Open disclosure and duty of candour — branching viva

Opening (candidate)

I would treat this as an open-disclosure event driven by the duty of candour. The child is now stable, so I would move to disclosure: confirm the facts and assemble the right people — a consultant leading, the nurse, a trained interpreter (not the child), and social-work support — then hold an initial conversation acknowledging what happened, giving the known facts, apologising, and describing next steps, with a follow-up planned to share the review findings and improvements. I would also ensure the distressed registrar is supported as a second victim. [1] [4]

Branch A — Definition and duty

Examiner: Define open disclosure, and distinguish it from the duty of candour. [1] [4]

Candidate: Open disclosure is the open, honest discussion with a patient and family of a patient safety incident that caused harm — the structured process. The duty of candour is the obligation to be open and honest when things go wrong; it can be a professional duty on the individual clinician (code of conduct) or a statutory duty on the organisation (e.g. CQC Regulation 20). The duty drives the process. [4] [5]

Branch B — The distressed registrar

Examiner: The registrar is tearful and unable to speak. Do they lead the meeting? [14]

Candidate: No — if they cannot lead safely, a senior colleague should lead the disclosure while the registrar receives peer support and clinical cover. The clinician involved in harm is a second victim; forcing an unsupported disclosure harms them and the family. I would arrange a debrief and protect their return to safe practice. [14]

Branch C — Language access

Examiner: The parents have limited English. The trained interpreter is an hour away. Wait, or proceed with the bilingual nurse? [5]

Candidate: I would wait for, or dial in, a trained interpreter rather than use an ad-hoc translator or the child. A disclosure of harm delivered without accurate language access is not really a disclosure. I would offer a brief, supportive holding message and confirm a time. [4] [5]

Branch D — The apology

Examiner: A colleague warns that saying sorry will admit legal liability. How do you respond? [1]

Candidate: I would offer a sincere expression of regret regardless. An apology is owed as honesty and compassion, and apology legislation in ANZ (and comparable protections elsewhere) prevents it being treated as an admission of liability. The evidence shows disclosure with apology is associated with reduced litigation, so the fear misreads the data. [1] [2]

Branch E — Failure mode

Examiner: The parents later tell you they found the decimal-point on the chart themselves. [2]

Candidate: This is the highest-risk scenario for trust, because they already suspect concealment. The only trust-repairing response is immediate, full, apologetic candour — I would not become defensive or minimise. Owning the conversation now can still repair the relationship. [2]

Close

Confirm understanding with teach-back, leave a written summary and a named contact, schedule the follow-up disclosure for the review findings and improvement plan, document the conversation, and arrange support for the second victim. [1] [10] [14]