Problem representation OSCE — infant return visit and residual-risk counselling

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]

Actor brief (caregiver)

Your 7-week-old was sent home yesterday with a viral label. Overnight the baby is less interactive and feeds poorly. You feel dismissed earlier and are worried. You become more trusting if the candidate names your concern and explains uncertainty without false reassurance. [4]

Examiner resource

Manikin summary available on request: mild tachycardia for age, otherwise near-normal first snapshot; baby less interactive than expected when handled. [5]

Marking domains

1. Data gathering and respect (2)

Greets caregiver; asks what is different from usual; notes prior visit; avoids leading premature viral questions; treats concern as data. [4]

2. Problem representation (3)

One sentence with age, return context, tempo, physiology/interaction, caregiver concern and leading threat posture. [1] [2]

3. Differential prioritisation (3)

Threat-first list; residual must-not-miss items if viral working diagnosis used; avoids specialty-silo dump. [3] [5] [8]

4. Diagnostic pause and safety actions (2)

Names what would change their mind; seeks senior review threshold; does not discharge on snapshot mildness alone. [5] [7] [10]

5. Communication under uncertainty (3)

Most likely problem; what is still being protected against; concrete next steps and return triggers; no false certainty. [3] [4]

6. Handover (2)

Provisional label, residual risks, actions/response, next discriminating step, caregiver concern. [6]

Global fail criteria

• Reassures and discharges solely because first numbers are mild
• Ignores caregiver concern
• Hands over “stable viral, no concerns” with no residual risk
• Publicly dismisses the parent for re-attending [4] [5] [7]

Teaching points after station

• Return visits rewrite the representation
• Caregiver concern belongs in the sentence
• Mild observations do not cancel a high-risk infant script
• Residual risk is part of competence, not indecision
• Later diagnostic feedback calibrates the next case [4] [5] [9]