Mandatory reporting and jurisdictional child-protection frameworks — OSCE

Candidate brief

You are the paediatric registrar on the ward. A 5-month-old infant was admitted overnight with a femur fracture. The history provided by the parents does not adequately explain the injury pattern, and the child-protection team has been consulted. A mandatory report will be made to the child-protection authority. The infant's parents are now at the bedside and have asked to speak with you. [8] [13]

You have 8 minutes to explain to the parents why a report is being made, what it means, and what will happen next, while maintaining a therapeutic and non-accusatory relationship. [6]

Examiner instructions

Assess the candidate's ability to: [8]

• Explain the mandatory-reporting duty honestly and without accusation or conjecture about who caused the injury. [8]
• Frame the report as an act of care and a statutory duty, not a personal judgement of the family. [6]
• Describe what the child-protection authority will do (assess, support, investigate) and that the clinical team will continue to care for the infant. [8]
• Acknowledge the parents' likely emotional response (anger, fear, feeling accused) without becoming defensive or retracting the duty. [6]
• Avoid promising outcomes the candidate cannot guarantee (e.g. 'nothing will happen') while offering reassurance about ongoing care. [8]
• Use plain language, check understanding, and offer a follow-up conversation and written information. [8]

Actor (parent) cues

• Initial reaction: anxiety and anger — 'Are you accusing us of hurting our baby?'
• If the candidate is defensive or vague, escalate: 'So you think we did this?'
• If the candidate explains the duty calmly and without accusation, shift to worry: 'What happens now? Will they take our baby away?'
• If asked about the injury, the parent should restate the original mechanism without elaboration. [8]

Marking schema

Excellent (8–10): Explains the duty clearly, frames it as statutory and child-focused, avoids accusation, acknowledges emotion, describes the agency role and ongoing care, checks understanding, offers follow-up. [8]

Pass (5–7): Explains the duty adequately but may be slightly accusatory or vague, or miss acknowledging the emotional response. Covers the pathway and ongoing care. [6]

Fail (below 5): Accuses the family, retracts or downplays the duty, promises false outcomes, cannot describe the pathway, or becomes defensive. [6]

Key teaching points

• The threshold for reporting is a reasonable belief — the candidate should not present the report as a certainty that the parents harmed the infant. [1]
• The injury pattern (femur fracture inconsistent with the mechanism in a non-rolling infant) is a sentinel injury that warrants a skeletal survey and a report. [13]
• Honest, non-accusatory communication usually preserves the therapeutic relationship; defensiveness or vagueness destroys it. [6]
• The report is not the endpoint — ongoing clinical care, follow-up and advocacy continue after the notification. [8]