Multidisciplinary child-protection case conference — viva

Opening question

You are the paediatric registrar. A 2-year-old has been admitted with an inflicted burn and healing fractures found on skeletal survey. The child-protection authority has convened an initial multidisciplinary case conference and invited you. Walk me through your understanding of the conference and your preparation. [5] [11]

Branch 1 — Purpose and types

Examiner: What is a multidisciplinary child-protection case conference, and how does it differ from other meetings in the child-protection pathway? [1]

Candidate should state: The case conference is a formal, structured meeting convened by the statutory child-protection authority that brings together all agencies involved with a child and family for information sharing, risk assessment, decision-making about whether the child needs a protection plan, and coordinated care planning. It has statutory weight. It differs from a strategy discussion, which is an urgent, time-limited meeting (typically police and social care) that decides whether to investigate. It differs from a clinical MDT, which has no statutory authority. It differs from a family group conference, which is a family-led decision-making model (the statutory model in New Zealand). The initial conference is the first full forum; the review conference reconvenes at intervals to reassess. [1]

Branch 2 — The written report and calibration

Examiner: How would you prepare your written report, and how do you calibrate your opinion? [5] [11]

Candidate should state: The report is the primary vehicle for my evidence. I structure it systematically: history from each informant noting discrepancies, examination with body map and photograph references, investigation results (skeletal survey, neuroimaging, bleeding screen), differential diagnosis stating what has been excluded, and opinion. I separate fact from opinion throughout. I calibrate certainty using standard language: healing posterior rib fractures are highly specific for inflicted injury and I state that with confidence. The burn pattern is consistent with inflicted injury. I do not attribute perpetrator identity — that is for the investigation and the court. I submit by the deadline and confirm it has been circulated. Lo and colleagues showed medical documentation quality drives conference outcomes, so the report is not a formality. [5] [11]

Branch 3 — Information sharing and decision-making biases

Examiner: What are the principles of information sharing at the conference, and what biases might affect the group's decision? [1] [3]

Candidate should state: Information sharing for child protection overrides common-law confidentiality. I share what is relevant and necessary for the protective purpose, document what I shared, and do not need family consent for statutory sharing — though I am transparent about the process. Regarding biases, Jent and colleagues showed that group decisions about substantiation are influenced by anchoring on early information, confirmation bias, and professional differences in risk tolerance. Cowley and colleagues found the quality of communication and the clarity of the medical evidence shape the risk assessment. If the group appears to be misinterpreting the evidence, I state my concern clearly and on the record, present the significance of the findings, and ask the group to consider the full picture. Professional silence in the face of misinterpretation fails the child. [1] [2] [3]

Branch 4 — Plan implementation and review

Examiner: The conference decides the child needs a protection plan. What makes a plan effective, and what is your role after the conference? [5]

Candidate should state: An effective plan identifies specific risks, names interventions, assigns each action to a named professional with a timeline, and sets a review date. A plan without named leads or timelines will not be implemented. My role after the conference is to implement the health-specific actions assigned to me — follow-up medical review, developmental assessment, therapy referrals — document them, and report on progress at the review conference. I communicate the plan to the clinical team providing ongoing care, because a plan that lives only in the conference minutes is not implemented. At the review conference I bring outcome data, not restatements of the original concern. [5]

Closing synthesis

Examiner: Summarise the paediatrician's defensible algorithm for the case conference. [1]

Candidate should state: Before the conference, I review the complete medical record, prepare a factual written report separating observation from opinion, calibrate my certainty honestly, and clarify my role and the conference format. During the conference, I present medical evidence in plain language, distinguish fact from opinion, answer questions from all attendees honestly, say 'I don't know' when I do not, contribute to the risk assessment and plan, and challenge misinterpretation on the record. After the conference, I record the outcomes and my commitments in the medical record, implement the health actions, communicate the plan to the clinical team, and prepare outcome data for the review conference. The conference is a statutory forum — I bring evidence, not certainty, and I never agree to actions I cannot deliver. [1] [5]