Explaining procedural sedation, fasting and risk to a family — communication OSCE

Station brief (8–10 minutes)

You have two linked tasks. First, explain to the parents in plain language what ketamine sedation involves, address their worry about the recent food, describe the monitoring, and prepare them for recovery. Second, outline to the examiner how the evidence on fasting and on monitoring shaped your reassurance. Use honest, specific language, acknowledge the real but rare risks, and confirm understanding with teach-back. Do not invent jurisdiction-specific statutory thresholds. [1]

Tasks for the candidate

1. Explain what ketamine does and why it suits a painful reduction, in language a worried parent can follow. [1]
2. Address the fasting worry honestly, framing it with the evidence that fasting does not reduce adverse events in emergency sedation. [2]
3. Describe the monitoring and the dedicated observer so the family understands how the airway is protected. [3]
4. Prepare the family for recovery, including the common emergence phenomena and the discharge plan, and offer a safety-net. [1]

Expected performance

Must hit. Names the medicine and what it does without jargon; explains that ketamine gives both sedation and pain relief while keeping breathing and protective reflexes working; states honestly that serious problems such as laryngospasm are rare and that a trained team and equipment are ready; addresses the food question with the evidence; describes the dedicated sedationist and capnography; prepares the family for recovery agitation and vomiting; offers a clear safety-net and point of contact. [1] [3]

Merit. Acknowledges the parents' fear without dismissing it; uses teach-back to confirm understanding; distinguishes the rare serious risks from the common expected effects; explains why fasting is not being imposed without sounding dismissive of their concern; explicitly names the independent sedationist; and invites questions throughout. [2] [1]

Fail. Overstates the safety to avoid the parents' worry; gives no information about monitoring or recovery; cannot explain why the recent food is not a reason to delay; promises the sedation is risk-free; offers no safety-net or point of contact; or uses language the family cannot follow. [1]

Sample candidate structure

"Thank you both for sitting with me. Your child has a break in the forearm that we need to straighten, and to do that safely and kindly we will give a medicine called ketamine that makes children sleep through the procedure and also takes the pain away, while keeping their breathing and their own airway reflexes working. That last part matters: it is not the same as a full general anaesthetic, and it is widely used in children for exactly this kind of injury." [1]

"I know you are worried because he ate an hour ago and you have heard children must fast before an anaesthetic. For the kind of sedation we use in the emergency department, the research actually shows that how long a child has fasted does not change the chance of a problem, so we are not going to make him wait in pain; instead we will have suction and the right positioning ready, and a team watching him closely. We would only delay if the procedure could safely wait, and a broken arm that needs straightening now cannot." [2]

"To keep him safe, one doctor whose only job is to watch him will stay with him the whole time, separate from the doctor fixing the arm. We will use monitors that watch his heart, his oxygen, and his breathing continuously, including one called capnography that watches his breathing even more closely than the oxygen monitor can, so we would notice any slowing of his breathing very early. We also have the equipment and medicines ready to support his breathing if we ever needed to, though that is uncommon." [3]

"After the procedure he will be sleepy for about half an hour to an hour, and some children are a bit upset or confused or dreamy as they wake, or feel sick, and all of that settles. We will watch him until he is back to his usual self and can drink safely, and then we will talk again about going home. I will write down what to watch for and give you a number to call. What questions can I answer before we start?" [1]