The communication domain in the ST1 paediatrics interview is a scenario, not a question. An assessor plays a parent, you talk to them, and they stay in role for the whole conversation, which means they push back, ask awkward questions and show emotion. Candidates who prepare by describing what they would say are surprised by how different it is to say it to someone who is not helping. This guide covers the scenarios that recur and how to handle each.
What is being scored
Listening, empathy, plain language, structure, adaptation to the person, and whether the conversation ends with the parent knowing what happens next. Clinical accuracy matters but it is secondary; a candidate who explains bronchiolitis perfectly to a parent who is still angry about the wait has not scored well.
The structure that scores
- Open by listening. Ask what they understand and what they are worried about before you say anything. Most scenarios turn on something the parent has not yet said.
- Acknowledge the feeling before the facts. "You have been waiting four hours with a sick child and that is exhausting" before any explanation of why.
- Give information in small pieces, in plain words, with a pause after each. Check understanding: "Does that make sense so far?"
- Involve the parent in the plan. What would help them? What do they need to be able to go home or to stay?
- Close with the next step, who will do it, when, and a named person to ask for.
The scenarios
The heart murmur. The parent is frightened by the word. Find out what they have heard, explain that most murmurs in babies are innocent and that the echo is to make sure, say what the echo involves and when, and give them something to do while they wait. Do not promise it is nothing; say it is probably nothing and you are checking.
The angry parent after four hours. Acknowledge first and genuinely. Then explain, briefly and without defending the department, what has happened and what will happen now. Offer what you can: a time, a plan, an update. The scoring is on whether you de escalate, not on whether you win the argument.
The father who refuses examination. Find out why before you persuade. Often there is a previous bad experience, a cultural concern, or a fear about what you will find. Address that, explain what the examination is for and what happens if it is not done, offer alternatives (the mother present, a different room, a chaperone), and if he still refuses, involve the senior and consider the child's safety.
Bronchiolitis and antibiotics. The parent wants antibiotics. Acknowledge that they want the best for their child, explain in plain words that this is a virus and antibiotics do not help it and can do harm, say what does help and what to watch for, and give clear return advice. Check they feel able to manage.
The leukaemia conversation. This is breaking bad news and SPIKES applies: the setting, what they already know, a warning shot, the information in small pieces, silence while they absorb it, and the plan with the oncology team's name and when they will arrive. Do not fill the silence.
The pregnant teenager. She is your patient. Explore her situation and her reasons, assess whether she understands the decisions in front of her, explain confidentiality and its limits, encourage her to involve a trusted adult, and involve safeguarding if there is any concern about exploitation or her safety. Do not promise absolute secrecy.
Handling the pushback
The assessor will test you. "Are you saying I am a bad parent?" "I want to see a consultant." "I read on the internet that..." Stay calm, acknowledge, answer honestly, and keep the conversation on the child. If the parent asks for a senior, agree readily; it is the right answer and it scores.
Practising
Write the six scenarios on cards and have someone play the parent, stay in role, and push back. Record yourself once. Most candidates find they explain too early and listen too little. Fix that and the station becomes one of the easier ones to score well in, because the structure is learnable and the assessors are scoring the structure.