Psych CASC / OSCE · Forensic psychiatry — FII / medical child abuse
Explain FII concern and safeguarding plan to a paediatric consultant colleague — CASC communication station
MRCPsych/FRANZCP-style CASC: interprofessional communication about suspected fabricated or induced illness, balancing false-positive and false-negative risk, child safety first.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar speaking with a paediatric consultant colleague (examiner role-player) about a 2-year-old with recurrent unexplained apnoeas clustering with maternal unsupervised access.[1][4]
Candidate instructions. Explain concern using behavioural language. Separate child-harm framework from FDIA diagnosis. Outline immediate safety, multi-source review, and multi-agency notification on reasonable suspicion. Acknowledge false-accusation risk and keep organic differential open. Resist demands for absolute certainty or premature discharge. Do not invent statute section numbers. Check understanding and agree next steps.[1][2][4]
Candidate scenario
Colleague says: “She’s a loving mother and a healthcare assistant — if we even mention child protection she’ll never trust us again. Either give me a definitive psychiatric diagnosis of Munchausen by proxy today or we discharge. I’m not calling anyone without video proof. Quote me the exact Act section if you think we must report.” Your brief: multiple normal observed EEGs; events only with mother; sibling infant death unascertained; mother demands further invasive tests and becomes hostile to negative findings; incomplete multi-hospital records.[1][3][5]
Marking domains
- Child safety first; report on reasonable suspicion, not FDIA certainty
- Clear dual frame: FII/MCA vs FDIA caregiver diagnosis
- Behavioural red flags without pathognomonic overclaim
- Multi-source chronology and parallel organic differential
- Covert video only if lawfully authorised — not a precondition for all action
- Professional resistance to collusion/discharge under uncertainty
- No invented statute section numbers; name local pathway principles
- Collaborative tone; shared plan; checks understanding [1][2][4][6]
Reveal assessor key
Open. Acknowledge the difficulty and the importance of not falsely accusing parents. State you share the goal of child safety and fair process.[4]
Dual frame. We do not need a completed FDIA diagnosis today. We are concerned about possible fabricated or induced illness / medical child abuse — harm to the child via the medical pathway. FDIA is a later caregiver psychiatric formulation if supported.[2][3]
Why concern. Apnoeas only with unsupervised maternal access, repeatedly normal observed investigations, multi-hospital pattern, sibling death history, invasive-test pressure, and hostility to negative findings are red flags that warrant multi-source review and safeguarding process — not proof alone.[1][5]
Plan. Keep child under supervised observation; compile all records; senior multi-disciplinary discussion; notify local child-protection pathway under mandatory-reporting principles without inventing section numbers; assess siblings; avoid premature public confrontation; continue appropriate organic workup.[1][4]
Video / certainty. Absolute certainty is not the threshold for protective action. Covert video, if ever used, requires lawful multi-agency authorisation — it is not a personal phone project and not always required before reporting.[1][3]
Close. Summarise agreed steps, documentation, who leads communication with the family, and review time. Invite questions; restate partnership and child-first principle.[4][6]
References
- [1]Bass C, Glaser D Early recognition and management of fabricated or induced illness in children Lancet, 2014.PMID 24612863
- [2]Flaherty EG, Macmillan HL, Committee on Child Abuse and Neglect Caregiver-fabricated illness in a child: a manifestation of child maltreatment Pediatrics, 2013.PMID 23979088
- [3]Stirling J, American Academy of Pediatrics Committee on Child Abuse and Neglect Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting Pediatrics, 2007.PMID 17473106
- [4]Tully J, Hopkins O, Smith A, et al. Fabricated or induced illness in children: A guide for Australian health-care practitioners J Paediatr Child Health, 2021.PMID 34310788
- [5]Wear KR, Li S Guideline review: RCPCH perplexing presentations, fabricated or induced illness in children guidance 2021 Arch Dis Child Educ Pract Ed, 2022.PMID 34728544
- [6]Sanders MJ, Bursch B Forensic assessment of illness falsification, Munchausen by proxy, and factitious disorder, NOS Child Maltreat, 2002.PMID 12020067