CCE-CE-203

CASE INFORMATION

Case ID: CCE-PEM-001
Case Name: Jason Mitchell
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2024
ICPC-2 Codes: A98 (Other administrative procedures)


COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Communicates appropriately to the patient and their workplace context.
1.2 Engages the patient to understand medical and occupational history.
1.4 Communicates effectively regarding fitness for work.
2. Clinical Information Gathering and Interpretation2.1 Conducts a structured occupational history.
2.2 Assesses medical conditions relevant to the job role.
3. Diagnosis, Decision-Making and Reasoning3.1 Determines fitness for work based on clinical assessment and job requirements.
4. Clinical Management and Therapeutic Reasoning4.1 Provides appropriate recommendations regarding work adjustments or restrictions.
5. Preventive and Population Health5.1 Identifies workplace health risks and advises on prevention.
6. Professionalism6.1 Ensures ethical and professional handling of medical confidentiality.
7. General Practice Systems and Regulatory Requirements7.1 Adheres to medico-legal requirements of pre-employment assessments.
9. Managing Uncertainty9.1 Appropriately handles unclear medical history and workplace requirements.

CASE FEATURES

  • Requests advice on maintaining fitness and meeting health requirements for the job.
  • Male patient attending for pre-employment medical assessment.
  • Applying for a FIFO (fly-in, fly-out) mining job requiring high physical demand and exposure to hazards.
  • Past medical history includes asthma and lower back injury.
  • Works in construction but has not had a formal workplace medical before.
  • Concerned about how his medical history may affect job eligibility.
  • Uncertain about required drug and alcohol testing, hearing tests, or lung function tests.

INSTRUCTIONS

You have 15 minutes to complete this case.

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

You are not required to perform a physical examination.

A patient record summary is provided for your reference.

Perform the following tasks:

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

SCENARIO

Jason Mitchell is a 34-year-old construction worker attending for a pre-employment medical assessment for a FIFO mining job. His potential employer requires fitness testing, spirometry, hearing tests, and drug/alcohol screening. Jason is concerned about his history of asthma and a lower back injury from two years ago, which required physiotherapy but no surgery.


PATIENT RECORD SUMMARY

Patient Details

  • Name: Jason Mitchell
  • Age: 34
  • Gender: Male
  • Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • Nil known

Medications

  • Salbutamol (Ventolin) PRN for asthma

Past History

  • Asthma since childhood, well-controlled, uses Ventolin occasionally.
  • Lower back injury (work-related, 2 years ago), managed with physiotherapy.

Social History

  • Works in construction for 10+ years, looking to transition to mining.

Family History

  • Father: Hypertension
  • Mother: Type 2 Diabetes

Smoking and Alcohol

  • Non-smoker
  • Drinks socially (1-2 standard drinks/week)

Vaccination and Preventative Health

  • Last tetanus booster: 4 years ago.
  • 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.


SCRIPT FOR ROLE-PLAYER

Opening Line:

“Hi Doc, I’ve got a pre-employment medical for a FIFO mining job, and I just wanted to check if my asthma and back injury will be a problem. Also, I’ve never done one of these before, so I don’t know what to expect.”


General Information

You are Jason Mitchell, a 34-year-old construction worker who has been offered a FIFO (fly-in, fly-out) mining job. The role requires manual labour, long shifts, heavy lifting, and exposure to dust. This is your first time undergoing a pre-employment medical, and you’re uncertain about the process and requirements.

You do not have any current symptoms but are worried about how your past medical history might affect your job application. Specifically, you have mild asthma and a lower back injury from two years ago.


Specific Information

(To be revealed when asked appropriate questions)

Background Information

  • Asthma: You’ve had it since childhood, and while it rarely flares up, dust and cold air can sometimes trigger wheezing. You only use Ventolin (Salbutamol) occasionally, and you’ve never been hospitalised for it.
  • Lower Back Injury: Two years ago, you injured your back lifting heavy materials at work. You had physiotherapy for six months, and while you don’t have ongoing pain, you try to avoid excessive heavy lifting.

Concerns About the Pre-Employment Medical

  • You don’t know what the medical exam involves and are nervous about being disqualified.
  • You’ve heard that they test lung function, hearing, and drug/alcohol levels, but you’re uncertain about the details.
  • You don’t want to lose this job opportunity, so you want to be upfront but also ensure you pass the medical.

Concerns About Asthma

  • You’re worried that the dust exposure in mining might trigger your asthma.
  • You rarely need your inhaler but want to confirm if asthma will be an issue.
  • You haven’t had a spirometry (lung function) test in years and are unsure what it involves.

Concerns About Your Back Injury

  • You don’t have daily pain, but heavy lifting for long hours might make your back sore.
  • You haven’t needed any pain medication for it in over a year.
  • You’re unsure if this past injury will stop you from passing the medical.

Concerns About Drug and Alcohol Testing

  • You drink alcohol occasionally, but you don’t use drugs.
  • You’re unsure if you need to avoid alcohol before the test.
  • You’re worried that your asthma inhaler might show up in the test results.

Emotional Cues and Body Language

  • Slightly anxious: You want this job and don’t want your past health issues to stop you.
  • Cautious and uncertain: You haven’t done a pre-employment medical before, so you need clear explanations.
  • Engaged but hesitant: You don’t want to say the wrong thing and risk being seen as unfit for work.

Questions You Might Ask the Doctor

  1. Will my asthma stop me from getting this job?
  2. What does the pre-employment medical involve?
  3. Should I be worried about the drug and alcohol test?
  4. Will my back injury be an issue?
  5. What happens if I don’t pass a part of the medical? Can I still get the job?

Key Information to Withhold Unless Asked

  • You don’t have any ongoing back pain, but you do avoid heavy lifting if possible.
  • You’ve never had a positive drug test or any concerns with substances.
  • You haven’t had a recent spirometry test, but you believe your lung function is fine.
  • You’re not taking any regular medication, apart from occasional Ventolin.

How to Respond to the Doctor’s Questions

If asked about your job role

  • “It’s a FIFO mining role, so I’ll be doing 12-hour shifts with heavy lifting, operating equipment, and being exposed to dust.”

If asked about your asthma symptoms

  • “It’s well controlled, I only use my puffer occasionally. I get wheezy sometimes with dust or cold air, but I’ve never needed hospital treatment.”

If asked about your back injury

  • “I hurt it lifting heavy materials two years ago. Physio helped, and I don’t have daily pain, but I try not to overdo it.”

If asked about drug or alcohol use

  • “I drink socially, maybe once or twice a week. I don’t use drugs at all.”

How You Should React to Advice Given by the Doctor

  • If the doctor explains what the medical involves, you should nod and ask follow-up questions if unsure.
  • If the doctor says your asthma might need monitoring, you should ask: “What can I do to make sure I meet the requirements?”
  • If the doctor reassures you that your back injury shouldn’t be an issue, you should appear relieved but still ask about any recommended exercises or precautions.
  • If the doctor talks about drug testing, you should listen carefully and ask: “Do I need to avoid alcohol before the test?”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Explain the components of the pre-employment medical assessment and its relevance to the patient’s role.

The competent candidate should:

  • Provide a clear, structured explanation of the pre-employment medical assessment, including:
    • General physical examination (height, weight, BMI, blood pressure).
    • Spirometry (lung function test for occupational dust exposure).
    • Audiometry (hearing test for noise exposure).
    • Drug and alcohol screening (standard for FIFO and high-risk jobs).
    • Musculoskeletal assessment (for manual labour roles).
  • Reassure the patient that mild asthma and a past back injury do not automatically disqualify them, but must be disclosed.
  • Explain the importance of workplace safety and fitness-for-work evaluations.
  • Address confidentiality concerns, explaining that only relevant health risks are reported to the employer.

Task 2: Assess and address the patient’s concerns about their asthma and back injury.

The competent candidate should:

  • Take a targeted history of asthma (triggers, severity, medication use, previous hospitalisations).
  • Explain that controlled asthma is usually not a barrier to employment but spirometry may be required.
  • Advise on occupational asthma risk in a dusty mining environment and preventive strategies (e.g., regular medication use, workplace exposure control).
  • Take a focused history of back injury (mechanism, treatment, current symptoms).
  • Explain that past back injuries are common and a functional assessment will determine suitability.
  • Provide practical strategies (e.g., physiotherapy, core strengthening, proper lifting techniques).

Task 3: Provide guidance on drug and alcohol testing, including legal and ethical considerations.

The competent candidate should:

  • Explain that drug and alcohol testing is standard in safety-sensitive industries.
  • Reassure the patient that Ventolin (Salbutamol) does not affect test results.
  • Advise abstinence from alcohol for at least 24 hours before testing to avoid false positives.
  • Clarify that illicit substances or unprescribed medications may result in disqualification.
  • Discuss ethical and legal obligations, including honest disclosure and the importance of workplace safety.

SUMMARY OF A COMPETENT ANSWER

  • Provides a clear explanation of the pre-employment medical and its relevance.
  • Addresses patient concerns about asthma, back injury, and drug testing with accurate, reassuring advice.
  • Discusses workplace safety, legal, and ethical aspects of the medical.
  • Encourages proactive health management (e.g., spirometry, physiotherapy).
  • Uses patient-centred communication to support anxiety and uncertainty.

PITFALLS

  • Failing to explain the pre-employment medical process clearly.
  • Minimising the importance of full disclosure of medical history.
  • Over-reassuring without addressing occupational risks of asthma.
  • Providing misleading advice on drug and alcohol testing.
  • Ignoring the psychosocial impact of potential job disqualification.

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

Competency Domains Assessed in This Case:

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, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers relevant history regarding asthma, back injury, and workplace concerns.
2.3 Interprets occupational health risks and testing requirements.

3. Diagnosis, Decision-Making and Reasoning

3.2 Identifies relevant workplace risks and fitness-for-work considerations.

4. Clinical Management and Therapeutic Reasoning

4.3 Provides appropriate preventative strategies for workplace health.

5. Preventive and Population Health

5.1 Discusses the importance of workplace health and safety measures.

6. Professionalism

6.2 Provides ethical guidance on disclosure and drug testing.

7. General Practice Systems and Regulatory Requirements

7.3 Discusses legal and regulatory aspects of pre-employment medicals.

9. Managing Uncertainty

9.1 Supports patient concerns with clear, structured advice.


Competency at Fellowship Level

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