Paediatric telehealth OSCE — video triage and rural consult · Paeds Cases

Prompt

Station A is a febrile toddler video visit with incomplete ear views. Station B is a rural ED requesting paediatric teleconsult support for a pale infant.

Station objectives

Perform pre-visit safety checks including location. [1]
Coach a caregiver-assisted remote exam and state limits. [1]
Demonstrate stewardship when images are inadequate. [1]
Activate EMS language for remote deterioration. [1]
Close with teach-back and concrete safety-netting. [7] [11] [15]

Station A — Febrile toddler video (8 minutes)

Setup: Actor caregiver with toddler prop or description; poor ear photo provided. [8]

Tasks:

Confirm identity, address, contacts, privacy. [1]
Remote first impression and guided RR/WOB/colour/rash check. [1]
Decline automatic antibiotics on unreadable otoscopy; plan in-person review if needed. [1]
Teach-back and red-flag safety-net. [3] [8] [10]

Critical fails: No location; child used as interpreter; antibiotics without adequate assessment; no safety-net; claiming full exam not performed. [3] [7] [9]

Station B — Rural tele-emergency (7 minutes)

Setup: ED doctor actor; infant described as pale with increased work of breathing. [15]

Tasks:

Prefer/request video; if audio only, state limits and push visual link. [1]
Structure advice: ABC priorities, what you need to see, transfer thinking, closed-loop handover. [1]
If deterioration, EMS/local activation language with address confirmation. [5] [6] [13]

Critical fails: Treating telephone as full visual assessment; no handover structure; ending call during instability. [5] [13]

Marking domains

Safety and location (must pass) [1]
Remote exam technique and honesty about limits [1]
Stewardship and medical-home reasoning [1]
Emergency communication [1]
Family-centred explanation and teach-back [1]
Equity/interpreter awareness when cued [1] [2] [9]

Debrief pearls

Location is a vital sign. Incomplete remote data is a disposition, not a guess. Video beats telephone for sick children when available. DTC antibiotic pressure is an exam trap. [3] [13] [15]

References

[1]Curfman A Pediatric Telehealth in the COVID-19 Pandemic Era and Beyond Pediatrics, 2021.PMID 34215677
[2]Curfman AL Telehealth: Improving Access to and Quality of Pediatric Health Care Pediatrics, 2021.PMID 34462339
[3]Ray KN Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits Pediatrics, 2019.PMID 30962253
[4]Wittman SR Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors JAMA Netw Open, 2024.PMID 38483387
[5]Marcin JP Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial JAMA Netw Open, 2023.PMID 36780158
[6]Marcin JP Telemedicine vs Telephone Consultations and Medication Prescribing Errors Among Referring Physicians: A Cluster Randomized Crossover Trial JAMA Netw Open, 2024.PMID 38421649
[7]Elliott T Conducting a Professional Telemedicine Visit Using High-Quality Webside Manner Curr Allergy Asthma Rep, 2022.PMID 35072928
[8]Erkkola-Anttinen N Smartphone Otoscopy Performed by Parents Telemed J E Health, 2019.PMID 30040525
[9]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review JBI Evid Synth, 2020.PMID 32813387
[10]Samuels-Kalow M Like a dialogue: Teach-back in the emergency department Patient Educ Couns, 2016.PMID 26597382
[11]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis Br J Gen Pract, 2025.PMID 39117428
[12]Katz AL Informed Consent in Decision-Making in Pediatric Practice Pediatrics, 2016.PMID 27456510
[13]Haynes SC Video vs Telephone Consultations for Pediatric Quality of Care in Emergency Departments Pediatrics, 2026.PMID 42409386
[14]Foster C Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics Pediatrics, 2022.PMID 35102417
[15]Schinasi DA Telehealth in pediatric emergency medicine Curr Probl Pediatr Adolesc Health Care, 2021.PMID 33551336

Station A — Febrile toddler video (8 minutes)

Setup: Actor caregiver with toddler prop or description; poor ear photo provided. [8]

Tasks:

Confirm identity, address, contacts, privacy. [1]

Remote first impression and guided RR/WOB/colour/rash check. [1]

Decline automatic antibiotics on unreadable otoscopy; plan in-person review if needed. [1]

Teach-back and red-flag safety-net. [3] [8] [10]

Critical fails: No location; child used as interpreter; antibiotics without adequate assessment; no safety-net; claiming full exam not performed. [3] [7] [9]

Station B — Rural tele-emergency (7 minutes)

Setup: ED doctor actor; infant described as pale with increased work of breathing. [15]

Tasks:

Prefer/request video; if audio only, state limits and push visual link. [1]

Structure advice: ABC priorities, what you need to see, transfer thinking, closed-loop handover. [1]

If deterioration, EMS/local activation language with address confirmation. [5] [6] [13]

Critical fails: Treating telephone as full visual assessment; no handover structure; ending call during instability. [5] [13]

Debrief pearls

Location is a vital sign. Incomplete remote data is a disposition, not a guess. Video beats telephone for sick children when available. DTC antibiotic pressure is an exam trap. [3] [13] [15]

References

[1]Curfman A Pediatric Telehealth in the COVID-19 Pandemic Era and Beyond Pediatrics, 2021.PMID 34215677
[2]Curfman AL Telehealth: Improving Access to and Quality of Pediatric Health Care Pediatrics, 2021.PMID 34462339
[3]Ray KN Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits Pediatrics, 2019.PMID 30962253
[4]Wittman SR Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors JAMA Netw Open, 2024.PMID 38483387
[5]Marcin JP Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial JAMA Netw Open, 2023.PMID 36780158
[6]Marcin JP Telemedicine vs Telephone Consultations and Medication Prescribing Errors Among Referring Physicians: A Cluster Randomized Crossover Trial JAMA Netw Open, 2024.PMID 38421649
[7]Elliott T Conducting a Professional Telemedicine Visit Using High-Quality Webside Manner Curr Allergy Asthma Rep, 2022.PMID 35072928
[8]Erkkola-Anttinen N Smartphone Otoscopy Performed by Parents Telemed J E Health, 2019.PMID 30040525
[9]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review JBI Evid Synth, 2020.PMID 32813387
[10]Samuels-Kalow M Like a dialogue: Teach-back in the emergency department Patient Educ Couns, 2016.PMID 26597382
[11]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis Br J Gen Pract, 2025.PMID 39117428
[12]Katz AL Informed Consent in Decision-Making in Pediatric Practice Pediatrics, 2016.PMID 27456510
[13]Haynes SC Video vs Telephone Consultations for Pediatric Quality of Care in Emergency Departments Pediatrics, 2026.PMID 42409386
[14]Foster C Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics Pediatrics, 2022.PMID 35102417
[15]Schinasi DA Telehealth in pediatric emergency medicine Curr Probl Pediatr Adolesc Health Care, 2021.PMID 33551336