Paeds Cases · clinical-assessment-and-reasoning
Problem representation OSCE — infant return visit and residual-risk counselling
Observed structured encounter testing one-sentence problem representation, threat-first differential, diagnostic pause, residual-risk counselling and handover.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 7-week-old returns overnight after a daytime 'likely viral' discharge. The caregiver is worried the baby is not himself. You must synthesise, prioritise, counsel and hand over under uncertainty.
Candidate brief
You have 10 minutes. [1]
- Take a focused history from the caregiver actor while observing the infant manikin description provided by the examiner.
- State a one-sentence problem representation.
- Give a threat-first differential with residual risks.
- Counsel the caregiver about uncertainty and next steps.
- Hand over to the examiner as night registrar. [1] [3]
References10ShowHide
- [1]Bowen JL Educational strategies to promote clinical diagnostic reasoning. The New England journal of medicine, 2006.PMID 17124019
- [2]McQuade CN Characteristics differentiating problem representation synthesis between novices and experts. Journal of hospital medicine, 2024.PMID 38528679
- [3]Bergl PA Keeping a Flexible Differential Diagnosis: an Exercise in Clinical Reasoning. Journal of general internal medicine, 2019.PMID 30847831
- [4]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
- [5]Bordini BJ Overcoming Diagnostic Errors in Medical Practice. The Journal of pediatrics, 2017.PMID 28336147
- [6]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
- [7]Croskerry P Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ quality & safety, 2013.PMID 23882089
- [8]Custers EJ Thirty years of illness scripts: Theoretical origins and practical applications. Medical teacher, 2015.PMID 25180878
- [9]Fernandez Branson C Improving diagnostic performance through feedback: the Diagnosis Learning Cycle. BMJ quality & safety, 2021.PMID 34417335
- [10]Berkwitt A Cognitive bias in inpatient pediatrics. Hospital pediatrics, 2014.PMID 24785565