CCE must know topics to cover

Core Areas to Read and Anticipate

• Confidentiality (general and specific scenarios)
• Alcohol abuse
• Smoking
• Drug-seeking behaviour / drug dependence
• Motivational interviewing and stages of change
• Elder abuse
• Non-accidental injury (NAI)
• Advance care planning (ACP)
• Substitute decision-making
• Involuntary assessment / treatment
• Public health (e.g. norovirus/influenza outbreaks in RACFs)
• Contact tracing
• Impaired colleague
• Anti-vax patients
• Workcover (state-based – general principles)
• Gillick competency
• Fitness to drive (e.g. exclusion periods)

1. Ethical & Legal “Must-Know” Domains

Domain	Core Rules	Frequently Tested Scenarios	Key References
Confidentiality & Privacy	Ethical, legal and professional obligation; persists after death. Breach only if serious risk, mandatory report or court order.	– Relative wants an update. – Teen requesting contraception. – Partner rings for STI results. – Colleague asks for chart info by phone.	MBA Good Medical Practice: Code of Conduct §3.4; RACGP privacy resources. Medical Board of AustraliaRACGP
Consent & Capacity	Adults presumed competent; children assessed via Gillick. Substitute decision-maker if incapacity. Document!	– Dementia patient: disclosure to family. – 15-yo seeking OCP. – Post-stroke aphasia.	Qld Guardianship Act; common law Gillick.
Mandatory Reporting & Public Health	Notifiable diseases, child abuse, impaired colleagues, fitness-to-drive. Use statutory forms, inform patient where possible.	– Norovirus outbreak in RACF. – Positive chlamydia test. – Unsafe driver after seizure.	Privacy Act 1988 s.16A; state Public Health Acts.
Fitness to Drive	Assess medical condition + risk; conditional vs unconditional licence; report if patient refuses to self-notify and risk is “significant.”	– OSA with ESS > 10. – Transient ischaemic attack. – Vision <6/12.	Austroads Assessing Fitness to Drive.
Advance Care Planning / VAD	Confirm current capacity; locate AHD, EPOA. Discuss goals and ceiling of care.	– COPD patient hospital avoidance plan. – VAD enquiry.	Qld VAD Act 2021.

Key Clinical Scenarios

1. Elderly Patients & Family Members

• Do not disclose without consent (unless incapacity/legal basis).
• May listen to concerns without breaching confidentiality.
• Use statements like:“Thanks for sharing this. Just so you’re aware, I can’t share anything in return unless [patient] has given me permission.”
• If capacity impaired → consider substitute decision-making/guardianship laws.

2. Unsolicited Information from Relatives

• Can accept information but cannot confirm any medical details without consent.
• Example phrase:“I can’t share anything without [patient’s] permission, but I’m happy to listen if you have concerns.”

3. Teenagers / Mature Minors

• Apply Gillick competence.
• Respect confidentiality if deemed competent.
• Clarify limits upfront:“Everything we talk about stays between us, unless I’m worried about your safety or someone else’s.”

4. STIs, Domestic Violence, Breaking Bad News

• Prioritise privacy and emotional safety.
• Legal caveats apply for serious risk or mandatory reporting.

5. Phone Calls from Other Doctors

• Confirm identity.
• Obtain patient consent unless:
  • Emergency situation
  • Legally mandated care

Legal & Ethical Exceptions

• Mandatory reporting (child abuse, fitness to drive, communicable diseases)
• Court subpoenas
• Risk of serious harm
• Continuity of care (implied consent)

Practical Tips

• Clarify confidentiality boundaries early.
• Document consent/refusal.
• Use team-based confidentiality training.
• Confidentiality remains after death.

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2. Substance Use & Behaviour-Change Stations

Core Principles

• Respect and empathy are essential.
• S8 prescribing must be:
  • Clinically justified
  • Legally compliant
  • Supported by full assessment

RACGP Guidance

• Risk-benefit analysis
• Use non-opioid options first
• Check prescription monitoring systems

🪜 Practical Approach

1. Initial Engagement

• Avoid early judgement or refusal.
• Validate concerns: “I can see this has been distressing for you.”

2. Clinical Assessment

• Detailed pain history
• Substance use screening
• Physical exam & previous records

3. Addressing Requests

• Avoid blunt refusal.
• Use professional language:“I don’t think this medication is the safest or most effective option for you at this time.”

4. Managing Anger

• Stay calm.
• Offer safe, supportive care.
• De-escalate or exit if safety threatened.

💊 Safe Prescribing

• Educate about opioid risks
• Multimodal plan: TCAs, duloxetine, physio
• Refer if needed

🧑‍⚕️ Exam Tips

• Show empathy + safe reasoning
• Avoid:
  • Flat refusals
  • Rushed closure

Topic	High-Yield Framework	Tips & Pitfalls
Alcohol, Smoking, Illicit Drugs	5 A’s + Stages-of-Change; AUDIT-C, DAST-10. Document brief intervention even if patient declines.	Don’t jump to pharmacotherapy before brief counselling; always safety-net withdrawal risks.
Drug-Seeking Behaviour	1) Hear the story. 2) Verify (My Health Record, real-time script monitor). 3) Offer multimodal plan. 4) Set boundaries (one prescriber, contract).	Avoid outright “no”—explain risk/benefit and legal limits; schedule follow-up, document thoroughly. RACGP opioids guideline. RACGP
Motivational Interviewing	OARS: Open questions, Affirm, Reflect, Summarise. Tie advice to patient’s own goals.	Practise 30-sec reflective statements—all exam stations reward empathy.

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3. Managing Difficult Interactions

3.1 Unreasonable Requests (certificates, imaging, antibiotics)

1. Explore the reason behind the request.
2. Explain professional obligations / Medicare rules.
3. Offer safe alternative or private pathway.
4. Document request, advice, and outcome.
   Avant guidance on certificates. Avant Avant

3.2 Angry or Threatening Patient

Early warning signs → de-escalate (calm voice, 45° angle, clear exit). Have a practice policy and MDO on speed-dial. RACGP MAT Health Clinic

Phrases & De-escalation Tools

🧠 Reflective Listening

• “It sounds like you’re feeling…”
• “From what you’ve told me…”

💞 Acknowledging Emotions

• “That sounds like a lot to deal with.”
• “I’m glad you came in to talk to me.”

❓ Clarifying & Exploring

• “Would it be fair to say…”
• “What would you say is worrying you most?”

🛑 Setting Boundaries

• “My priority is your safety.”
• “Let’s work together to find a way forward.”

🔥 De-escalation (RACGP)

• Recognise early warning signs
• Maintain calm tone and open posture
• Do not block exits
• Use neutral language:“I want to make sure we both feel safe.”

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4. Vulnerable Populations

Group	Key Points	Common Station Triggers
Elder Abuse	Private interview, screen with EASI, mandatory report if life-threatening.	Bruises, relative answers all questions.
Non-Accidental Injury (Children)	History incongruent with injury; full top-to-toe exam; report to Child Safety immediately.	Spiral fracture; cigar burns.
Impaired Colleague	Duty to patient safety > collegial loyalty; speak to colleague first if safe, then notify AHPRA.	Smell of alcohol in theatre, fentanyl discrepancies. adelaidenow

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5. Public-Health & Occupational Scenarios

Situation	Immediate Actions	Follow-Up
RACF Influenza Outbreak	Notify PHU; antiviral prophylaxis; droplet precautions.	Vaccination audit, staff education.
Contact Tracing (STI/COVID)	Counsel patient, complete notification form, liaise with PHU.	Re-test window period, partner therapy.
WorkCover & Certificates	Use state form, objective findings, capacity-based duties.	Schedule review, communicate with employer (with consent).

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6. Communication Frameworks to Memorise

Scenario	Framework	2–3 Key Phrases
Breaking Bad News	SPIKES + NURSE	“I’m afraid the results aren’t what we hoped.” / “It’s normal to feel shocked.”
Behaviour Change	5 A’s	“On a scale of 0–10, how ready…?”
Aggression	ACKNOWLEDGE – AGREE – CHOOSE Exit	“I want to help, but I need us both to feel safe.”

🌐 SPIKES Framework

• S – Setting: Privacy, no interruptions
• P – Perception: Explore understanding
• I – Invitation: Level of detail desired
• K – Knowledge: Give warning shot; avoid jargon
• E – Emotion: Acknowledge emotions
• S – Strategy/Summary/Support: Plan & follow-up

🫂 NURSE Framework

Letter	Skill	Example Phrase
N	Naming	“You seem really overwhelmed…”
U	Understanding	“I understand why this is upsetting.”
R	Respecting	“I respect how you’ve handled this.”
S	Supporting	“We’re here for you.”
E	Exploring	“Can you tell me what’s worrying you most?”

💡 Clinical Tips

• Use calm tone, active listening
• Avoid:
  • Jargon
  • Overloading with detail
  • Minimising emotion

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7. Critical Appraisal Stations

1. Identify study type (RCT, cohort, case–control).
2. Internal validity: randomisation, blinding, allocation concealment.
3. Results: effect size, 95 % CI, p-value.
4. Applicability: population similarity, primary care relevance.

Practise 5-minute critiques of abstracts with a peer; use RACGP Research in General Practice syllabus.

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8. Common CCE Pitfalls

(from Exam Reports)

Common Pitfall	Practical Strategies to Avoid It
Not reading the case/question correctly	Initial pause to read the stem twice; underline action verbs and data provided. Summarise aloud (“So I need to…”) to lock in the task before starting.
Disorganised / chaotic answers	Adopt a consistent framework (e.g. ISBAR for presentations, SOAP for consultations). Use a visible mind‑map or note grid during reading time to structure ideas.
Ignoring the patient’s agenda	Open with “What were you hoping we’d cover today?” and revisit ICE (Ideas, Concerns, Expectations) after key sections.
Scattergun differentials / management	Cluster symptoms & timelines before brainstorming. Aim for Top 3 likely + 2 red‑flag diagnoses, then targeted management aligned to those.
Missing key demographic / case features	Write the patient’s age, sex, context in the margin; check every plan or prevention point against these anchors.
Spending too long on one aspect (e.g. history)	Rehearse time‑boxing (e.g. 3 min focused history, 1 min exam recap). Keep a small digital or desk timer in practice sessions.
Inability to formulate comprehensive differentials	Use mnemonics when stuck; group by system or acuity to prompt breadth. VINDICATE V: vascular I: infection N: neoplasm D: degenerative or drugs I: iatrogenic or intoxication C: congenital A: autoimmune T: trauma E: endocrine/metabolic
Ordering irrational investigations	Apply the “Will it change management now?” test; cross‑check against RACGP Testing Wisely list.
Not identifying priorities	ABCDE snapshot immediately; list urgent issues first, then chronic, then preventive.
Missing clinical deterioration	Build red‑flag review into every plan: “If pain worsens, fever, haemodynamic changes → ED.” Practice spotting abnormal vitals in mocks.
Irrelevant preventive advice	Tailor advice to age, sex, risk factors; avoid generic check‑lists. Use evidence‑based prompts (e.g. Red Book age tables).
Discomfort with uncertainty	Explain the plan: “We’re not 100% sure today; here’s what we’ll monitor and when we’ll reassess.” Validate uncertainty as normal.
Poor patient education / language	Use teach‑back: “Could you tell me in your own words…?” Provide written or visual aids.
Lack of follow‑up & safety‑netting	Finish with specific timeframe (“I’d like to see you in 48 hrs or sooner if…”) and ensure contact details are confirmed.