Higher paediatric training interviews are scenario driven, and the communication scenario means talking to a parent played by an assessor rather than describing what you would say. Candidates who prepare only the clinical content are surprised by how much of the mark sits in that conversation. This guide covers the scenarios that recur and how to approach the parent conversation.
The format
Stations with two assessors each, covering clinical reasoning, communication, professionalism and commitment. The clinical scenarios are pitched at a paediatric registrar leading the acute unit or the neonatal unit. The communication scenario is usually with a parent, sometimes with a teenager, and the assessor stays in role.
The clinical scenarios
The acute paediatric presentations that recur:
- The six week old with a fever, feeding poorly, who becomes mottled and lethargic.
- The four year old with a fever, a non blanching rash and a prolonged capillary refill.
- The two year old who has been fitting for ten minutes on arrival.
- The twelve year old with type 1 diabetes, vomiting, with a glucose of 30.
- The eight month old wheezy and feeding poorly with a respiratory rate of 70.
- The newborn who is not breathing at delivery.
- The ten year old with headache, vomiting and drowsiness.
- The child who develops anaphylaxis on the ward.
Answer as the registrar: the structured assessment, the immediate treatment with the paediatric specifics (weight based doses, the cerebral oedema risk in DKA, the fluid calculations), the escalation, the involvement of the consultant and the retrieval service if needed, and the conversation with the parents. Say what you would do afterwards: the debrief, the incident report if one is needed, the documentation.
The safeguarding scenarios
- A toddler with bruises of different ages and an account that does not fit.
- Parents who refuse a blood transfusion for their child on religious grounds.
- A fifteen year old who wants contraception without her parents knowing.
- A parent who wants to take their child home against advice.
These are scored on structure and safety: the child's welfare is paramount, you gather information without accusing, you involve the senior and the safeguarding team early, you document carefully, and you know the legal frameworks that apply, including Gillick competence and the route to court for a refused transfusion. Say what you would actually do, including the conversation with the parents, which is often the follow up.
Talking to the parent
When the assessor plays the parent, treat it as a real consultation. The scenarios that recur:
- The mother angry that her child has waited four hours.
- Telling a parent their baby has a heart murmur and needs an echo.
- Explaining why a child with bronchiolitis does not need antibiotics.
- The father who refuses to let you examine his child.
- Telling a parent that a blood test suggests leukaemia and the oncology team are coming.
- The teenager who asks you not to tell her parents she is pregnant.
Use SPIKES where there is bad news, and in every case start by listening. Acknowledge the feeling before the facts. Use plain words, check understanding, and agree the next step and a named contact. Assessors score adaptation: the angry parent needs acknowledgement and a plan; the frightened parent needs calm and information in small pieces; the parent refusing examination needs to be understood before being persuaded.
Commitment and professionalism
Expect why paediatrics with evidence, what you will find hardest, how you will sustain a career with its out of hours load, and an audit or QI project in child health. Have a one minute answer for each with a specific in it.
Practise the parent conversations aloud with someone who stays in role and pushes back, because that is the condition in the room.