Teaching, supervision and feedback OSCE — procedural error and the deteriorating registrar

Station objectives

1. Run a structured feedback conversation using ask-tell-ask within an explicit educational alliance. [6] [9]
2. Give specific, behaviour-focused feedback paired with a co-created action plan. [1] [2]
3. Set a defensible entrustment and supervision level for a procedural task. [8] [5]
4. Distinguish a learner in difficulty from a struggling learner and arrange safe, supportive supervision. [5] [7]

Candidate brief

You are the paediatric consultant. You have 12 minutes for Station A and 12 minutes for Station B. Examiners score process, structure and synthesis over encyclopaedic recall. [6] [5]

Station A — Structured feedback after a procedural error

Setup: A registrar twice attempted cannulation on a distressed toddler and failed; you succeeded. The parent is upset and the registrar is avoiding you. [3]

Expected actions:

• Choose a private, calm setting once emotion has settled, and name the alliance before the message. [3] [7]
• Ask for the registrar's self-assessment of the attempts. [6]
• Share specific, behaviour-focused observations balanced with what they did well. [1]
• Co-create a single action plan the registrar owns — simulation, observation, a defined technique. [9]
• Agree an explicit entrustment level for the next attempt with direct supervision available. [8]
• Document the feedback, the plan and a follow-up date. [5]

Station B — The deteriorating registrar

Setup: A previously competent registrar has become withdrawn over six weeks and is making uncharacteristic errors; the team has labelled them "underperforming." [7]

Expected actions:

• Distinguish a learner in difficulty from a struggling learner and justify the more likely diagnosis from the subacute change. [5]
• Screen kindly and privately for health, wellbeing, fatigue and personal crisis. [7]
• Arrange practitioner-health support and adjust workload while maintaining appropriate confidentiality. [5]
• Narrow the entrustment margin and increase supervision now to keep patients safe and let the registrar learn. [8]
• Name the pathway — supervisor of record, training body, remediation — should errors persist or become unsafe. [5]

Marking anchors

Clear pass: structured feedback with self-assessment, specific behaviours and a co-created plan; explicit alliance; defensible entrustment; correct learner-in-difficulty framing with safe supervision. [6] [8] Borderline: correct facts but no values or action plan, or a single-option "just do better" message; entrustment left vague. [1] Fail: judgemental framing of the person; ignoring the alliance; signing entrustment without observation; labelling without screening for difficulty; failing to keep the patient safe. [5] [3]

Debrief pearls

• Feedback is about performance, evaluation about the person — never confuse them. [1]
• Name the alliance before delivering a difficult message; safety first, then teach. [3] [5]
• A learner in difficulty and a struggling learner look alike — screen before you judge. [7]