Expected response	Details and comments	Pass criteria
Acknowledgment (verbal and/or written)	Medical administration Complainant
Investigation	Medical records Staff involved (medical and nursing) ComplainantCheck daughter not adult (If candidate asks, daughter is 14 years old)
Response	Timely (< 72 hours ideally) Non-judgemental Apologise sincerely/honestly without admission of liability Verbal better/written if unable	No denial if apology appropriate
Counsel staff Medical defence as appropriate
Audit/quality	Review ED processes, change as indicated Use as educational exercise Arrange for someone to speak to surgeon about criticising colleagues	System review
Keep records of complaints

Question 2: The patient and her mother wish to speak to the registrar concerned. Would you agree to this and, if so, under what circumstances? (2 minutes)

Expected response	Details and comments	Pass criteria
Specifics of complaint	Appropriate in most cases Helps successful resolution	Pros and cons
Environment	Quiet, uninterrupted area Adequate time set aside Preferably neutral informal environment (Prompt candidate for environment if not given)	Appropriate environment
Doctor concerned	Fully informed pre-meeting Apology honest, sincere Senior staff present +/– mentor Medical defence aware/give consent as appropriate	Involve administration
Hospital	Medical administration aware/give consent

Question 3: You discuss this complaint with the registrar involved. She promptly bursts into tears and admits to having used pethidine for most of the year. She has become increasingly depressed about her inability to cope. What will you do now? (2 minutes)

Expected response	Details and comments	Pass criteria
Complaint-related	Not appropriate for registrar to meet with complainant Manage complaint without this meeting	Prompt to address
Workplace issues	Will need time off — needs sick leave certificate Arrange cover for shifts Maintain confidentiality
Medical issues	Offer to arrange screening for HIV, Hep B, C etc. Offer medical and drug support services re management/rehabilitation etc.
Psychiatric issues	Requires urgent objective assessment and management of depression and potential for self-harm May need admission to a psychiatric/drugs of dependency facility Explore psychosocial supports — family/partner/friends etc.	Appropriate psychological care and follow-up
Legal issues	Must be reported to Medical Board Inform medical administration Maintain confidentiality within the hospital	Appropriate reporting
Other	Make aware of AMA/impaired practitioner service; supervised and well-monitored clinical practice; provision of mentors

Question 4: When would you be happy for this registrar to return to work in ED? (1 minute)

Expected response	Details and comments	Pass criteria
Medical	Appropriate drug-free interval, with ongoing drug screening and dependence help Mentor available
Psychiatric	Ongoing support and monitoring
Medicolegal	Negotiate with medical administration and medical board regarding restrictions (e.g. cannot write S8 prescriptions)

SCE 2: medical

A 29-year-old ambulance officer presents after 24 hours of vomiting. He looks sweaty and unwell. His initial observations are as follows:

• SaO₂ 99% (room air).

Question 1: How would you assess this man? (2 minutes)

Expected response	Details and comments	Pass criteria
History — presenting complaint/systems review	Symptoms: fever, abdominal pain, change in bowel habit, dysuria, frequency, cough, sputum, fluid intake, postural symptoms, headache	History features
Past history	Any previous episodes similar Other medical conditions: particularly immunosuppressive(Prompt candidate: any predisposing factors?)
Social	Alcohol, medications, drugs Contacts with similar (home/work) Travel	Medication and contacts history
Examination	For cause — all systems potentially relevant
Investigations	Bedside: BSL, urinalysis, ECG Lab: full blood profile (infection), U&Es (renal function, Na, K), Ca, LFT if indicated on history or examination Cultures: urine, blood Radiology: chest X-ray	BSL, ECG, basic labs

Question 2: How will you manage him? (2 minutes)

Expected response	Details and comments	Pass criteria
Triage	Australasian Triage Scale (ATS) 2 Resuscitation area, team approach
Resuscitation	ABC — needs O₂, IV fluids and monitor response, non-invasive monitoring	Basic description of ABC approach
Specific treatment	Depends on what is found, e.g. goal-directed therapy and antibiotics for severe sepsis
Disposition	Depends on findings and response

Question 3: Here are the lab results [to be handed over]. Please interpret them. (2 minutes)

Question 4: You consider hypoaldosteronism as a likely cause. What are the differences between the available steroids? (1 minute)

Expected response	Details and comments	Pass criteria
	Hydrocortisone: glucocorticoid and mineralocorticoid action; can still do a short synacthen test Fludrocortisone: both properties but greater mineralocorticoid action Dexamethasone and prednisone: glucocorticoid

SCE 3: surgical/trauma

You are the consultant on call in a rural hospital on a Thursday evening. You receive a call from your registrar who has just been notified that ambulance officers are bringing in an unconscious woman who was involved in a head-on collision with a truck on the highway. Her current observations are:

• GCS 5 (E1, M2, V2)

• PR 110/min

• BP 105/70 mmHg.

She has a large frontal laceration, partially obstructed breathing and SaO₂ 92% on high-flow O₂. A Guedel airway could not be inserted. Th e registrar is an advanced trainee and there is also one RMO on duty. You will probably arrive at ED a few minutes aft er the patient.

Question 1: How would you respond to this call? (2 minutes)

Expected response	Details and comments	Pass criteria
Immediately come in		Come in
Prepare department	ED staff — current ED nursing, medical, auxiliary staff; other help as available for this patient and rest of department; activate a trauma call if hospital policy Other staff — surgical team, lab and X-ray (If asked, inform candidate that a lab and radiology with CT capability are on-site) Prepare the resuscitation bay including airway equipment, drugs, warmed fluids, O negative blood	Consider all aspects
Obtain moreinformation if possible	ED staff Ambulance

Question 2: You arrive to find the registrar has successfully intubated the patient, who is now beginning to move with extensor posturing of the right leg and arm and coughing on the ETT. She appears to be pregnant. The secondary survey findings are:

• a laceration of the left upper eyelid and a dilated pupil unresponsive to light

• a closed fracture of the left clavicle

• the abdomen is consistent with a gravid uterus at the level of the umbilicus.

Outline your actions from this point. (2 minutes)

Expected response	Details and comments	Pass criteria
EMST/ATLS directed resuscitation	A — confirm ETT placement and that a cervical collar is present B — confirm adequate ventilation bilaterally C — ensure 2 × large bore IV cannulae, administer fluids, assess peripheral pulses and perfusion. Consider wedging to the left while maintaining spinal alignment (pregnant) (When asked, tell candidate she is well perfused) D — clarify GCS pre-intubation, assess other pupil (other pupil is normal — local trauma to left orbit), reflexes, plantar responses, BSL (if/when asked BSL 2 — should treat as soon as known and keep monitoring) E — need to examine back/perineum Keep warm once examined	Adequate address to life threats Orderly approach
Rapid neurological assessment and decision to allow to wake or paralyse/sedate	Cannot leave biting on tube Extensor posturing is an ominous sign; together with the pupil dilatation it suggests imminent coning — traumatic mydriasis of left pupil is a possibility, but should not dissuade against instituting aggressive treatment for raised intracranial pressure Should maintain ETT with sedation/paralysis (Prompt candidate to address if not mentioned)	Pros and cons
Recheck vital signs after immediate management including BSL (if not done already)	As above	BSL earlier or now
Secondary survey	Neurology — as much as possible prior to paralysing Secondary survey with full head-to-toe examination when able Assessment of pregnancy will be needed but not an immediate priority; likely 20-week gestation based on fundal height and thus no role for emergency delivery	Pregnancy acknowledged Gestational age assessment reasonable
Ancillary	Orogastric tube Urinary catheter

Question 3: A secondary survey reveals no other injuries. The patient remains haemodynamically stable: pulse 90–100, systolic BP 100–110. How would you investigate this patient further? (2 minutes)

Expected response	Details and comments	Pass criteria
Chest X-ray	Shield abdomen Ensure tubes correctly placed Look for other thoracic abnormalities	Trauma series
Lateral C-spine X-ray	(If asked, plain films show anterior crush # C4)
Pelvis X-ray	Can discuss pros and cons
ECG	Can discuss pros and cons
Labs	Full blood profile, U&Es, BSL Group and hold — blood type as minimum (Rhesus status) ß-HCG (discuss utility if mentioned)	BSL Rhesus status
CT scan of head and cervical spine	Encircling abdominal shield (Prompt discussion about how to clear the thoracolumbar spine)	CT scan of head and cervical spine
Assess pregnancy	Doppler for fetal heart rate initially Ultrasound if available Consider CTG if > 26/40	Who and when
Abdominal assessment	US/CT/DPL/nothing (Prompt discussion)	Pros and cons

Question 4: The retrieval team will be able to transport the patient in approximately 90 minutes. What else needs to be done in the interim? (1 minute)

Expected response	Details and comments	Pass criteria
Bed arranged (if not already)	Liaise with ICU, neurosurgery and obstetric teams at accepting hospital	Arrange bed
Packaged for transport	Lines secured Notes copied X-rays — preferably originals — with patient	Package appropriately
Notification of relatives, including prognosis	(If running well on time, state the patient’s identity is currently unknown and ask candidate how they would identify her. Prompt that she has a medic alert bracelet but no wallet)	Notification
Registrar education	Importance of BSL (missed) Constructive feedback about trauma management How to use medic alert for patient ID

SCE 4: paediatrics

A six-year-old French girl is brought into your Emer gency Department by a casual baby-sitter after a fall at home. The child is distressed and will not move her left arm. The left elbow is swollen and tender. The distal pulse and sensation are normal.

Question 1: What is your immediate management? (2 minutes)

Expected response	Details and comments	Pass criteria
Triage	ATS 2/3
ABC	Exclude immediate life threats and look for other injuries	Basic ABC
Specific	Analgesia — discuss options and ask for correct doses (Prompt candidate for estimated weight) Apply sling and ice pack Circulation observations repeated after sling/splint	Appropriate analgesia options Weight estimate reasonable
Disposition	X-ray Orthopaedic consultation Possibility of needing reduction in theatre — issues of consent (need to contact parent/guardian) Consider non-accidental injury (NAI)	X-ray NAI

Question 2: X-rays have been performed [give to candidate]. Please describe them. (1 minute

A displaced supracondylar fracture should be diagnosed. A posterior fat pad sign is also present (haemarthrosis).

Question 3: On re-examination, the pulse in the arm is now absent. What will you do now? (1 minute)

Expected response	Details and comments	Pass criteria
Remove arm from sling and straighten it	Check whether pulse returns as doing it (It does not)
Expedite orthopaedic review for likely emergent reduction in theatre	Note issues of consent	Urgent orthopaedic review

Question 4: The orthopaedic surgeon arrives and the pulse is still absent. He instructs that the child be taken immediately to theatre. How will you obtain consent for this procedure? (1 minute)

Expected response	Details and comments	Pass criteria
	Surgeon primarily responsible for consent Try all avenues to contact parents Urgent situation (threat to limb) and may need consent from medical administration	Consent options discussed

Question 5: The parents arrive just as the child is being taken to theatre. The father starts conversing angrily with the baby-sitter in French. How will you manage this situation? (2 minutes)

Expected response	Details and comments	Pass criteria
Determine whether father can speak English	If not, will need an interpreter (baby-sitter no longer appropriate as sole interpreter) Awareness of interpreter service essential (If candidate can speak French, ask them what they would do if it was a language they could not speak)	Need appropriate communication
Defuse situation	Be mindful of potential NAI on part of baby-sitter or parents
Address consent issues	Provide information on procedure (may need to come from surgical team)

SCE 5: equipment/skills

You have just intubated a 75-year-old, 60 kg woman with respiratory failure after a fall in which she sus tained a flail chest with pulmonary contusions. Due to circumstances within your hospital, you must arrange for her transfer to another hospital’s ICU.

Question 1: Please set up this ventilator [Oxylog 1000] to ventilate this patient and check that it is working correctly. (2 minutes)

Expected response	Details and comments	Pass criteria
Describe	Ventilator identified Circuit with HME and PEEP valve (Prompt candidate, if necessary)	Oxylog 1000
Check oxygen source and turn on	Check alarms
Set	Rate 12–14; MV 5–7 L/min; TV 400–500 mL; FiO₂no air mix initially PEEP valve set at 5 cmH₂O initially (Prompt candidate for rate and minute volume, if necessary)	Appropriate settings
Demonstrate	Working as expected Spirometer use

Question 2: How would you monitor this patient’s respiratory status over the next two hours? (1 minute)

Expected response	Details and comments	Pass criteria
Clinical	Vital signs — pulse, blood pressure Chest examination — expansion and auscultation findings; frequency/character of secretions
Monitors	ECG; SaO₂; ETCO₂	ECG, SaO₂, ETCO₂ essential
Other	Alarms — peak pressure, supply failure and disconnect ABG — perform serially to optimise ventilation Chest X-ray — repeat if deterioration occurs

Question 3: Fifteen minutes later, you are called back to the patient because the SaO₂has dropped to 70%. Detail the possible causes and your immediate management. (2 minutes)

Expected response	Details and comments	Pass criteria
Possible causes	Probe off (usually obvious) Poor blood flow to probe area O₂supply failure or disconnection Leaks (circuit, cuff deflation, high peak pressures) ETT problems — endobronchial migration, dislodgement or blockage Disease complications (e.g. pneumothorax, haemothorax, evolving contusions) Ventilator dysynchrony (Prompt candidate to start from one end and work along)	At least three of these
Action	Assume it is a real problem Disconnect patient from ventilator and hand ventilate with 100% O₂ Examine patient — ensure trachea midline, chest expansion, air entry and breath sounds Consider suctioning airway Check monitors — SaO₂, ETCO₂, airway pressures Check ventilator and O₂supply before reconnecting to Oxylog May need extra PEEP May need to involve intensivist — reassess fitness to transfer and need for a better ventilator	Remove Oxylog from decision

Question 4: The retrieval service calls to say that it will not be able to collect the patient for another 12 hours. What will you do? (2 minutes)

Expected response	Details and comments	Pass criteria
Consider other transport options	Road/rotary/fixed wing Consider level of escort available and ability to travel by chosen method	Pros and cons
Consider other bed options	Liaise with local intensivist for assistance — may need to admit this patient and transfer out someone more stable Liaise with other nearby hospitals Remain in ED if necessary but negotiate the most appropriate possible staff to care for her	Other options
Other	Continue quality supportive care: • orogastric tube and urinary catheter • fluids • sedation and paralysis • eye, mouth and pressure area care Communicate with relatives Keep in touch with retrieval service and update receiving hospital regularly	Ongoing patient management

SCE 6: communication

You have been managing Amy Jones, a 16-year-old girl who presented alone with PV bleeding. A urine β-HCG is positive and ultrasound shows a viable fetus. Amy has requested that her mother not be told she is pregnant. The nurse has just approached you saying that Amy’s mother is demanding to see you immediately. She has been escorted to the relatives’ room and is awaiting your arrival.

You will role-play a conversation with Mrs Jones, who will be played by an actor. The examiners will not interact with you and will be observing only.

Information for examiners

The actor who will play Amy’s mother has been briefed with the following background information:

• You are divorced.

• Your daughter, Amy, was adopted. She moved out of home four months ago to live with her boyfriend.

• Amy has been working at a local supermarket.

• Until Amy moved out, you shared custody of Amy with your ex-husband.

Information for actor playing Amy’s mother

When the doctor tells you that Amy is an adult, you will get upset. However, you will calm down and accept the situation if the information is presented to you appropriately.

uestion: This is Mrs Jones, the mother of Amy. Please discuss the situation with her.

Expected response	Details and comments	Pass criteria
Introduction	Identify self by name as doctor caring for Amy	Essential
Confirm information known	Clarify what the mother knows and her concerns Use non-confrontational manner Preserve Amy’s confidentiality Explain the legal implications of confidentiality as related to minors and adults Clarify the legal status of Amy as a minor or an adult; adult defined from age 16 if living independently or the individual has a child	Reasonable approach expected Establish rapport Active listening picking up non-verbal cues Body language appropriate Language appropriate — not medical jargon
Information released only with consent	Will be classified as adult Information can be passed on only with the consent of the patient	Identify status as adult Protect confidentiality
Resolution of situation	Empathise with mother’s position Offer to liaise with Amy with intention of creating direct dialogue between them	Reasonable resolution