|Theme:||Explanation / Negotiation|
|Suitable for:||F1/F2; Junior paediatric trainee (ST1-2); GP trainee|
|Clinical scenario:||Three week old baby in A&E who has a fever of 38.9, poor feeding and irritability.|
|Information for candidate:||You are asked to go and explain to this baby’s parent that they need a septic screen and what this will involve.|
|Information for actor:||You are the parent of Alice, a three week old baby who has been having temperatures at home up to 39 degrees.
(If the candidate asks for any further history – the baby was born at 38 weeks, and has been feeding poorly for the last 24 hours. There were no problems in pregnancy, and the baby was only kept in hospital for a short period for phototherapy for jaundice. There is a two year old sibling at home with other parent. This child is well.)
When you are told that the baby needs a lumbar puncture, you are upset and refuse to have this done. You had an epidural in labour which did not work and caused you a lot of pain.
|Information for scenario lead:||Clarify that the candidate knows what a septic screen involves before they start the scenario.
Terminate the scenario when an agreement has been reached between the doctor and parent, or when they ask for a senior to come and talk with the parent.
|Possible points for discussion in debrief:||How to explain a medical procedure – use of jargon or medical terminology
Communicating with a parent who is distressed or anxious
Body language, choice of words
Explaining your clinical reasoning to a parent
Negotiation of difficult conversation and escalation to senior
Clinical discussion – what does a septic screen involve, what will happen to the baby next
Clinical discussion – what risks do you need to warn parents about
The clinical details of this simulation scenario are not based on any one particular case. Similarity to any real life clinical scenario or child is purely coincidental.