CASE INFORMATION

Case ID: CCE-CHI-001
Case Name: Liam Thompson
Age: 5 years
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A78 (Childhood Illness – Other), R72 (Whooping Cough), N72 (Measles), L72 (Poliomyelitis)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communication is appropriate to the person and the sociocultural context. 1.2 Engages the patient’s caregiver 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 Gathers a comprehensive history from the caregiver, including vaccination history, exposure risks, and symptom progression.
3. Diagnosis, Decision-Making and Reasoning	3.1 Forms a structured differential diagnosis based on clinical presentation and history.
4. Clinical Management and Therapeutic Reasoning	4.1 Implements appropriate management plans for suspected vaccine-preventable diseases.
5. Preventive and Population Health	5.1 Promotes public health messaging regarding vaccination and herd immunity.
6. Professionalism	6.3 Addresses parental vaccine hesitancy using an evidence-based, empathetic approach.
7. General Practice Systems and Regulatory Requirements	7.1 Recognises legal requirements for reporting notifiable diseases.
9. Managing Uncertainty	9.1 Identifies key red flags that require urgent intervention in unvaccinated children.
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises and escalates cases of severe illness requiring hospitalisation.

CASE FEATURES

Need for legal notification and contact tracing.
5-year-old child with cough, fever, and rash, unvaccinated due to parental vaccine hesitancy.
Symptoms suggest a vaccine-preventable illness (e.g., measles, pertussis, polio).
Parental concern about vaccine safety and disease severity.
Public health implications of potential outbreaks.

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

Liam Thompson, a 5-year-old boy, presents with his mother, Samantha Thompson, to your general practice clinic. He has been unwell for the past five days with a persistent cough, fever, and a rash that started on his face and spread down his body. His mother reports he has not been vaccinated due to concerns about vaccine safety.

PATIENT RECORD SUMMARY

Patient Details

Name: Liam Thompson
Age: 5 years
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known allergies

Medications

Paracetamol PRN for fever

Past History

Generally well
No history of previous hospital admissions

Social History

Lives with both parents and one older sister (8 years old).

Family History

No known chronic illnesses in family.

Smoking

No exposure to smoking at home.

Alcohol

Not applicable.

Vaccination and Preventative Activities

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:

“Doctor, I’m really worried about Liam. He’s had a fever for days, a bad cough, and now this rash. I don’t know what’s going on!”

General Information

(To be provided freely if the candidate asks open-ended questions)

Liam is 5 years old and generally a healthy child.
He started getting sick five days ago with a fever, runny nose, and cough.
Two days ago, he developed a red, blotchy rash that started on his face and spread downwards.
The cough has worsened, and sometimes it sounds like a “whoop” when he breathes in.

Specific Information

(Only provided if the candidate asks targeted questions)

Background Information

He is not vaccinated—his parents have always been hesitant about vaccines.
Liam’s older sister (8 years old) attends school, and some children there have been sick with similar symptoms.
The family lives in a suburban area and Liam attends daycare three days per week.

History of Presenting Illness:

Day 1-2: Fever (peaking at 39°C), mild cough, and runny nose.
Day 3: Rash appeared on his face and neck, then spread to his chest and arms.
Day 4-5: Cough worsened—sounds like a barking or whooping sound. Liam sometimes gasps for air after a coughing fit.
He has not vomited, but his appetite is poor.
He wakes up at night coughing and struggles to settle back to sleep.
He is still playing but gets tired easily.
No recent travel or exposure to animals.

Parental Concerns About Vaccination:

(Samantha becomes defensive and uneasy when vaccines are mentioned.)

“I’ve read so many things about vaccines causing autism. I just don’t want to take that risk.”
“I’ve heard vaccines contain dangerous chemicals like mercury and formaldehyde.”
“He’s been fine until now—why would I inject him with something unnecessary?”
“Can’t natural immunity protect him better than vaccines?”
“The government is pushing vaccines so hard. I don’t trust it.”
“Do we even need vaccines now that he’s already sick?”

Emotional Cues and Behaviour:

Appears anxious and defensive when discussing vaccination.
Tears up when talking about Liam’s worsening condition.
Crosses arms and leans back if she feels judged.
Open to discussion if the doctor remains calm, empathetic, and non-judgmental.
Reluctantly nods when discussing Liam’s symptoms and how sick he looks.
Watches Liam closely during the consultation and occasionally holds his hand.

Questions for the Candidate:

(These should be asked naturally during the consultation.)

“Do you think this is serious? Is he going to be okay?” (Tone: Worried, slightly panicked.)
“Are vaccines really that safe? I’ve heard so many horror stories.” (Tone: Defensive but searching for reassurance.)
“If Liam has this illness now, does he still need vaccines later?” (Tone: Curious, unsure.)
“Can this spread to my daughter and other family members?” (Tone: Alarmed.)
“What can I do to help him at home? Should I be taking him to the hospital?” (Tone: Desperate for guidance.)

Possible Escalation (Only if prompted by the candidate)

If the doctor mentions hospitalisation, Samantha initially resists the idea:

“Hospital? Is it really that bad? He’s just been coughing!” (Tone: Shocked.)
“What if we just watch him at home for a few more days?” (Tone: Hesitant, worried.)
If the doctor explains red flags (breathing difficulty, cyanosis, dehydration), she reluctantly agrees:
- “I just want him to be okay. If you think it’s best, I’ll take him in.” (Tone: Emotional but trusting.)

Final Emotional Response:

If the doctor explains things well, Samantha softens and becomes more open.
If the doctor is judgmental or dismissive, she shuts down and refuses further discussion.
By the end of the consultation, she should be more willing to consider vaccination in the future.

Key Role-Playing Notes:

Stay defensive about vaccines initially, then slowly soften if the doctor is empathetic.
Show real concern about Liam’s illness—make it clear you want what’s best for him.
React emotionally if the doctor suggests hospitalisation—this should feel like a big step.
Ask direct but natural questions—make the doctor explain things clearly.
Don’t make it too easy—challenge the doctor’s explanations, but be willing to listen.

End Scene:

Samantha sighs, squeezing Liam’s hand. “I just want him to be okay. If vaccines can really prevent this from happening again, maybe I should think about it. I just… I don’t know. Can we talk more about this later?”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the child’s mother to assess the severity of illness and determine the most likely diagnosis.

The competent candidate should:

Use open-ended questions to explore the history of present illness, including fever, rash progression, cough, and difficulty breathing.
Assess for “whooping” cough, stridor, cyanosis, respiratory distress, dehydration, and changes in consciousness.
Elicit vaccination history and explore the family’s vaccine hesitancy in a non-judgmental and empathetic manner.
Identify potential exposure to communicable diseases (e.g., school/daycare outbreaks).

Task 2: Explain the most likely diagnosis and discuss the next steps in management, including hospital referral if necessary.

The competent candidate should:

Explain the likely diagnosis, such as measles or pertussis, using clear, jargon-free language.
Justify the need for urgent hospital assessment if red flags are present (e.g., severe respiratory distress, cyanosis, dehydration).
Address infection control measures to prevent household and community spread.
Advise supportive management at home for mild cases.

Task 3: Address the mother’s vaccine hesitancy and provide evidence-based information about immunisation.

The competent candidate should:

Explore specific parental concerns about vaccines in an empathetic, non-confrontational manner.
Provide evidence-based reassurance about vaccine safety and debunk common misconceptions.
Explain the risks of vaccine-preventable diseases (e.g., measles complications, pertussis mortality in infants).
Discuss catch-up vaccination options and encourage future immunisation.

Task 4: Provide advice on monitoring symptoms and when to seek urgent medical care.

The competent candidate should:

Clearly outline red flags that warrant urgent medical attention.
Educate the parent on symptom progression and when to return for review.
Provide written information about illness management and infection prevention.

SUMMARY OF A COMPETENT ANSWER

Thorough history-taking, identifying key features of a vaccine-preventable illness.
Non-judgmental, empathetic approach when discussing vaccine hesitancy.
Clear and structured explanation of diagnosis and next steps.
Strong focus on patient safety, including criteria for hospital referral.
Effective health education, reinforcing infection control and vaccine benefits.

PITFALLS

Failure to recognise severe respiratory distress and the need for urgent hospitalisation.
Judgmental or confrontational approach to vaccine hesitancy, leading to parental resistance.
Overcomplicated medical jargon, making explanations unclear to the parent.
Inadequate safety netting, failing to highlight red flags for deterioration.
Lack of infection control advice, risking further spread to others.

REFERENCES

MARKING

Each competency area is assessed on a 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 symptoms, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers essential clinical information relevant to vaccine-preventable illnesses.
2.2 Interprets symptoms to formulate a differential diagnosis.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises and prioritises life-threatening conditions.
3.2 Demonstrates logical clinical reasoning and decision-making.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a safe and evidence-based management plan.
4.2 Refers appropriately based on the severity of illness.

5. Preventive and Population Health

5.1 Provides appropriate health education and preventive care.
5.2 Discusses immunisation and public health implications.

6. Professionalism

6.1 Demonstrates ethical, patient-centred care.
6.2 Maintains a non-judgmental and empathetic approach.

7. General Practice Systems and Regulatory Requirements

7.1 Adheres to Australian immunisation guidelines and reporting requirements.

9. Managing Uncertainty

9.1 Recognises and addresses parental concerns while ensuring best patient care.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies vaccine-preventable illnesses and recognises signs of severe disease.

Competency at Fellowship Level

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