Documentation OSCE — capturing a perishable finding to court standard

Station objectives

1. Capture an injury to court standard using the three-shot rule with a scale. [3]
2. Label and store images only in the secure clinical record with chain-of-custody governance. [1] [9]
3. Distinguish observed fact from interpreted opinion in the written record. [10] [6]
4. Communicate with the family about why photographs are taken and how they are stored, while completing the safeguarding pathway. [8]

Candidate brief

You are the paediatric doctor in an acute assessment area. You have 12 minutes for Station A and 12 minutes for Station B. Examiners score capture quality, integrity governance, and the fact-versus-opinion distinction more than encyclopaedic lists. [3] [10]

Station A — Non-mobile infant, patterned arm mark

Setup: Caregiver and 4-month-old infant, seen for coryza. A 2 cm ovoid bruise with a fingertip pattern is found on the outer arm. The infant is not yet rolling independently. The department is busy. [3]

Expected actions:

• Examine the child fully undressed and run a top-to-toe injury inventory before reaching for the camera. [3]
• Photograph the three-shot set (orientation, mid-range, close-up with scale) before any procedure, scale in plane, camera perpendicular. [3]
• Body-map the injury with site, colour, shape, and two-dimensional measurement; record developmental mobility. [8]
• Label each image with identity, date, time, and site; transfer to the secure clinical record only. [1] [9]
• Refer to the child-protection team and make the mandatory report; document the verbatim mechanism and test it against developmental plausibility. [6]

Station B — Deficient record and court statement

Setup: Six weeks later you review the file. One close-up has no scale; another was taken on a personal phone and later deleted. You are asked to prepare a court statement. [1] [10]

Expected actions:

• State that the scale-less close-up is dimensionless and the deleted phone image is irrecoverable; both reflect improvisation rather than protocol. [3] [1]
• Structure the statement: facts as observed, mechanism verbatim as the caregiver's account, opinion labelled with reasoning, uncertainty disclosed. [10] [6]
• Acknowledge the deficient images honestly and stay within competence; do not overstate certainty. [10]
• Recommend embedding the standardised protocol and remote peer review to prevent recurrence. [2]

Marking anchors

Clear pass: three-shot set with scale before any procedure, secure storage with no personal device, body map with measurements, clean fact-versus-opinion distinction, honest disclosure of deficient images. [3] [10] Borderline: correct facts but photographs after dressing, or uses a personal phone without recognising the integrity problem, or states opinion as fact. [1] [9] Fail: omits the scale and orientation shot, stores on a personal phone, or conflates opinion with fact and overstates certainty in the statement. [3] [10]

Debrief pearls

• Photograph before you dress, before you clean, and before any procedure. [3]
• A close-up without a scale is dimensionless. [3]
• Never store clinical images on a personal phone; use the secure record. [1] [9]
• Fact is fact, opinion is opinion; you are a witness, not the investigator. [10] [6]