Anaemia: diagnostic approach — OSCE

Station brief (candidate)

• Explain that the count confirms iron-deficiency anaemia by its pattern, not a mysterious or dangerous label. [1]
• Take a focused diet and blood-loss history from the role-player, including milk volume. [1]
• Outline how the mean corpuscular volume and reticulocyte count classified the anaemia, and what red flags would change the plan. [1] [4]
• Agree iron therapy, milk and diet changes, review timing, and a safety-net using teach-back. [1] [2]
• Use shared decision-making and offer an interpreter if language differs. [5]

Role-player notes

You are a worried parent who offers large volumes of cow's milk because solids are a daily battle, and you feel easily judged. If the doctor shames you, you shut down; if they explain the blood result kindly and give a practical plan, you engage. You will ask whether this is leukaemia and why they are not just sending you home with tablets. [1]

Expected candidate performance

• Names iron-deficiency anaemia in plain language and links it to milk and diet without blame. [1]
• Explains how MCV and reticulocytes classified the anaemia and what made iron deficiency the working diagnosis. [4]
• Screens red flags such as fever, bruising, bone pain, dark urine or severe lethargy that would change the plan. [1]
• Plans iron treatment at the correct dose principle, diet change, follow-up labs for response, and specific return precautions. [1] [2]
• Uses teach-back and shared decision-making, and offers an interpreter rather than relying on a child to translate. [5]

Marking anchors

| Domain | Borderline | Clear pass | [1] | |--------|------------|------------| [1] | | Explanation | Labels "low blood" only | Mechanism plus cause plus what it is not | [1] | | Reasoning | Treats every microcytosis as iron | Uses MCV and reticulocytes, keeps mimics in mind | [4] | | Plan | Iron tablets alone | Iron plus diet and milk plus response check | [1] | | Safety | Vague "come back if worried" | Specific red-flag safety-net | [2] | | Relationship | Blaming tone | Trauma-informed partnership with teach-back | [5] |

Clinical marking reflects iron-deficiency reasoning, red-flag screening, safety-netting and shared decision-making standards. [1] [2] [5]