Transition readiness and transfer from paediatric to adult care — branching viva

Opening (candidate)

I would frame transition as a multi-year process, not a birthday discharge. I would start now: introduce a transition policy, track and assess readiness, build self-management skills, produce a portable summary and a diabetes emergency plan, identify and introduce adult endocrinology with a warm handoff, and confirm the first adult visit happened. [1] [4]

Branch A — Definition

Examiner: What is the difference between transition and transfer? [1]

Candidate: Transition is the purposeful, planned movement from child-centred to adult-oriented care with continuous services before, during and after the move. Transfer is only the single handoff event inside that process. Conflating them is the central error. [1]

Branch B — Readiness

Examiner: The readiness score is low. Should you delay transfer until it improves? [3]

Candidate: No. The score is a developmental teaching map, not a gate. A low result identifies which skills to build and which adult supports to put in place. Withholding transfer abandons the young person at the cliff, because the move will happen regardless. [3]

Branch C — The transfer package

Examiner: What exactly should travel with her to adult care? [1]

Candidate: A portable medical summary, her medication and allergy list, a written diabetes emergency plan with sick-day and hypoglycaemia rules, outstanding surveillance such as retinal and renal screening, and key contacts with her goals. Adult care should inherit a complete picture, and she keeps a safety net. [1]

Branch D — Failure mode

Examiner: What happens if we discharge her at 18 with a letter and no adult appointment? [12]

Candidate: That is the defining unsafe act. She is at high risk of loss to follow-up, rising HbA1c, and a lapse-related presentation such as diabetic ketoacidosis. I would secure a named adult home and confirm attendance before stepping back. [12] [6]

Close

Examiner: How do you know it worked? [6]

Candidate: I confirm she attended her first adult appointment, retained a named adult endocrinology and primary home, demonstrated the self-management skills we targeted, and did not present acutely. If she misses an appointment, I treat loss to follow-up as urgent and actively re-engage her. [1] [6]