CASE INFORMATION

Case ID: CCE-2025-001
Case Name: James Anderson
Age: 32
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S18 (Burns)

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 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 information on the burn mechanism, size, depth, and potential complications.
3. Diagnosis, Decision-Making and Reasoning	3.2 Differentiates between superficial, partial-thickness, and full-thickness burns and determines appropriate management.
4. Clinical Management and Therapeutic Reasoning	4.1 Provides immediate first aid and evidence-based wound care. 4.2 Prescribes appropriate pain management. 4.4 Recognises indications for specialist referral.
5. Preventive and Population Health	5.2 Provides burn prevention advice (workplace and home safety).
6. Professionalism	6.1 Provides empathetic and patient-centred care.
7. General Practice Systems and Regulatory Requirements	7.1 Documents burn characteristics and treatment plan as per medico-legal requirements.
8. Procedural Skills	8.1 Demonstrates appropriate dressing technique for burn management.
9. Managing Uncertainty	9.1 Recognises red flags requiring hospital admission.
10. Identifying and Managing the Patient with Significant Illness	10.2 Identifies signs of infection or delayed healing.

CASE FEATURES

No previous significant burns or medical history.
A 32-year-old male presents with a burn injury sustained while cooking at home.
Patient reports pain, redness, and blistering on the right forearm.
Needs wound assessment, pain relief, and burn care advice.
Concerns about scarring and infection risk.

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, but a burn description will be provided.

A patient record summary is available.

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

James Anderson, a 32-year-old chef, presents with a burn injury to his right forearm. He was cooking at home when he accidentally spilled boiling oil on his skin. He reports immediate pain, redness, and blistering, which has worsened over the last 3 hours. He has not applied any first aid except for running cold water for a minute.

He is concerned about scarring, as his job requires him to frequently work with customers. He also wants to know how to prevent burns in the future.

Burn description:

Location: Right forearm (anterior surface).
Size: ~5cm x 8cm.
Depth: Partial-thickness (blisters, redness, pain, capillary refill intact).
Surrounding skin: Mild erythema, no signs of infection.

PATIENT RECORD SUMMARY

Patient Details

Name: James Anderson
Age: 32
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known allergies.

Medications

Nil regular medications.

Past History

Nil significant medical history.

Social History

Works as a chef in a restaurant.
Smoker: Nil
Alcohol: Occasional

Vaccination and Preventative Activities

Tetanus status unknown.

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 accidentally spilled hot oil on my arm while cooking, and it’s really painful. I’m worried about scarring.”

General Information

You are James Anderson, a 32-year-old chef who works in a busy restaurant kitchen.
Earlier today, while cooking at home, you accidentally knocked over a pan of boiling oil, which splashed onto your right forearm.
You felt immediate burning pain, and within about 10–15 minutes, blisters started forming.
You briefly ran the burn under cold water for about a minute, but then stopped because you weren’t sure what to do next.
You haven’t applied any creams or dressings.
You are right-handed and worried about how this might affect your ability to work.

Specific Information

(Only reveal if asked)

Symptoms & Burn Details

Pain level: 4/10 (constant, worsens when moving the arm).
Blisters: Formed within an hour, fluid-filled, some have started bursting slightly.
Skin changes: Area is red, swollen, and warm to touch.
No oozing, pus, or foul smell.
No fever, dizziness, nausea, or breathing difficulty.

Past Medical History & Lifestyle

No previous burns or significant medical history.
No known allergies.
No chronic health conditions.
No regular medications.
Tetanus vaccination status unknown.
Social history:
- You live alone in an apartment.
- You work long hours in a busy restaurant kitchen.
- You occasionally drink alcohol but do not smoke.

Patient Concerns & Expectations

Concern 1: Scarring & Work Impact

“Doctor, my job involves working with customers and handling food. Will this leave a scar? I don’t want it to look bad or affect my work.”

You are worried about permanent scarring, especially since the burn is on your dominant arm.
You use your hands and arms a lot in your profession and don’t want long-term mobility issues.

Concern 2: Infection Risk & Wound Care

“How do I stop this from getting worse? Should I be worried about an infection?”

You haven’t cleaned the burn properly and are concerned about infection.
You want to know what signs to watch for and how to care for the wound at home.

Concern 3: Need for Specialist Referral

“Will I need to see a burn specialist or go to the hospital?”

You trust your GP’s opinion but want to know if you need a specialist review or hospital care.
You are concerned about complications affecting work.

Concern 4: Prevention Advice

“How can I avoid this happening again? I work with hot oil every day.”

Since you work in a fast-paced kitchen, you want practical advice on burn prevention at work.
You are willing to follow recommendations to prevent future burns.

Emotional Cues & Body Language

You appear mildly anxious but not in distress.
Your arm is held slightly away from your body to avoid contact with clothing.
You occasionally wince in pain when moving your arm.
Your tone of voice is calm but with underlying concern about scarring and workability.

Patient’s Likely Questions

“What type of burn do I have? How bad is it?”
“Do I need antibiotics?”
“Will I be able to go to work tomorrow?”
“When should I come back for a check-up?”
“Do I need a tetanus shot?”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history from the patient regarding the burn injury.

The competent candidate should:

Establish when and how the burn occurred.
Identify first-aid measures taken and time to presentation.
Assess pain, presence of blisters, and signs of infection.
Explore impact on function (e.g., dominant hand, work implications).
Confirm tetanus vaccination status.
Gather relevant medical history, including allergies, medications, and past burns.
Identify patient concerns (scarring, work, infection).

Task 2: Explain the classification and severity of the burn.

The competent candidate should:

Classify the burn based on depth and extent:
- Superficial (first-degree): Red, painful, no blisters.
- Partial-thickness (second-degree): Blisters, painful, moist.
- Full-thickness (third-degree): White/charred, painless.
Explain how burns are assessed using Total Body Surface Area (TBSA).
Reassure that this appears to be a partial-thickness burn but requires monitoring.

Task 3: Provide appropriate management advice.

The competent candidate should:

First aid:
- Run cool running water over the burn for 20 minutes (even if delayed).
- Avoid ice, creams, or home remedies.
Wound care:
- Non-adherent dressing (e.g., hydrocolloid, silicone-based).
- Avoid rupturing blisters unless infected.
- Elevate the limb to reduce swelling.
Pain relief:
- Paracetamol ± ibuprofen as needed.
Infection prevention:
- Monitor for redness, swelling, or pus.
- Assess need for tetanus booster.
Follow-up:
- Review in 48 hours for dressing change and infection monitoring.
- Referral if wound worsens or healing is delayed.

SUMMARY OF A COMPETENT ANSWER

Thorough history-taking, covering mechanism, first aid, symptoms, and medical background.
Correct classification of the burn based on depth and severity.
Clear, structured management plan, including first aid, dressing advice, pain relief, and infection prevention.
Appropriate follow-up plan, ensuring review and escalation if necessary.
Patient-centred approach, addressing concerns about scarring, work, and long-term impact.

PITFALLS

Failing to assess tetanus status, which is essential for burns.
Incorrect burn classification, leading to inappropriate management.
Inadequate first aid advice, such as not recommending 20 minutes of cool running water.
Recommending inappropriate treatments, like ice, butter, or topical antiseptics.
Not addressing work concerns, particularly for a chef handling hot equipment.
Overlooking infection risks, such as burst blisters.

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 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 relevant clinical history, including risk factors and red flags.

3. Diagnosis, Decision-Making and Reasoning

3.2 Demonstrates clinical reasoning in classifying and managing the burn.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan, including first aid, dressing care, and pain relief.
4.3 Provides clear follow-up advice, including infection monitoring.

5. Preventive and Population Health

5.1 Provides education on burn prevention and workplace safety.

6. Professionalism

6.2 Acts in the patient’s best interest, considering work implications.

7. General Practice Systems and Regulatory Requirements

7.1 Recognises need for tetanus vaccination and appropriate follow-up.

8. Procedural Skills

8.1 Demonstrates appropriate burn wound care and dressing application.

9. Managing Uncertainty

9.1 Recognises need for review and potential referral if healing is delayed.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies potential complications (infection, scarring, functional impairment).

Competency at Fellowship Level

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