Paediatrics: Specialty Training Interview Questions Australia

Why paediatrics, and why this network?

Evidence: the paediatric and neonatal terms, the sick children, the audit, the course, the experience with children outside medicine. Then the network: its hospitals, rural sites, teaching and reputation, in terms that show homework.

What are the qualities of a good paediatric trainee, and which do you have?

The qualities: safe with the sick child, patient with families, communicates with children and parents, works with nurses, advocates, studies. Say which you can evidence and which you are still building.

What do you know about RACP paediatric basic training, its rural requirements and its examinations?

The length, the written and clinical examinations and when they fall, the rural and community requirements, the supervision. Two accurate sentences, then what will be hardest.

What experience have you had with children and families that shows you are suited to this?

Specific experiences: a child you calmed, a parent you reassured, a role with children outside medicine. Say what each taught you about working with families.

What will you find hardest about paediatrics?

Honest: the sick child who deteriorates fast, the distress of families, child protection work, the out of hours load. Name one and say how you would manage it.

A mother is angry that her child has waited four hours in the emergency department. Speak to her.

Acknowledge first and genuinely. Then explain briefly what has happened and what will happen now, without defending the department. Offer what you can: a time, a plan, an update. De escalation is the mark.

You need to tell parents that their baby has a serious congenital condition. Begin that conversation.

SPIKES: the setting, what they understand, a warning shot, the information in plain words and small pieces, silence, and the plan with the specialist team's name and when they will see the baby. Do not fill the silence.

Explain to a parent why their child with bronchiolitis does not need antibiotics.

Acknowledge that they want the best for their child, explain plainly that this is a virus and antibiotics do not help and can harm, say what does help and what to watch for, and give clear return advice. Check they feel able to manage.

A father refuses to let you examine his child and wants to leave. What do you say?

Find out why before you persuade. Address it, explain what the examination is for and what happens if it is not done, offer alternatives, and if he still refuses, involve the senior and consider the child's safety.

A toddler has bruises of different ages and the parents' account does not fit. What do you do?

The child first. A full history from each parent, a full examination with a body map, no confrontation. The senior and the child protection team before the family leaves, the investigations, and honest communication: the injuries need to be looked into. Know your state's mandatory reporting law. Document everything.

Parents refuse a blood transfusion for their child on religious grounds. What do you do?

The child's interests first. Explore the refusal, explain the risks, offer alternatives, involve the consultant and the hospital's legal team early, and know that where the transfusion is life saving the court can authorise it and in an emergency the doctors act. Respect the parents throughout.

How do you provide culturally safe care to an Aboriginal child and family, and who can help you?

Define it as the family's experience, then your actions: the Aboriginal liaison officer early, the family's role in decisions, the meaning of the illness in the community, flexibility about care and discharge, interpreters, and the humility to ask. Say who can help: the liaison officer, the community health service.

Parents want to take their child home against advice. What do you do?

Assess whether the parents can consent for the child, find out why, address what you can, explain the risks, involve the senior, and if the child is at risk and they still insist, know that the child protection team and the state's authority can act. Most resolve with listening and a senior conversation; say that first.

A six week old is brought in with a fever of 38.5 and poor feeding. Talk us through your assessment and management.

• Follow-up: The infant becomes mottled and lethargic. What now, and who do you call?

Under three months, fever is sepsis until proven otherwise: the full septic screen including lumbar puncture, intravenous antibiotics now at the weight based dose, fluids by weight, the consultant called. When mottled and lethargic, a fluid bolus, reassessment, and retrieval if not in a tertiary centre. Say you would not wait for results.

A four year old has a fever, a non blanching rash and a capillary refill of four seconds. What do you do?

Meningococcal sepsis: antibiotics immediately, fluid boluses by weight with reassessment after each, the consultant and retrieval, the public health notification. Say the dose and the volume per kilogram.

A two year old has been fitting for ten minutes when they arrive. What do you do?

ABCDE, oxygen, the glucose, then the status pathway: a benzodiazepine, repeated once, then the second line agent, with the consultant called and anaesthetics or retrieval involved if it continues. Know the pathway and the doses by weight. Say what you would tell the parents.

A twelve year old with type 1 diabetes presents with vomiting and a glucose of 30. Walk us through your management and its risks in children.

Cautious fluids, insulin after the fluids rather than with them, slow correction, potassium replacement, and the risk of cerebral oedema with its warning signs and treatment. Use the paediatric DKA guideline and involve the consultant and the paediatric intensive care service early.

An eight month old is wheezy, feeding poorly and has a respiratory rate of 70. What do you do?

Bronchiolitis: supportive care, oxygen if hypoxic, feeding support, minimal handling, no antibiotics or bronchodilators in most cases. Know the escalation signs and the role of high flow and intensive care. Then the conversation with the parents.

A three day old baby is jaundiced and sleepy. What is your approach?

The bilirubin against the hour specific chart, the risk factors, the feeding assessment, the possibility of sepsis or haemolysis, phototherapy or exchange transfusion by the threshold, the consultant. Sleepy is a warning sign.

A five year old has a limp and a low grade fever. What are you worried about?

Septic arthritis until proven otherwise: the criteria, the bloods, the imaging, urgent orthopaedic involvement, and the differential including transient synovitis and the serious diagnoses that must not be missed.

A child develops anaphylaxis on the ward. What do you do?

Intramuscular adrenaline at the weight based dose immediately, repeated if needed, then oxygen, fluids and the rest. Stop the trigger, record the allergy, tell the parents. Say the dose.

What are the main challenges facing child health services in Australia, including for Aboriginal and rural children?

Child health inequalities for Aboriginal and rural children, child protection caseloads, children's mental health presentations, workforce, the winter surges. Say what a registrar can do about one.

How does child protection work in this state when a concern is raised?

The mandatory report to the state's child protection authority, the hospital's child protection team, the assessment, the investigation by the authority, and the court if needed. Know your state's law: who must report, what, to whom, and the protection for reporters.