Teaching, supervision and feedback in paediatrics — formative SAQs

SAQ 1 — Structured feedback after a procedural error (10 marks)

A senior registrar has twice attempted cannulation on a distressed toddler and failed. The parent is upset. You, the consultant, succeeded on the next attempt. The registrar avoids you for the rest of the shift. [1] [3]

Questions

1. Outline a structured feedback conversation using the ask-tell-ask model for this encounter. (5 marks) [7] [10]
2. How does the educational alliance change what you say and when you say it? (3 marks) [3] [8]
3. What would you document, and what supervision arrangement would you agree for the next procedural attempt? (2 marks) [6] [9]

Model answer

Ask-tell-ask structure (5). First create a private, calm setting once the shift pressure eases and emotions settle. Ask: invite the registrar's own self-assessment ("how did those attempts go for you, and what was going through your mind?"). Tell: share specific, behaviour-focused observations (site choice, restraint, the child's escalation, when to stop and call for help) rather than global judgement, balanced with what they did well (consent, positioning). Ask: coach them to name the next step — simulation practice, watching you cannulate, a defined technique — so they own the action plan. [7] [10]

Role of the educational alliance (3). The alliance — trust and partnership — determines whether the message lands or triggers defensiveness. Name it explicitly: "I'm investing in this because you're going to be excellent." Timing matters: deliver feedback close to the event but not in the heat of a tearful, shamed moment, because fear and threat shut down reflection. [3] [8]

Documentation and supervision (2). Document the specific feedback, the agreed action plan and a follow-up date. Set an explicit entrustment level for the next cannulation — direct supervision with you scrubbed in or immediately available — based on observed competence, and escalate to the supervisor of record if the difficulty persists. [6] [9]

SAQ 2 — The deteriorating registrar: struggling learner or learner in difficulty? (10 marks)

A previously competent registrar has become withdrawn over six weeks, is making uncharacteristic medication errors, and confides they are sleeping badly. The team has labelled them "underperforming." [8] [6]

Questions

1. Distinguish a struggling learner from a learner in difficulty, and justify which is more likely here. (4 marks) [6]
2. Outline your immediate assessment and the support pathway. (3 marks) [8] [6]
3. How do you reconcile patient safety with supporting this trainee? (3 marks) [6] [9]

Model answer

Struggling learner versus learner in difficulty (4). A struggling learner has a competence gap needing remediation; a learner in difficulty has performance dragged down by health, wellbeing, fatigue or personal circumstance. They look alike, and confusing them is harmful. The subacute change in a previously competent registrar, plus withdrawal and poor sleep, points to a learner in difficulty rather than an isolated competence failure, though the two can coexist and must be reassessed once support begins. [6]

Assessment and support (3). Take a kind, private history screening for health, wellbeing, fatigue and personal crisis; arrange review through practitioner-health services; and adjust workload and supervision while support is put in place. Avoid informal labels and keep confidentiality appropriate to risk. [8] [6]

Safety and support together (3). Supporting the trainee and protecting patients are not opposed: increase supervision and the entrustment safety margin now, so the registrar can continue to learn safely rather than be exposed beyond their current capacity. If errors persist or are unsafe, move formally into the training-body and remediation pathway with the supervisor of record, while keeping the therapeutic relationship intact. [6] [9]