CASE INFORMATION

Case ID: CCE-THROAT-01
Case Name: John Williams
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2024
ICPC-2 Codes: R21 – Throat symptom/complaint

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates effectively in a culturally appropriate manner. 1.2 Gathers information about the patient’s symptoms, concerns, and expectations. 1.4 Provides clear explanations and engages in shared decision-making.
2. Clinical Information Gathering and Interpretation	2.1 Takes a structured history to assess the cause of throat symptoms. 2.3 Identifies red flag symptoms that indicate serious pathology.
3. Diagnosis, Decision-Making, and Reasoning	3.1 Formulates a differential diagnosis for throat symptoms. 3.2 Uses clinical reasoning to identify potential complications.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an evidence-based management plan. 4.2 Provides symptomatic and targeted treatment as appropriate.
5. Preventive and Population Health	5.1 Provides education on preventing throat infections and complications.
6. Professionalism	6.1 Demonstrates empathy and professionalism in patient communication.
7. General Practice Systems and Regulatory Requirements	7.1 Documents the consultation appropriately, including red flag symptoms and management plan.
8. Procedural Skills	8.1 Performs or refers for relevant investigations (e.g., throat swab).
9. Managing Uncertainty	9.1 Recognises when referral is required for persistent or worsening symptoms.
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies and escalates care if signs of airway compromise, peritonsillar abscess, or systemic illness are present.

CASE FEATURES

Concerned about strep throat and possible antibiotics.
34-year-old male with 3-day history of sore throat.
Complains of difficulty swallowing and mild fever.
No cough but reports swollen glands and white spots on tonsils.
Smoker with occasional alcohol use.
No known drug allergies.

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

John Williams, a 34-year-old male, presents with a sore throat for three days. He describes difficulty swallowing and mild fever but no cough. He has noticed swollen glands and white spots on his tonsils. John is a smoker and consumes alcohol occasionally. He is concerned about whether he has strep throat and whether he needs antibiotics.

PATIENT RECORD SUMMARY

Patient Details

Name: John Williams
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Nil regular medications

Past History

No significant medical history

Social History

Smoker (10 cigarettes per day)
Occasional alcohol use

Family History

No family history of throat conditions or autoimmune diseases

Smoking

Yes (10 cigarettes/day)

Alcohol

Yes, occasional

Vaccination and Preventative Activities

Last flu vaccine: not taken this year
Up to date with childhood vaccinations

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’ve had a really sore throat for three days, and it feels like it’s getting worse. I’m worried I might have strep throat and need antibiotics.”

General Information

(Information the role-player can freely share when asked open-ended questions.)

The sore throat started three days ago.
Initially felt a bit of irritation, but it has become progressively worse.
Experiencing painful swallowing.
No cough but has swollen glands in the neck.
Has noticed white spots on the tonsils.

Specific Information

(Only revealed when the candidate asks direct, specific questions.)

Background Information

Feels tired and run-down but still able to do daily activities.
Had a mild fever yesterday (38°C) but hasn’t checked today.
No runny nose, congestion, or sneezing.
No nausea, vomiting, or rash.
Has had similar sore throats before, but not as bad.
No past history of tonsillitis or need for antibiotics.
Concerned because a friend recently had strep throat.

History of Presenting Complaint

Pain level: 6/10, worse when swallowing.
Fever: Had chills last night, no night sweats.
Swallowing issues: Can drink water, but eating is painful.
Breathing difficulty: No shortness of breath, no drooling.
Voice changes: Slightly hoarse but no stridor.
Pain radiation: No ear pain, no jaw pain.
Headache: Mild, probably from dehydration.

Medications Tried

Taking paracetamol every 6 hours, which helps a little.
Tried throat lozenges, lukewarm tea with honey, and saltwater gargles—mild relief but pain persists.
No history of allergies to medications.

Smoking and Alcohol History

Smoker: 10 cigarettes per day for the past 10 years.
Alcohol: Drinks 1–2 times per week, socially.

Family History

No family history of autoimmune diseases, recurrent infections, or immune deficiency.

Emotional Cues and Body Language

(How the role-player should act.)

Appears mildly anxious, shifting in the chair, occasionally rubbing the throat.
Looks tired and slightly uncomfortable.
Frowns when swallowing, occasionally pauses to swallow carefully.
Concerned about needing antibiotics—leans forward when the doctor discusses treatment.
If the doctor suggests it’s viral, looks a little unsure and skeptical but relieved if reassured.
If peritonsillar abscess or epiglottitis is mentioned, becomes visibly worried and asks: “Is that serious? Do I need to go to hospital?”

Concerns & Expectations

(The patient’s key concerns and expectations for the consultation.)

Concerned about strep throat:
- “My friend had strep throat last week. Could I have it too?”
Worried about worsening symptoms:
- “Why is it getting worse instead of better?”
Asking about antibiotics:
- “Do I need antibiotics, or will this go away on its own?”
Relief for symptoms:
- “What can I do to feel better?”
Smoking and throat health:
- “Does smoking make this worse? Should I quit?”

Questions the Patient Might Ask

(The role-player can ask these naturally during the consultation.)

“If it’s not strep throat, what else could it be?”
“Is there a test for this? Do I need a throat swab?”
“How long will this last? When should I worry?”
“Can I still go to work? Will I spread this to my family?”
“What’s the best treatment? Should I be taking something stronger?”
“If it gets worse, what should I do?”

Possible Escalation or Additional Details (If Relevant)

If the candidate misses red flag questions, the patient may mention increased pain, difficulty swallowing, or more fatigue.
If asked about recurrent sore throats, the patient might mention one or two mild ones per year, never needing treatment.
If the doctor asks about referral concerns, the patient might say:
- “Do I need to see a specialist or get my tonsils removed?”

Expected Outcome

(What the patient is hoping to achieve from the consultation.)

Reassurance about the severity of the throat infection.
Advice on symptom relief and when to seek further help.
Guidance on smoking cessation if relevant.
Clear explanation of whether antibiotics are needed.
Information on when to worry and when to come back.

Key Role-Player Behaviours

If the doctor is reassuring and explains clearly, the patient should look relieved and nod along.
If the doctor doesn’t explain well, the patient can remain uncertain and ask more questions.
If the doctor mentions complications (e.g., abscess, hospitalisation), the patient should show visible concern and ask if it’s serious.

End of Consultation

The patient thanks the doctor and says:
“Okay, I’ll follow your advice. Thanks, Doctor. I’ll come back if it doesn’t get better.”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient

The competent candidate should:

Use open-ended questions to explore the onset, duration, progression, and severity of the throat symptoms.
Elicit red flags, including difficulty breathing, drooling, severe pain, stridor, or muffled voice.
Ask about associated symptoms, such as fever, cough, runny nose, ear pain, swollen glands, fatigue, rash, and recent illnesses.
Enquire about recent sick contacts (e.g., friend with strep throat) and past history of recurrent throat infections.
Assess medication use, including self-medication with pain relief and lozenges.
Review smoking history and explore its impact on throat symptoms.
Explore the patient’s ideas, concerns, and expectations, particularly regarding antibiotics.

Task 2: Explain the likely diagnosis and differential diagnoses

The competent candidate should:

Explain that the most likely cause is viral pharyngitis, based on gradual onset, absence of cough, and presence of fever and throat pain.
Discuss the possibility of bacterial pharyngitis (strep throat) and how it is distinguished from viral causes.
Mention other differentials, including infectious mononucleosis, peritonsillar abscess, epiglottitis, or postnasal drip-related throat irritation.
Address the patient’s concern about needing antibiotics, explaining the criteria for bacterial vs viral infections.
Discuss the Centor Criteria for predicting streptococcal pharyngitis.

Task 3: Develop an appropriate management plan

The competent candidate should:

Reassure the patient that most sore throats are self-limiting and do not require antibiotics.
Recommend symptomatic treatment, including analgesia (paracetamol, ibuprofen), saltwater gargles, honey, warm fluids, and throat lozenges.
Advise on hydration, rest, and smoking cessation (if relevant).
Discuss the role of antibiotics if Centor Criteria indicate bacterial infection.
Provide red flag warnings: worsening pain, difficulty swallowing, stridor, difficulty breathing, or prolonged fever.
Discuss the potential need for a throat swab if bacterial infection is suspected.
Safety-net and advise on follow-up if symptoms persist or worsen.

SUMMARY OF A COMPETENT ANSWER

Elicits key history features, including red flags and risk factors.
Explains differential diagnoses and discusses viral vs bacterial causes.
Manages patient expectations regarding antibiotics.
Provides clear symptomatic management advice and red flag warnings.
Ensures safety-netting and follow-up instructions.

PITFALLS

Failing to assess red flags (e.g., stridor, drooling, or severe pain).
Not addressing patient concerns about antibiotics or strep throat.
Overprescribing antibiotics without clinical justification.
Neglecting symptomatic management advice for pain relief.
Missing an opportunity for preventive advice, such as smoking cessation.

REFERENCES

MARKING

Each competency area is assessed 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 sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations, and the full impact of their illness experience.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Obtains sufficient, relevant history to inform decision-making.
2.2 Identifies and investigates key clinical signs and symptoms.

3. Diagnosis, Decision-Making and Reasoning

3.1 Formulates a reasonable differential diagnosis.
3.2 Explains the likely diagnosis effectively.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a safe and appropriate management plan.
4.2 Balances symptomatic management with antibiotic stewardship.

5. Preventive and Population Health

5.1 Provides appropriate advice on smoking cessation and general health.

6. Professionalism

6.1 Demonstrates ethical prescribing practices.

9. Managing Uncertainty

9.1 Identifies when further investigation or specialist referral is needed.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises red flag symptoms and provides appropriate escalation.

Competency at Fellowship Level

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