthalmology review.

8. Procedural Skills

8.1 Explains the indications for and process of fluorescein staining and slit lamp examination.

9. Managing Uncertainty

9.1 Provides a structured approach to managing eye sensation abnormalities when the cause is unclear.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises red flags for neurological or infectious causes and refers urgently if indicated.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD