Teaching, supervision and feedback in paediatrics — branching viva

Stem

You are the paediatric consultant responsible for teaching, supervision and feedback across a ward, clinic and simulation suite. The examiner will challenge the theory and the limits of each. [2] [5]

Branch 1 — Definitions

Examiner: Define feedback in one sentence and distinguish it from evaluation and assessment. [1]

Strong answer: Feedback is specific information about a learner's observed performance, intended to guide future improvement. Evaluation is a judgement about the person; assessment is a measurement of competency. Feedback is formative and developmental, while evaluation is often summative and judgemental. [1] [2]

Examiner: Why does the same feedback land for one learner and bounce off another? [3]

Strong answer: The educational alliance — the trust and partnership between teacher and learner — is the integrating mechanism. Specificity, timeliness and psychological safety drive acceptance, and emotions mediate uptake: fear shuts down reflection, while a felt sense of safety opens it. [3] [7]

Branch 2 — Structuring a feedback conversation

Examiner: Walk me through the ask-tell-ask model for a registrar who mishandled a fluid bolus. [6]

Strong answer: Ask the registrar for their own self-assessment first, tell them your specific behaviour-focused observations balanced with what they did well, then ask them to define the next step so they own the action plan. Name the alliance before delivering the message. [6] [9]

Examiner: The team uses the feedback sandwich. What is your view? [6]

Strong answer: The sandwich often buries the developmental message and can erode trust when the praise feels insincere. Prefer structured models that name behaviour directly within a respectful alliance. [6] [1]

Branch 3 — Simulation and serious events

Examiner: After a deterioration simulation, how do you debrief? [4]

Strong answer: Use debriefing with good judgment. Open with the rules of psychological safety, then use advocacy-inquiry pairs: state a concrete observation and a hypothesis about the frame behind it, and invite the learner's view with a genuine question. The debrief is where most of the learning lives. [4]

Branch 4 — Supervision and entrustment

Examiner: How do you decide how closely to supervise a procedure? [8]

Strong answer: Entrustment is a judgement about how much supervision keeps the patient safe, based on directly observed competence for that specific task. Move along the continuum from observe-only, through direct and indirect supervision, up to minimal supervision and independent practice, and make the level explicit so neither of you is guessing. [8] [5]

Examiner: A registrar is about to give a ten-fold opioid overdose on the ward round. [5]

Strong answer: Stop the error and correct it immediately — safety first. Give a brief direct correction now and arrange fuller, alliance-based feedback once the moment has passed. Escalate to the supervisor of record and training body if unsafe practice is repeated. [5]

Branch 5 — The learner who is deteriorating

Examiner: A previously competent registrar has become withdrawn and is making errors over six weeks. What is your first move? [5]

Strong answer: Distinguish a struggling learner — a competence gap needing remediation — from a learner in difficulty, whose performance is dragged down by health, wellbeing, fatigue or circumstance. The subacute change in a previously competent registrar points to a learner in difficulty, so screen for wellbeing and personal crisis and arrange practitioner-health support before assuming incompetence. [5] [7]

Examiner: They keep making errors. How do you balance support and safety? [8]

Strong answer: Increase supervision and narrow the entrustment margin now so the registrar learns within a safe zone, rather than being exposed beyond capacity. If errors persist or are unsafe, move formally into the remediation pathway with the supervisor of record while keeping the relationship intact. [8] [5]

Examiner extras

• Feedback is about performance, evaluation about the person — name the difference. [1]
• R2C2 unfolds as relationship, reaction, content, coaching. [9]
• Direct observation is the most underused assessment tool; you cannot feed back on what you never watched. [5]
• Workplace-based assessment targets the "does" layer of Miller's pyramid. [8]