PLAB 2 Mock Test Feedback :: Febrile Convulsions :: Paediatrics

Mock Date: 19/03/2025

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

Where You Are: FY2 in Paediatric department

Who Your Patient Is: Melanie Carl, a 30-year-old lady who has brought her 2-year-old child, Jenny Carl

Other Information: None.

What You Must Do: Please talk to the mother, take a focused history, discuss the management of the child, and address her concerns.

Special Note: BNF in the station.

My Performance:

🔍Let’s Deep Dive into your performance:

The Domain-wise evaluation shows areas where you did well and others where you have room to grow. 

• A "Yes" means you covered that point effectively

• A "Partial" indicates that you did some of it well but missed some key details. 

• A "No" means there was an important opportunity that wasn’t addressed.

Don’t worry if you see several areas marked "No" or "Partial"—this is common and simply highlights where you can focus your learning. 

By reflecting on these areas and practicing, you’ll be able to improve and feel more confident in your consultations. Remember, every bit of feedback is an opportunity to grow, and you’re on the right path by taking these steps.

Timestamps are provided to show exactly when during the consultation you covered or missed key points. Reviewing these can help you see how well you're managing your time and where you might need to be more efficient in addressing important areas.

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Confirm patient's full name and age: Jenny Carl, 2 years old	00:28, 00:32	Yes	You confirmed both the name and age early in the consultation.
Data Gathering	Incident history: Ask about events before, during, and after the fit	01:50–03:01	Partial	You asked about the fit, its duration, urination, pallor, and responsiveness. However, you didn’t ask what was happening before the fit, like if she was playing, sleeping, or eating, and you could have explored how long she was unresponsive after more thoroughly.
Data Gathering	Symptoms related to ear infection: Inquire about ear discharge, pulling at ear	01:04–01:12, 06:01	Yes	You explored pulling at ear and ear discharge clearly.
Data Gathering	Rule out any other source of infection	01:17–01:21	Yes	You asked about cough, vomiting, headache – effectively ruled out other sources.
Data Gathering	Understand family history of febrile seizures or epilepsy disorders	—	No	You didn’t ask about any family history of febrile seizures or epilepsy, which is important in risk assessment. You could’ve asked this when clarifying whether this was the first episode.
Data Gathering	Fever history: Ask about duration, any antipyretics given (e.g., paracetamol)	00:47, 07:18	Partial	You asked about fever but not about duration directly. The mother volunteered they gave paracetamol, but you didn’t ask it proactively.
Data Gathering	Developmental history: Confirm up-to-date immunizations and normal development	03:59–04:04	Partial	You confirmed immunizations, but didn’t ask about normal development milestones or concerns.
Data Gathering	Allergy history: Confirm allergy to amoxicillin	04:07–04:12	Yes	You clearly confirmed penicillin allergy.
Data Gathering	Past medical history, understand the mother's pregnancy and the child's birth history	03:48–03:56	Yes	You asked about pregnancy and birth; well done.
Management	Explain diagnosis: Febrile convulsion likely due to ear infection	05:00–06:28	Yes	You explained the fit was likely a febrile seizure and connected it to possible ear infection.
Management	Prescribe azithromycin or clarithromycin for ear infection due to amoxicillin allergy	—	No	You mentioned referring to ENT but did not prescribe an alternative antibiotic considering the allergy.
Management	Provide other means of bringing the fever down like sponging, hydration	—	No	You only suggested paracetamol, did not mention sponging or keeping hydrated.
Management	Advise on fever management: Use paracetamol and ibuprofen	07:18–07:42	Partial	You advised on paracetamol but did not mention ibuprofen as another option.
Management	Educate on febrile convulsions: Explain benign nature and management during a fit	05:55–06:45	Partial	You explained febrile seizures are benign, but did not educate on what to do during a fit like not putting anything in the mouth, placing in recovery position, etc.
Management	Referral to first fit clinic	—	No	This was not mentioned. Referral to ENT was stated, but not first fit clinic.
Management	Safety netting: Advise to return if rash, persistent crying, or increased concern	—	No	You asked to return if it happens again, but didn’t mention red flags like rash, drowsiness, irritability, etc.
Management	Follow-up: Arrange GP appointment in 3-5 days	—	No	Follow-up advice with GP was not discussed.
Management	Provide leaflet: Information on febrile convulsions and ear infections	—	No	You didn’t mention or offer a leaflet for further reading.
Interpersonal Skills	Acknowledge and validate mother's emotions and concerns	01:39, 03:28, 05:34	Yes	You acknowledged her distress at multiple points.
Interpersonal Skills	Use sensitive and empathetic language throughout the consultation	03:28–03:39	Partial	You showed some empathy but were slightly mechanical at times. Tone could have been warmer throughout, especially at key emotional points.
Interpersonal Skills	Signpost: Clearly explain each step of the consultation and management plan	03:33, 04:40	Partial	You signposted your exam plan, but the management explanation lacked structure. You could have broken it down more clearly.
Interpersonal Skills	Ensure clear and effective communication: Check understanding and address questions	07:02, 07:43	Partial	You answered questions, but didn’t actively check the mother's understanding or invite her to ask more questions at the end.
Interpersonal Skills	Reassure: Offer hope for improvement with proper adjustments	05:34, 07:48	Yes	You reassured that the child was fine and this could be managed.

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation
Diagnosis	You made the likely diagnosis but didn’t mention differential like meningitis, which was raised by the mother.	✔️
Examination
Findings
Issues
Management	Many key management components were missed.	✔️
Rapport
Listening	You missed some cues (e.g., worry about recurrence) and didn’t explore family history.	✔️
Language
Time	You spent a lot of time on history, but rushed or missed key parts of management (e.g., safety netting, follow-up).	✔️

Additional Remarks

🧠 Data Gathering: You had a structured start and elicited most key history. However, you missed exploring family history and were a bit passive in exploring duration of fever and developmental milestones. Try to be proactive and thorough. The examiner wants to see logical thinking – keep a checklist in your head and don’t leave things to assumption.

🩺 Management: This was your weakest area. You gave the likely diagnosis and reassurance, but missed practical next steps: no antibiotic prescription despite known allergy, no fever control measures beyond paracetamol, no safety netting or follow-up. Always remember: diagnosis + treatment + what to watch out for + follow-up = complete care. Structure it and say it clearly.

💬 Interpersonal Skills: You showed kindness and were polite, but a little flat in tone. Avoid sounding rehearsed — empathize like it’s real. You did some signposting but it could’ve been stronger, especially in management. Always check understanding and invite questions at the end.