Infections in immunocompromised children — OSCE

Station brief (candidate)

• Explain what neutropenia means in plain language a parent can understand and act on.
• State clearly when the parent must bring the child to hospital and why the threshold is any fever, not a high fever.
• Outline what will happen when they arrive: cultures, empiric antibiotic within the hour, admission.
• Agree a written fever action plan and confirm understanding with teach-back.
• Avoid reassuring the parent that a low-grade fever can wait, or that the child's appearance is a reliable guide. [1] [2]

Role-player notes

You are the parent of a 6-year-old who has just started maintenance chemotherapy for leukaemia. You are anxious but cooperative. You have heard the word "neutropenia" but do not understand it. You believe a low-grade fever can wait until morning and that the emergency department is only for high fevers. You become anxious and frustrated if the doctor uses jargon without explaining it, or if they dismiss your worry about bringing the child in "for nothing". You respond well when the doctor explains the reasoning, gives you a clear written plan, and uses teach-back to confirm you understand. [2]

Expected candidate performance

1. Opening and plain-language explanation: "The chemotherapy lowers the white blood cells that fight infection — that is called neutropenia. While your child's counts are low, even a small fever can be a sign of a serious infection that we must treat straight away." [1]
2. Threshold and why: "Bring your child in for any temperature of 38 degrees or above — not just high fevers. How well your child looks is not a reliable guide during neutropenia, because the very cells that normally make a child look obviously sick are the ones that are missing." [2]
3. What happens on arrival: "We will take blood samples — including from the central line — give an antibiotic through the drip within the hour, and keep your child in for observation. We do not wait for test results before starting treatment." [1]
4. Written fever action plan: Agree and hand over a written plan: take the temperature if the child feels hot or unwell; present immediately for any fever of 38 °C or above, any rash, any breathing difficulty, or any parental concern; tell the triage nurse the child is on chemotherapy with a central line. [1]
5. Teach-back: "Tell me in your own words when you would bring your child in, and what you would say at triage." Confirm understanding and correct gaps. [2]
6. Prophylaxis and follow-up: Confirm the child is on the recommended prophylaxis (for example, co-trimoxazole for Pneumocystis) and arrange the oncology follow-up contact. [3]

Marking domains

• Accurate plain-language explanation of neutropenia that a parent can act on.
• Correct and safe threshold — any fever, not just high fever — with a clear reason.
• Accurate description of the hospital pathway (cultures, empiric therapy within the hour, admission).
• A specific, written fever action plan with teach-back confirmation.
• Respectful communication that validates parental concern and avoids false reassurance. [1] [2]

Common fails

• Telling the parent that a low-grade fever can wait until morning.
• Using the word "neutropenia" without explaining it.
• Failing to state that appearance is not a reliable guide during neutropenia.
• No written fever action plan, or no teach-back to confirm understanding.
• Reassuring the parent that the central line and prophylaxis make fever unlikely, rather than planning for it. [1] [2]