CCE – Core Areas to Read and Anticipate
1.1 Why these areas matter
The CCE frequently tests more than clinical diagnosis. Many stations assess whether the candidate can manage ethical, legal, behavioural, communication, vulnerable-patient, public-health and occupational scenarios in a safe Australian general practice context.
1.2 High-yield core areas
| Core area | What to revise | Common CCE trigger |
|---|---|---|
| Confidentiality | Privacy, disclosure, exceptions, family requests | Relative asks for results |
| Alcohol misuse | Harm assessment, withdrawal risk, motivational interviewing | Haematemesis, elevated LFTs, family concern |
| Smoking | 5 A’s, readiness to quit, pharmacotherapy | COPD, pregnancy, CVD risk |
| Drug dependence / drug-seeking behaviour | Safe prescribing, boundaries, de-escalation | Lost opioid script, early repeat |
| Motivational interviewing | OARS, stages of change, ambivalence | Lifestyle change, alcohol, smoking |
| Elder abuse | Private interview, safety, capacity | Controlling relative, bruises |
| Non-accidental injury | Safeguarding, mandatory reporting | Inconsistent injury history |
| Advance care planning | Goals of care, AHD, EPOA | Frailty, dementia, COPD |
| Substitute decision-making | Capacity, supported decision-making, legal substitute | Dementia, delirium |
| Involuntary assessment / treatment | Capacity, serious risk, mental health legislation | Psychosis, suicidality |
| Public health | Outbreak management, notification | RACF norovirus/influenza |
| Contact tracing | STI notification, partner notification, confidentiality | Chlamydia, gonorrhoea |
| Impaired colleague | Patient safety, escalation, AHPRA | Colleague intoxicated or unsafe |
| Anti-vax patients | Respectful risk discussion, vaccine hesitancy | Parent refuses childhood vaccines |
| WorkCover | Capacity certificates, objective findings | Workplace injury/stress leave |
| Gillick competence | Mature minor consent/confidentiality | Teen contraception/STI request |
| Fitness to drive | Austroads principles, restriction advice | Seizure, syncope, dementia |
| Critical appraisal | Study design, validity, applicability | Research abstract station |
| Difficult interactions | Angry/threatening patient, boundaries | Opioid refusal, complaint |
2. Ethical & Legal “Must-Know” Domains
2.1 Overview
Ethical and legal domains are high-yield because they test:
- professionalism
- medico-legal reasoning
- patient safety
- confidentiality
- consent and capacity
- documentation
- escalation
identifies confidentiality, consent/capacity, mandatory reporting, fitness to drive, and advance care planning as key ethical and legal domains.
3. Confidentiality — General and Specific Scenarios
3.1 Core rule
Confidentiality is an ethical, legal and professional duty. It generally continues after death. Disclosure without consent is only justified in limited circumstances, such as mandatory reporting, serious risk, court order, or continuity of care.
3.2 CCE approach
3.2.1 Start by clarifying confidentiality
Use early, clear language:
“Most of what we discuss is confidential unless I’m concerned about your safety or someone else’s safety.”
3.2.2 Ask permission before sharing
“Would you be comfortable if I discussed this with your daughter?”
3.2.3 Document consent or refusal
Document:
- who was present
- what was discussed
- what the patient consented to
- what information was disclosed
- any refusal of consent
3.3 Common confidentiality scenarios
| Scenario | Correct approach | Useful phrase |
|---|---|---|
| Relative wants an update | Listen, but do not disclose without consent | “I can listen to your concerns, but I can’t share information without permission.” |
| Partner asks for STI results | Do not disclose; encourage patient-led disclosure/contact tracing | “I can’t provide another person’s results.” |
| Teen requests contraception | Assess Gillick competence and safeguarding | “Most of this is confidential unless I’m worried about safety.” |
| Colleague asks for chart information | Verify identity, need-to-know, and consent | “I need to confirm the clinical reason and patient consent.” |
| Family concerned about dementia | Accept information, do not confirm diagnosis without consent | “Thank you for telling me. I can consider this in their care.” |
3.4 Confidentiality with family members
3.4.1 If family gives information
You can accept information.
You should not:
- confirm diagnosis
- disclose medications
- disclose results
- discuss management without consent
3.4.2 Good wording
“I’m happy to hear your concerns, because they may help with care. However, I can’t discuss the patient’s medical details unless they agree.”
3.5 Confidentiality in adolescents
3.5.1 Key principles
Assess:
- maturity
- understanding
- voluntariness
- risk of coercion
- safeguarding concerns
3.5.2 Good wording
“You can speak to me privately. I would only need to involve others if I was worried about your safety or someone else’s safety.”
3.6 Common pitfalls
| Pitfall | Better approach |
|---|---|
| Accidentally confirming diagnosis to family | Listen without confirming |
| Not explaining confidentiality limits | Explain early |
| Automatically involving parents | Assess Gillick competence first |
| Forgetting documentation | Document consent, refusal and rationale |
4. Consent, Capacity and Gillick Competency
4.1 Core principles
Adults are presumed to have capacity unless there is evidence otherwise. Capacity is:
- decision-specific
- time-specific
- affected by context and complexity
4.2 Capacity assessment
A patient should be able to:
| Capacity element | Meaning | Example question |
|---|---|---|
| Understand | Comprehend relevant information | “Can you tell me what you understand about this?” |
| Retain | Hold information long enough to decide | “Can you explain what we discussed?” |
| Weigh | Balance risks and benefits | “What do you see as the pros and cons?” |
| Communicate | Express a decision | “What would you like to do?” |
4.3 Common CCE scenarios
| Scenario | Key issue | Management |
|---|---|---|
| Dementia patient refusing help | Capacity and safety | Assess capacity, involve supports with consent |
| Delirium refusing treatment | Temporary impaired capacity | Treat reversible cause, urgent care if unsafe |
| Aphasia after stroke | Communication ≠ incapacity | Use communication aids/interpreter/speech pathologist |
| Depression refusing treatment | Mental illness ≠ incapacity | Assess risk, capacity, suicidality |
| Teen requesting contraception | Gillick competence | Assess maturity, safety, confidentiality |
4.4 Gillick competency
4.4.1 Definition
A young person may be able to consent to medical treatment if they have sufficient maturity and understanding to appreciate the nature, consequences and risks of the decision.
4.4.2 CCE approach
Assess:
- age and maturity
- understanding of treatment
- understanding of risks/benefits
- ability to reason
- voluntariness
- coercion or abuse
- sexual safety
- mental health risk
4.4.3 High-yield phrase
“I’d like to understand how much you know about the options, the benefits, the risks, and what could happen if we don’t treat.”
5. Mandatory Reporting and Public Health Duties
5.1 Key concept
Mandatory reporting applies where the law requires disclosure to protect individuals or the public. identified areas include child abuse, communicable diseases, impaired colleagues and fitness-to-drive concerns as commonly tested scenarios.
5.2 Common mandatory reporting areas
| Area | Example CCE scenario | Candidate response |
|---|---|---|
| Child protection | Non-accidental injury | Ensure safety, report as required, document |
| Public health | Notifiable disease / outbreak | Notify PHU, infection control |
| Impaired practitioner | Colleague intoxicated at work | Prioritise patient safety, escalate |
| Fitness to drive | Unsafe driver after seizure | Advise restriction, consider reporting if risk persists |
| Serious risk of harm | Threats, severe violence risk | Breach confidentiality if legally/ethically justified |
5.3 How to explain mandatory reporting
“I want to be upfront with you. Most of what we discuss is confidential, but because I’m concerned about safety, I have a professional and legal responsibility to take further steps.”
5.4 Documentation
Document:
- exact words used by patient/family
- clinical findings
- risk assessment
- advice given
- reports made
- people contacted
- safety plan
6. Fitness to Drive
6.1 Why this is high-yield
Fitness to drive is a common medico-legal CCE topic.
6.2 Common scenarios
| Scenario | Key risk | Management focus |
|---|---|---|
| Seizure | Sudden incapacity | Driving restriction, specialist review |
| Syncope | Recurrence risk | Cause assessment, temporary restriction |
| TIA/stroke | Neurological recurrence/impairment | Austroads-based restriction |
| Dementia | Judgement, reaction time, navigation | Cognitive and functional assessment |
| OSA | Sleepiness and crash risk | ESS, treatment adherence |
| Visual impairment | Inadequate visual acuity/fields | Optometry/ophthalmology assessment |
| Hypoglycaemia | Sudden loss of consciousness | Diabetes medication review, driving advice |
6.3 Consultation structure
6.3.1 Assess
Ask about:
- event details
- recurrence
- warning symptoms
- insight
- occupation
- commercial vs private licence
- treatment adherence
- patient understanding
6.3.2 Advise
Explain:
- driving may need to stop temporarily
- restrictions are about safety, not punishment
- conditional licences may be possible
- follow-up and review are required
6.3.3 Document
Document:
- condition
- advice given
- patient response
- whether patient agrees to stop driving
- escalation/reporting decision
6.4 Useful phrase
“I understand this has a big impact on your independence. My role is to help keep you and others safe while we work out when it is safe to drive again.”
7. Advance Care Planning, Substitute Decision-Making and End-of-Life Care
7.1 Advance Care Planning
Advance care planning is commonly tested in frailty, dementia, COPD, palliative care and RACF contexts.
7.2 Core components
| Component | What to explore |
|---|---|
| Understanding | “What do you understand about your illness?” |
| Values | “What matters most to you?” |
| Goals | Comfort, longevity, independence, staying at home |
| Fears | Hospitalisation, pain, loss of dignity |
| Substitute decision-maker | EPOA / legally recognised substitute |
| Documentation | AHD, goals-of-care plan, RACF plan |
7.3 Good phrases
“What would be most important to you if your health worsened?”
“Are there treatments you would or would not want?”
“Who would you trust to make decisions for you if you couldn’t speak for yourself?”
7.4 Substitute decision-making
7.4.1 When it applies
Substitute decision-making applies when:
- the patient lacks capacity for the specific decision
- a decision is required
- a legally appropriate substitute decision-maker exists
7.4.2 Candidate approach
- Assess capacity first.
- Use supported decision-making where possible.
- Identify the correct substitute.
- Clarify known patient values.
- Document reasoning.
7.5 Common pitfalls
| Pitfall | Better approach |
|---|---|
| Jumping straight to family decision | Assess patient capacity first |
| Focusing only on forms | Explore values and goals |
| Using jargon | Use clear, compassionate language |
| Avoiding the topic | Normalise ACP as planning ahead |
8. Involuntary Assessment / Treatment
8.1 Common CCE scenarios
- acute psychosis
- suicidal patient refusing help
- manic patient with risk-taking behaviour
- severe depression with high suicide risk
- intoxicated patient lacking capacity
- delirious patient refusing hospital transfer
8.2 Core principles
Involuntary assessment or treatment may be considered when:
- the patient lacks capacity or has severe mental illness impairing judgement
- there is serious risk to self or others
- less restrictive options are not safe
- urgent assessment is required
8.3 management
| Step | Action |
|---|---|
| 1 | Assess immediate safety |
| 2 | Assess capacity and risk |
| 3 | Involve family/supports if appropriate |
| 4 | Contact acute mental health / ambulance / ED |
| 5 | Use least restrictive pathway |
| 6 | Document carefully |
8.4 Useful phrase
“I’m concerned that your safety is at immediate risk. I would like to involve urgent mental health support today.”
9. Alcohol Abuse / Alcohol Dependence
9.1 Common CCE scenarios
| Scenario | Key concern |
|---|---|
| Haematemesis after binge drinking | GI bleed, gastritis, varices, withdrawal risk |
| Elevated LFTs | Harm assessment, dependence, liver disease |
| Partner concerned | Readiness, family impact, safety |
| Recurrent falls | Intoxication, head injury, elder risk |
| Anxiety/insomnia | Alcohol as coping strategy |
| Request for diazepam | Dependence, withdrawal, safe prescribing |
9.2 Assessment
9.2.1 Alcohol history
Ask:
- type of alcohol
- standard drinks/day
- frequency
- binge pattern
- morning drinking
- blackouts
- withdrawal symptoms
- prior attempts to cut down
- triggers
- impact on work/family
9.2.2 Dependence features
Assess:
- tolerance
- cravings
- loss of control
- continued use despite harm
- withdrawal
- neglect of responsibilities
9.2.3 Risk assessment
Assess:
- suicidality
- self-harm
- violence
- driving
- child safety
- withdrawal seizures
- delirium tremens
- comorbid depression/anxiety
9.3 Management
9.3.1 Brief intervention
Use:
- non-judgemental feedback
- link alcohol to patient’s concerns
- ask permission to discuss change
- negotiate realistic goals
9.3.2 Motivational phrase
“What do you like about drinking, and what are the downsides for you?”
9.3.3 Withdrawal safety
Do not advise abrupt cessation in dependent drinkers without assessing withdrawal risk.
9.3.4 Treatment options
| Severity | Management |
|---|---|
| Low-risk / hazardous use | Brief intervention, reduction plan, follow-up |
| Harmful use | Counselling, mental health support, pathology, review |
| Dependence | Detox planning, addiction services, pharmacotherapy |
| High-risk withdrawal | Hospital or supervised detox |
9.4 Pharmacotherapy after detoxification/cessation
| Medication | Role | Key notes |
|---|---|---|
| Acamprosate | Helps maintain abstinence | Best after cessation; useful where abstinence is goal |
| Naltrexone | Reduces reward/craving | Avoid in opioid use/dependence; consider liver context |
| Disulfiram | Aversion therapy | Less commonly used; requires high motivation/supervision |
10. Smoking Cessation
10.1 Common scenarios
| Scenario | Focus |
|---|---|
| COPD review | Lung function, exacerbation prevention |
| Pregnancy | Maternal and fetal risk, non-judgemental support |
| CVD risk | Absolute risk reduction |
| Pre-operative review | Wound healing, anaesthetic risk |
| Low motivation | Motivational interviewing |
10.2 5 A’s framework
| Step | What to do | Example |
|---|---|---|
| Ask | Identify smoking status | “How many cigarettes do you smoke per day?” |
| Advise | Clear personalised advice | “Stopping is the most important step for your lungs.” |
| Assess | Readiness to quit | “How ready do you feel to make a change?” |
| Assist | Offer supports | NRT, varenicline, Quitline |
| Arrange | Follow-up | Review in 1–2 weeks |
10.3 Management options
10.3.1 Behavioural
- Quitline
- counselling
- trigger planning
- relapse prevention
- family support
- written quit plan
10.3.2 Pharmacotherapy
- nicotine replacement therapy
- combination NRT
- varenicline where appropriate
10.4 Useful phrase
“Most people need several quit attempts. A relapse does not mean failure; it helps us refine the plan.”
11. Drug-Seeking Behaviour / Drug Dependence
11.1 Common scenarios
| Scenario | Candidate challenge |
|---|---|
| Lost opioid script | Empathy + safe prescribing |
| Early repeat | Dependence risk |
| Benzodiazepine demand | Withdrawal vs misuse |
| Angry patient demanding S8 | De-escalation |
| New patient requesting opioids | Verification and records |
| Chronic pain crisis | Validate pain without unsafe prescribing |
11.2 Consultation approach
11.2.1 Engage first
“I can see you’re in distress. Let’s work through this safely.”
11.2.2 Assess
Ask about:
- pain and function
- medication history
- dose escalation
- withdrawal symptoms
- mental health
- substance use
- overdose history
- previous prescribers
- prescription monitoring
11.2.3 Set boundaries
“I’m not comfortable prescribing this today because I’m concerned about safety, but I do want to help manage your symptoms.”
11.2.4 Offer alternatives
- non-opioid analgesia
- physiotherapy
- psychology
- pain clinic
- addiction medicine
- planned follow-up
- single prescriber arrangement
11.3 Common pitfalls
| Pitfall | Better approach |
|---|---|
| Bluntly saying “no” | Explain risk and offer alternatives |
| Appearing judgemental | Use neutral language |
| Prescribing under pressure | Prioritise safety |
| Not checking records | Verify before prescribing |
| Escalating conflict | De-escalate and set boundaries |
12. Motivational Interviewing and Stages of Change
12.1 Why this matters
Motivational interviewing is high-yield for alcohol, smoking, obesity, diabetes, medication adherence and substance use.
12.2 OARS framework
| Skill | Meaning | Example |
|---|---|---|
| O | Open questions | “What concerns you about this?” |
| A | Affirmation | “You’ve already taken a big step by coming in.” |
| R | Reflection | “Part of you wants change, but part of you is unsure.” |
| S | Summary | “So your main goals are better sleep and less stress.” |
12.3 Stages of change
| Stage | Patient attitude | GP approach |
|---|---|---|
| Pre-contemplation | “I don’t have a problem.” | Raise awareness, avoid arguing |
| Contemplation | “Maybe I should change.” | Explore pros and cons |
| Preparation | “I’m ready soon.” | Make a plan |
| Action | “I’m changing now.” | Support and troubleshoot |
| Maintenance | “I’m trying to keep going.” | Relapse prevention |
| Relapse | “I slipped up.” | Normalise, re-engage |
12.4 Useful phrases
“Would it be okay if we talked about how this might be affecting your health?”
“On a scale of 0 to 10, how ready do you feel to change?”
“Why that number and not a lower number?”
13. Managing Difficult Interactions
13.1 Common scenarios
unreasonable requests, angry patients and threatening behaviour as common difficult-consultation areas.
| Scenario | Core skill |
|---|---|
| Antibiotic demand | Explore expectations, explain reasoning |
| Opioid refusal | Boundary-setting |
| Certificate request | Objective assessment |
| Angry complaint | De-escalation |
| Threatening patient | Safety first |
| Vaccine refusal | Respectful risk discussion |
14. Angry or Threatening Patient
14.1 Immediate priorities
14.1.1 Maintain safety
- keep calm tone
- maintain exit access
- do not block the door
- avoid sudden movements
- keep safe distance
- call for help if needed
14.1.2 De-escalate
Use:
- calm voice
- neutral language
- acknowledgement
- choices
- boundaries
14.2 Useful phrases
“I can see you’re very frustrated.”
“I want to help, but I need us both to feel safe.”
“I’m happy to continue if we can speak respectfully.”
“If this continues to feel unsafe, I will need to pause the consultation and get assistance.”
14.3 Management
| Situation | Response |
|---|---|
| Frustrated but not unsafe | Listen, acknowledge, problem-solve |
| Verbally aggressive | Set clear boundary |
| Threatening behaviour | Prioritise safety, terminate if needed |
| Weapon or imminent threat | Leave, call police/security |
| Ongoing risk | Document, practice policy, MDO advice |
14.4 Common pitfalls
| Pitfall | Better approach |
|---|---|
| Arguing | Acknowledge and redirect |
| Matching anger | Stay calm |
| Blocking exit | Maintain safety |
| Continuing unsafe consultation | Pause/terminate if necessary |
| No documentation | Document objectively |
15. Vulnerable Populations
Vulnerable-population stations assess whether the candidate can recognise risk, protect safety, communicate sensitively and escalate appropriately.
examples – elder abuse, NAI and impaired colleagues as key vulnerable-population/professionalism areas.
16. Elder Abuse
16.1 Common scenarios
| Scenario | Red flag |
|---|---|
| Relative answers all questions | Coercive control |
| Bruises or injuries | Physical abuse |
| Poor hygiene or malnutrition | Neglect |
| Missing money | Financial abuse |
| Fearful patient | Psychological abuse |
| Medication withheld | Neglect/control |
16.2 Approach
16.2.1 Speak to patient alone
“I routinely speak with all my patients alone for part of the consultation.”
16.2.2 Assess safety
Ask:
- “Do you feel safe at home?”
- “Has anyone hurt or frightened you?”
- “Is anyone controlling your money, medications or decisions?”
16.2.3 Assess capacity
Determine whether the patient can make decisions about:
- living situation
- finances
- medical care
- accepting supports
16.2.4 Management
- immediate safety plan
- social work
- aged care assessment
- legal/support services
- involve substitute decision-maker only if appropriate
- document objectively
16.3 Common pitfalls
| Pitfall | Better approach |
|---|---|
| Interviewing only with relative present | Speak to patient alone |
| Accusing family | Use neutral, safety-focused language |
| Ignoring capacity | Assess decision-specific capacity |
| No safety plan | Develop practical plan |
17. Non-Accidental Injury
17.1 Common scenarios
| Scenario | Concern |
|---|---|
| Bruising in non-mobile infant | Physical abuse |
| Spiral fracture | Mechanism mismatch |
| Burns with clear margins | Inflicted injury |
| Delay in presentation | Neglect/abuse |
| Repeated injuries | Ongoing harm |
| Inconsistent history | Fabricated explanation |
17.2 approach
17.2.1 Assess clinical safety
- ABCDE if acutely unwell
- full examination
- pain management
- urgent hospital referral if needed
17.2.2 Safeguarding assessment
Assess:
- developmental stage
- injury pattern
- explanation consistency
- previous presentations
- family stressors
- siblings at risk
17.2.3 Management
- do not accuse
- ensure child safety
- mandatory reporting where threshold met
- hospital referral for serious injury
- document carefully
17.3 Useful phrase
“I’m concerned that the injury and the explanation don’t fully match, so I need to make sure your child is safe and properly assessed.”
18. Public-Health & Occupational Scenarios
18.1 Overview
Public-health and occupational stations test broader GP duties, including community protection, notification, outbreak control and work-capacity certification.
19. Public Health — RACF Norovirus / Influenza Outbreaks
19.1 Common RACF outbreak scenarios
| Outbreak | Key features |
|---|---|
| Norovirus | vomiting, diarrhoea, rapid spread |
| Influenza | fever, cough, myalgia, respiratory symptoms |
| COVID-like illness | respiratory outbreak, vulnerable residents |
| Gastroenteritis outbreak | multiple residents/staff affected |
19.2 management priorities
19.2.1 Immediate actions
- identify outbreak
- isolate affected residents
- infection control precautions
- notify Public Health Unit where required
- communicate with RACF staff
- assess vulnerable residents
- consider hospital transfer if clinically deteriorating
19.2.2 Infection control
| Measure | Purpose |
|---|---|
| Hand hygiene | Reduce transmission |
| PPE | Protect staff/residents |
| Isolation/cohorting | Reduce spread |
| Environmental cleaning | Especially important in gastroenteritis |
| Staff exclusion if symptomatic | Prevent ongoing transmission |
| Vaccination audit | Influenza/COVID prevention |
19.3 Follow-up
- review affected residents
- monitor hydration
- monitor vitals
- review medications
- communicate with families where appropriate
- document outbreak advice
20. Contact Tracing
20.1 Common scenarios
- chlamydia
- gonorrhoea
- syphilis
- HIV
- hepatitis
- COVID/influenza outbreak context
20.2 approach
| Step | Action |
|---|---|
| 1 | Explain diagnosis confidentially |
| 2 | Discuss transmission and treatment |
| 3 | Identify partners/contacts |
| 4 | Encourage contact notification |
| 5 | Use public health support where required |
| 6 | Arrange retesting/follow-up |
20.3 Confidentiality principle
Do not disclose the patient’s identity unnecessarily.
20.4 Useful phrase
“Part of managing this infection is helping partners get tested and treated, while protecting your confidentiality as much as possible.”
21. WorkCover — State-Based General Principles
21.1 Common scenarios
| Scenario | CCE focus |
|---|---|
| Back injury at work | Functional capacity |
| Stress leave | Psychosocial assessment |
| Employer pressure | Confidentiality and objectivity |
| Patient requests prolonged certificate | Evidence-based certification |
| Return-to-work planning | Capacity and restrictions |
21.2 Approach
21.2.1 Assess
- mechanism of injury
- diagnosis
- objective findings
- function
- work duties
- psychosocial factors
- barriers to return to work
21.2.2 Certificate principles
Certificates should be:
- accurate
- objective
- capacity-based
- time-limited
- aligned with clinical findings
21.2.3 Communication
Information to employer/insurer requires patient consent, except where legislation permits/mandates relevant communication.
21.3 Useful phrase
“My role is to provide an objective medical assessment of your capacity, not simply to approve or deny leave.”
22. Impaired Colleague
22.1 Common scenarios
| Scenario | Concern |
|---|---|
| Doctor smells of alcohol | Immediate patient safety |
| Unsafe prescribing | Patient harm |
| Cognitive decline | Competence |
| Mental health impairment | Fitness to practise |
| Drug diversion | Serious professional risk |
22.2 Principles
Patient safety takes priority over collegial loyalty.
impaired colleague scenarios is high-yield.
22.3 Management approach
| Step | Action |
|---|---|
| 1 | Ensure immediate patient safety |
| 2 | Do not ignore or collude |
| 3 | Speak to colleague if safe and appropriate |
| 4 | Escalate to senior/practice principal |
| 5 | Notify appropriate body if mandatory threshold met |
| 6 | Document objectively |
22.4 Useful phrase
“I’m concerned about patient safety, and I need to escalate this appropriately.”
23. Anti-Vax Patients / Vaccine Hesitancy
23.1 Common scenarios
| Scenario | Candidate task |
|---|---|
| Parent refuses childhood vaccines | Explore concerns |
| Patient fears side effects | Risk communication |
| Misinformation from social media | Correct respectfully |
| Flu vaccine refusal in pregnancy | Discuss benefits and safety |
| RACF vaccine refusal | Public-health and individual risk |
23.2 Approach
23.2.1 Start with respect
Avoid arguing or dismissing.
“Can I ask what worries you most about the vaccine?”
23.2.2 Explore concerns
Ask about:
- safety fears
- prior adverse reaction
- misinformation
- cultural concerns
- needle fear
- mistrust
23.2.3 Provide clear advice
Use:
- plain language
- absolute risk where possible
- personalised benefits
- permission-based advice
23.2.4 Keep door open
“I respect that this is your decision. I’m happy to revisit it anytime.”
23.3 Common pitfalls
| Pitfall | Better approach |
|---|---|
| Debating aggressively | Explore concerns first |
| Overloading with data | Use clear, relevant information |
| Dismissing fears | Validate emotion |
| Ending relationship | Keep follow-up open |
24. Communication Frameworks to Memorise
24.1 Overview
SPIKES, NURSE, OARS and de-escalation phrases is high-yield communication frameworks.
25. SPIKES — Breaking Bad News
25.1 Framework
| Step | Meaning | Candidate action |
|---|---|---|
| S | Setting | Privacy, support person, no interruptions |
| P | Perception | Ask what patient understands |
| I | Invitation | Ask how much detail they want |
| K | Knowledge | Warning shot, clear information |
| E | Emotion | Pause, acknowledge emotion |
| S | Strategy/Summary | Plan next steps and support |
25.2 Useful phrases
“I’m afraid the results are not what we were hoping for.”
“Would you like me to explain what this means now?”
“I can see this is a lot to take in.”
26. NURSE — Responding to Emotion
26.1 Framework
| Letter | Skill | Example |
|---|---|---|
| N | Naming | “You seem overwhelmed.” |
| U | Understanding | “I can understand why this is upsetting.” |
| R | Respecting | “You’ve handled a lot.” |
| S | Supporting | “We’ll support you through this.” |
| E | Exploring | “What worries you most right now?” |
27. OARS — Motivational Interviewing
27.1 Framework
| Letter | Skill | Example |
|---|---|---|
| O | Open questions | “What would you like to change?” |
| A | Affirmations | “You’ve already made progress.” |
| R | Reflections | “You’re feeling torn.” |
| S | Summaries | “So the main issue is stress drinking.” |
28. De-escalation Framework
28.1 Approach
| Step | Action |
|---|---|
| Acknowledge | “I can see you’re upset.” |
| Clarify | “Help me understand what happened.” |
| Boundary | “I want to help, but we need respectful communication.” |
| Choice | “We can continue calmly, or pause and come back.” |
| Safety | Leave/escalate if unsafe |
29. Critical Appraisal Stations
29.1 Why this matters
Critical appraisal stations may test whether a candidate can interpret research and apply it to general practice.
study type, internal validity, results and applicability are key areas.
29.2 Basic structure
| Domain | What to assess |
|---|---|
| Study type | RCT, cohort, case-control, systematic review |
| Population | Similar to Australian GP patients? |
| Intervention | Practical, available, acceptable? |
| Comparator | Usual care/placebo/alternative |
| Outcomes | Patient-oriented vs surrogate |
| Bias | Selection, performance, detection, attrition |
| Results | Effect size, CI, p-value |
| Applicability | Would this change GP management? |
29.3 Useful candidate structure
29.3.1 Identify the study
“This appears to be a randomised controlled trial assessing…”
29.3.2 Assess validity
Consider:
- randomisation
- allocation concealment
- blinding
- follow-up completion
- intention-to-treat analysis
29.3.3 Interpret results
Consider:
- absolute risk reduction
- relative risk reduction
- number needed to treat
- confidence intervals
- clinical significance
29.3.4 Apply to GP
Ask:
- Are patients similar to my patient?
- Is intervention available in Australia?
- Are benefits meaningful?
- Are harms acceptable?
- Will this change management?
30. Common CCE Pitfalls
30.1 Overview
CCE pitfalls including misreading the task, disorganised answers, ignoring patient agenda, scattergun management, poor prioritisation, irrational investigations and weak safety-netting.
30.2 Pitfalls and corrections
| Pitfall | Why it loses marks | Better strategy |
|---|---|---|
| Not reading the case properly | Misses actual task | Read stem twice; identify action verbs |
| Disorganised answer | Examiner cannot follow reasoning | Use a consistent structure |
| Ignoring patient agenda | Poor patient-centred care | Ask ICE early |
| Scattergun differentials | Poor prioritisation | Top 3 likely + red flags |
| Spending too long on history | No time for management | Time-box sections |
| Irrational investigations | Unsafe/unfocused care | Ask: “Will this change management?” |
| Missing deterioration | Safety risk | Include red flags and escalation |
| Generic prevention advice | Not tailored | Use age/risk-specific advice |
| Poor uncertainty handling | Appears unsafe | Explain monitoring and review |
| Weak safety-netting | Unsafe closure | Give timeframe and red flags |
| Poor patient education | Low health literacy | Use teach-back |
31. CCE Management Template
31.1 Use this structure in most stations
31.1.1 Opening
- introduce self
- confirm patient identity/context
- establish rapport
- clarify agenda
31.1.2 Focused assessment
- presenting issue
- red flags
- relevant history
- psychosocial context
- risk assessment
31.1.3 Patient perspective
Ask:
- ideas
- concerns
- expectations
- impact on life
31.1.4 Clinical reasoning
Explain:
- likely diagnosis
- important differentials
- what is serious/not serious
- uncertainty
31.1.5 Management
Include:
- immediate safety
- investigations if needed
- treatment options
- referrals
- lifestyle/education
- shared decision-making
31.1.6 Safety-net
Always state:
- what to watch for
- when to return
- when to go to ED
- follow-up timeframe
32. Final High-Yield Summary
32.1 The safest CCE candidate is
- structured
- empathic
- clinically safe
- legally aware
- non-judgemental
- clear with boundaries
- able to manage uncertainty
- strong at follow-up and safety-netting
32.2 In difficult stations, prioritise
| Station type | Priority |
|---|---|
| Ethical | Consent, confidentiality, documentation |
| Behaviour change | Motivation, ambivalence, autonomy |
| Angry patient | Safety, de-escalation, boundaries |
| Vulnerable patient | Private assessment, safeguarding |
| Public health | Notification, outbreak control |
| WorkCover | Function, objectivity, capacity |
| Fitness to drive | Public safety, clear restrictions |
| Critical appraisal | Validity, results, applicability |
32.3 Golden rule
A calm, structured, empathic and safe GP will usually score better than a candidate who gives exhaustive information but misses the patient’s agenda, risk assessment, or follow-up plan.