Bilateral newborn hearing refer before rural discharge — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar. Noah is 30 hours old and looks well. Bilateral OAE is a refer. The family wants rural discharge today. Father believes the startle response proves normal hearing. You have 12 minutes with the family and 5 minutes for examiner discussion. [8]

Information available on request

• Gestation 39+1, SVD, birth weight 3.5 kg, no craniofacial anomaly. [7]
• No NICU stay, no known congenital infection yet tested. [11]
• Ear canals appear patent; infant startles to a slammed door. [7]
• Nearest diagnostic ABR is at the regional base hospital; family has one car and limited leave from work. [8]
• Mother’s preferred language is English; mobile reception at home is intermittent. [13]

Tasks

1. Explain the refer result without over-calling deafness. [8]
2. Outline the 1-3-6 pathway and the immediate next booking. [1]
3. Address the startle-response misconception. [7]
4. Design a capability-matched rural follow-up and safety-net plan. [8]

Marking anchors

Must-hit

• States refer ≠ diagnosis of deafness. [1]
• Books diagnostic audiology; does not cancel on startle. [7]
• Uses 1-3-6 language correctly. [1]
• Names owner, contacts and transport reality for rural follow-up. [8]
• Links early confirmation to language benefit if asked. [3]

Merit

• Discusses unilateral versus bilateral implications if laterality changes. [17]
• Mentions residual risk concept even after a later pass if risk factors emerge. [12]
• Uses teach-back. [8]

Fail

• Tells parents the baby is deaf on screening alone. [8]
• Cancels refer because the infant startles or feeds well. [7]
• Discharges with no booked diagnostic pathway or owner. [8]