Teaching, supervision and feedback in paediatrics — formative SAQs

SAQ 1 — Structured feedback after a procedural error (10 marks)

A senior registrar has twice attempted cannulation on a distressed toddler and failed. The parent is upset. You, the consultant, succeeded on the next attempt. The registrar avoids you for the rest of the shift. ^{[1] [3]}

Questions

1. Outline a structured feedback conversation using the ask-tell-ask model for this encounter. (5 marks) ^{[7] [10]}
2. How does the educational alliance change what you say and when you say it? (3 marks) ^{[3] [8]}
3. What would you document, and what supervision arrangement would you agree for the next procedural attempt? (2 marks) ^{[6] [9]}

Model answer

Ask-tell-ask structure (5). First create a private, calm setting once the shift pressure eases and emotions settle. Ask: invite the registrar's own self-assessment ("how did those attempts go for you, and what was going through your mind?"). Tell: share specific, behaviour-focused observations (site choice, restraint, the child's escalation, when to stop and call for help) rather than global judgement, balanced with what they did well (consent, positioning). Ask: coach them to name the next step — simulation practice, watching you cannulate, a defined technique — so they own the action plan. ^{[7] [10]}

Role of the educational alliance (3). The alliance — trust and partnership — determines whether the message lands or triggers defensiveness. Name it explicitly: "I'm investing in this because you're going to be excellent." Timing matters: deliver feedback close to the event but not in the heat of a tearful, shamed moment, because fear and threat shut down reflection. ^{[3] [8]}

Documentation and supervision (2). Document the specific feedback, the agreed action plan and a follow-up date. Set an explicit entrustment level for the next cannulation — direct supervision with you scrubbed in or immediately available — based on observed competence, and escalate to the supervisor of record if the difficulty persists. ^{[6] [9]}