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Paeds Casesclinical-assessment-and-reasoning

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.

osce clinical reasoning and communication station1 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
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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]

  1. Take a focused history from the caregiver actor while observing the infant manikin description provided by the examiner.
  2. State a one-sentence problem representation.
  3. Give a threat-first differential with residual risks.
  4. Counsel the caregiver about uncertainty and next steps.
  5. Hand over to the examiner as night registrar. [1] [3]
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References10ShowHide
  1. [1]Bowen JL Educational strategies to promote clinical diagnostic reasoning. The New England journal of medicine, 2006.PMID 17124019
  2. [2]McQuade CN Characteristics differentiating problem representation synthesis between novices and experts. Journal of hospital medicine, 2024.PMID 38528679
  3. [3]Bergl PA Keeping a Flexible Differential Diagnosis: an Exercise in Clinical Reasoning. Journal of general internal medicine, 2019.PMID 30847831
  4. [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. [5]Bordini BJ Overcoming Diagnostic Errors in Medical Practice. The Journal of pediatrics, 2017.PMID 28336147
  6. [6]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
  7. [7]Croskerry P Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ quality & safety, 2013.PMID 23882089
  8. [8]Custers EJ Thirty years of illness scripts: Theoretical origins and practical applications. Medical teacher, 2015.PMID 25180878
  9. [9]Fernandez Branson C Improving diagnostic performance through feedback: the Diagnosis Learning Cycle. BMJ quality & safety, 2021.PMID 34417335
  10. [10]Berkwitt A Cognitive bias in inpatient pediatrics. Hospital pediatrics, 2014.PMID 24785565
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