CASE INFORMATION

Case ID: CCE-2025-001
Case Name: Emily Johnson
Age: 29
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: W78 – Observation/health education/advice/diet pregnancy

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communication is appropriate to the person and sociocultural context. 1.2 Engages the patient to gather information about symptoms, ideas, concerns, expectations, and impact. 1.4 Communicates effectively in routine and difficult situations.
2. Clinical Information Gathering and Interpretation	2.1 Uses an organised and logical approach to history-taking. 2.2 Identifies relevant symptoms and risk factors.
3. Diagnosis, Decision-Making and Reasoning	3.1 Formulates an appropriate assessment of the patient’s pregnancy status and needs.
4. Clinical Management and Therapeutic Reasoning	4.1 Provides appropriate lifestyle and dietary advice for pregnancy. 4.2 Identifies and manages common pregnancy-related concerns.
5. Preventive and Population Health	5.1 Advises on recommended screening tests and vaccinations in pregnancy.
6. Professionalism	6.1 Provides patient-centred, evidence-based advice with empathy.
7. General Practice Systems and Regulatory Requirements	7.1 Recognises appropriate referral pathways (e.g., shared care, midwifery, obstetric specialist).
9. Managing Uncertainty	9.1 Provides reassurance and safety-netting advice for the patient.

CASE FEATURES

Requests clarification about exercise safety.
First pregnancy at 12 weeks gestation.
Concerns about nutrition and exercise during pregnancy.
Mild nausea but no vomiting.
Recent booking bloods and ultrasound were normal.
Uncertain about which foods to avoid and what supplements to take.

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

Take an appropriate history.
Outline the differential diagnosis and key investigations required.
Address the patient’s concerns.
Develop a safe and patient-centred management plan.

SCENARIO

Emily Johnson, a 29-year-old woman, presents for a routine antenatal check-up at 12 weeks gestation. This is her first pregnancy, and she is generally feeling well but has some mild nausea without vomiting. She is unsure about dietary requirements, particularly regarding foods to avoid, supplements to take, and safe exercise.

She recently had her booking blood tests and ultrasound, which were all normal. She has no medical conditions, takes a pregnancy multivitamin, and is otherwise healthy. She wants clarification on pregnancy nutrition and exercise recommendations.

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Johnson
Age: 29
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Pregnancy multivitamin

Past History

Nil significant medical history

Social History

Works as a teacher

Family History

No history of gestational diabetes or pre-eclampsia in family
No history of congenital conditions

Smoking and Alcohol

Non-smoker
Stopped alcohol intake since conception

Vaccination and Preventative Activities

Willing to discuss pertussis and influenza vaccinations
Up to date with vaccinations (influenza, COVID-19, MMR before pregnancy)

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

ROLE-PLAYER SCRIPT

Opening Line

“Hi Doctor, I just wanted to check if I’m eating right and doing the right things for my baby.”

General Information

You are 12 weeks pregnant with your first baby.
You feel mostly well but experience some morning nausea, although you haven’t vomited.
You take a pregnancy multivitamin daily.
You have been trying to eat healthily, but you are confused about what’s safe and what to avoid.

Specific Information

(Only Provide If Asked)

Background Information

You are worried about foods that could harm the baby and whether you need extra supplements.
You have heard conflicting advice about exercise and want to make sure you’re not doing anything risky.
Your first ultrasound and blood tests were normal.
You are feeling excited about the pregnancy but also a bit overwhelmed with all the different recommendations.

Dietary Concerns

You have been avoiding soft cheeses, raw seafood, deli meats, and raw eggs because you heard they carry bacteria that could harm the baby.
You have cut down on fish because you’re worried about mercury, but you’re not sure if you should be eating more fish for omega-3.
You still drink one coffee per day, but you’re not sure if that’s okay.
You are not sure if you need to take extra iron or calcium on top of your multivitamin.
You have reduced your intake of processed foods, but you’re not sure about artificial sweeteners or additives.

Exercise Concerns

You enjoy walking and yoga, but you stopped jogging because someone told you it could be bad for the baby.
You used to do light strength training but stopped because you’re unsure if it’s safe.
You have seen pregnancy yoga online but don’t know which poses are safe or unsafe.
You want to stay fit but are afraid of doing something harmful to the pregnancy.

Weight Gain and Body Changes

You feel worried about gaining too much weight and wonder how much is normal during pregnancy.
You have heard that pregnant women need to “eat for two,” but you don’t want to overeat unnecessarily.
Your clothes are starting to feel tighter, and you wonder if it’s too early to start showing.

Vaccinations and Screening

You had all your childhood vaccinations and got a flu shot last year.
You have heard about the whooping cough vaccine but are not sure when to get it.
You haven’t had a glucose test yet and don’t know when it happens.
You haven’t had the COVID-19 booster since falling pregnant and want to know if it’s safe.

Emotional Cues

You are excited about your pregnancy, but also nervous because it’s your first time, and you don’t want to make any mistakes.
You smile and seem happy, but when discussing food safety and exercise, you appear slightly anxious and uncertain.
You fidget with your hands when asking about potential risks to the baby.
You laugh a little when saying that you have been Googling everything, but you also look overwhelmed by too much information.
You feel reassured when the doctor gives clear, simple advice, and you nod when given specific recommendations.
You want validation that you’re doing the right thing and seeking reassurance that you’re making the best choices for your baby.

Questions for the Candidate (Ask Naturally During Consultation)

Is it okay to have coffee during pregnancy? I still have one cup a day, but I’ve heard mixed things about caffeine.
Do I need extra vitamins or supplements apart from my pregnancy multivitamin? Should I be taking extra iron or calcium?
I’ve stopped jogging because someone told me it’s not safe when you’re pregnant. Should I stop completely, or is it okay to continue?
I heard that I should get a whooping cough vaccine, but I don’t know when. When should I get it?
Do I need to do a glucose test? I haven’t had one yet, but I heard that some women need it to check for diabetes.
How much weight should I be gaining during pregnancy? I don’t want to overeat, but I also don’t want to be underweight.
Is it safe to do yoga during pregnancy? Are there any poses I should avoid?
Some people have told me to stop eating sushi, but what about cooked sushi or vegetarian options?
I haven’t had my COVID-19 booster since falling pregnant. Should I get it now, or is it better to wait?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Provide dietary and lifestyle advice for a pregnant patient

The competent candidate should:

Reassure the patient that a balanced diet is key and discuss essential nutrients needed during pregnancy, including folate, iron, calcium, and omega-3 fatty acids.
Explain safe food handling practices to reduce the risk of Listeria and toxoplasmosis, advising to avoid raw seafood, deli meats, unpasteurised dairy, and undercooked eggs.
Advise on appropriate fish consumption, recommending low-mercury fish such as salmon and sardines while avoiding high-mercury fish like shark and swordfish.
Address caffeine intake, confirming that one cup of coffee per day (under 200mg caffeine) is generally safe.
Discuss weight gain recommendations, explaining that weight gain depends on pre-pregnancy BMI and should be gradual and steady.
Provide hydration advice, encouraging plenty of water and limiting sugary or caffeinated beverages.

Task 2: Address exercise concerns and provide recommendations

The competent candidate should:

Explain that exercise is beneficial during pregnancy and discuss safe activities such as walking, swimming, and prenatal yoga.
Reassure the patient that moderate exercise is safe, avoiding high-impact sports, heavy lifting, and activities with a high risk of falls.
Discuss pelvic floor exercises to help prevent incontinence and support delivery.
Address common misconceptions about jogging and confirm that if she was jogging before pregnancy, she can continue with modifications.
Advise listening to her body, avoiding overheating, and stopping exercise if feeling dizzy or unwell.

Task 3: Explain vaccination and screening during pregnancy

The competent candidate should:

Explain the importance of the whooping cough vaccine (pertussis), ideally given between 20–32 weeks.
Discuss influenza and COVID-19 vaccinations, reassuring the patient that they are safe and recommended in pregnancy.
Clarify glucose screening for gestational diabetes, usually performed at 24–28 weeks unless the patient has risk factors requiring earlier testing.
Review routine blood tests and ultrasounds, ensuring the patient understands the timing and purpose of anatomy scans, iron studies, and thyroid function tests.

SUMMARY OF A COMPETENT ANSWER

Provides clear, evidence-based dietary advice, including nutrient needs and safe foods.
Explains safe and beneficial exercises during pregnancy.
Addresses common misconceptions and fears with reassurance and clear guidance.
Discusses routine vaccinations and screening tests in pregnancy.
Uses patient-centred communication, ensuring concerns are addressed empathetically.

PITFALLS

Providing inaccurate or outdated dietary advice (e.g., advising complete avoidance of fish instead of low-mercury options).
Failing to reassure the patient about safe exercise options, leading to unnecessary restrictions.
Not addressing weight gain concerns, potentially contributing to unhealthy eating habits.
Neglecting to discuss vaccinations, missing an opportunity for preventive care.
Overloading the patient with medical jargon, instead of providing practical, easy-to-follow advice.

REFERENCES

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, and expectations of healthcare.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers essential dietary and lifestyle information relevant to pregnancy.
2.3 Interprets the patient’s risk factors and provides appropriate recommendations.

3. Diagnosis, Decision-Making and Reasoning

3.1 Identifies key issues in nutrition, exercise, and preventive health.
3.3 Prioritises patient concerns and provides evidence-based advice.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides safe, practical recommendations for pregnancy diet and exercise.
4.3 Ensures vaccination and screening needs are addressed.

5. Preventive and Population Health

5.1 Discusses preventive health strategies, including vaccinations and screening tests.

6. Professionalism

6.1 Provides non-judgemental, patient-centred care.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures care aligns with national pregnancy guidelines.

8. Procedural Skills

(Not applicable in this case)

9. Managing Uncertainty

9.1 Provides reassurance and clear recommendations despite patient concerns.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises the importance of gestational diabetes screening and appropriate nutritional counselling.

Competency at Fellowship Level

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