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PLAB 2 Mock test feedback:: Paediatrics Symptomatic Differentials: 8 Weeks Vaccination

Updated: Aug 22


Summary

This PLAB 2 station involves counselling a parent (Emma Smith) about her baby’s upcoming vaccination. The parent is concerned about possible side effects (including autism) and wants clarification about whether the vaccine is compulsory. The doctor must educate, reassure, and support informed decision-making while respecting autonomy.



Key Points


Core System: Immunisation & Public Health

  • Vaccine discussed: Six-in-one vaccine (protects against diphtheria, hepatitis B, Hib, polio, tetanus, pertussis)

  • Parental concerns: Autism, fever, long-term safety, whether vaccination is compulsory

  • Legal status: Vaccinations are not compulsory by law in the UK but strongly recommended as per NHS immunisation schedule

  • Public health importance: Herd immunity protects vulnerable groups who cannot be vaccinated



Important Considerations

  • Always answer direct questions first (e.g., “Is it compulsory?” → “No, it’s not legally compulsory, but strongly recommended…”)

  • Avoid excessive talking; allow pauses so parents can express concerns

  • Address misinformation (no scientific link between MMR and autism)

  • Tailor explanation depending on parent’s knowledge of how vaccines work

  • Document concerns raised and information provided



Diagnostic Approach (Data Gathering in Station)

  • Confirm baby’s age and upcoming vaccination schedule (8, 12, 16 weeks, plus booster later)

  • Ask about:

    • Recent fever, illness, hospital admission → may defer vaccination

    • Feeding, drinking, growth, and development

    • Allergies, medications, past medical problems

    • Family history of adverse vaccine reactions or immunodeficiency

  • Explore ICE (Ideas, Concerns, Expectations):

    • What has mother heard about vaccines?

    • Specific concerns (side effects, autism)

    • What outcome does she expect from the consultation?



Management


Explanation & Education

  • Vaccine benefits: Strong protection early in life, prevents severe illness

  • Herd immunity: Protects wider community, especially those medically unable to receive vaccines

  • Address autism concern: No scientific evidence supports a link

  • Side effects: Mild fever, irritability, redness/swelling at injection site – usually self-limiting


Practical Details

  • Location: Given in GP surgery or health centre by trained staff

  • Contraindications: Previous anaphylaxis to vaccine, encephalopathy within 7 days of prior dose


Supportive Measures

  • Offer leaflets/pamphlets with NHS immunisation information

  • Safety netting: Advise parents to return if baby develops persistent fever >7 days, seizures, inconsolable crying, or severe reaction

  • Follow-up: Reassure they can return before or after vaccination with any further questions



Communication Skills

  • Use empathetic phrases (“I understand your concern; it’s normal to feel worried”)

  • Avoid jargon; use plain, parent-friendly language

  • Keep answers concise → first answer the question, then explain further

  • Encourage parent’s involvement in decision-making

  • Check understanding and summarise key points at the end



Ethical Considerations

  • Respect parental autonomy: cannot force vaccination, but must advocate strongly for it

  • Uphold GMC principles: patient partnership, clear communication, avoiding misinformation

  • Document discussion clearly in medical notes



Additional Resources

  • NHS Immunisation Schedule: NHS Vaccinations

  • GMC Good Medical Practice – communication and patient partnership standards

  • PLAB Examiner Tips – avoid rehearsed phrases, keep consultation structured

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