Counsel parents given a new diagnosis of transposition — OSCE

Candidate brief

You have eight minutes to counsel the parents of a two-day-old infant with a new diagnosis of transposition of the great arteries, confirmed on echocardiogram, with the baby stable on a prostaglandin infusion and an arterial switch planned within the week. Use a structured, honest, empathic approach that names the problem in plain language and builds a shared plan. [1] [2]

Key teaching and communication objectives

Acknowledge and validate the parents' fear before delivering information, name the baby by name, and allow silence. Explain in plain language that the two main blood vessels leaving the heart have swapped places, so the blood that should go to the lungs goes back to the body instead, which is why the baby went blue. Reassure them that the problem is mechanical and well understood, that the ductus — a small vessel present at birth — is being kept open with a medicine called prostaglandin to buy time, and that an operation exists that physically swaps the vessels back to where they belong. [1]

Address the surgery directly and without euphemism. Explain that the operation is called an arterial switch, that it is performed in the first weeks of life, that it restores a normal circulation so that the left side of the heart pumps to the body in the usual way, and that the surgeon will move the coronary arteries — the heart's own blood supply — with great care. Frame the operation as a repair that aims for a normal or near-normal life, not as a palliation, and be honest that it is major surgery with real but now small risks. [4]

Address the prognosis honestly and with hope. Share that survival after the arterial switch is now over ninety per cent, that most children grow up to go to school, play sport, and live independently, and that the baby will be followed by a cardiac team for life — not because they are fragile, but because the team watches for problems that are usually silent and treatable. Acknowledge that there may be some differences in attention or learning for some children, and that the team will monitor development and support it early. [12] [4]

Close with a shared plan and a clear next step: the timing of the surgery, the name of the surgeon and coordinator, what to expect in the days before, where the parents can stay, and a connection to a support organisation for families affected by congenital heart disease. Invite the parents to return with any question, however small, and name the person they should call. [1]