PLAB 2 Mock Test Feedback :: Night Terrors :: Paediatrics

Mock Date: 02/04/2025

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:

You are an FY2 doctor in a GP surgery. Your patient is Margo Stone, a 30-year-old mother who is concerned about her 5-year-old son, Mason, who has been waking up in the middle of the night screaming for the past 4 months. Mason's father had similar episodes in childhood. Margo is worried and wants to know if Mason is having nightmares or if there is something serious going on.

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	Patient identifiers: Confirm Margo Stone's full name and age	00:19	No	You asked for the patient's name and age but did not confirm the surname “Stone” or full name. Always confirm full name to avoid identity issues.
Data Gathering	Confirm the reason for the visit: Concerns about her son Mason's nocturnal episodes	00:35	Yes	You appropriately confirmed the reason for consultation early on. Well done.
Data Gathering	History of present illness: Frequency, timing, and nature of Mason's nocturnal episodes	01:29	Yes	You covered the timing (middle of the night), frequency (almost daily for 4 months), and nature (screaming). Great detailed exploration here.
Data Gathering	Ask if Mason remembers the episodes in the morning	03:41	Yes	You asked this directly and noted that Mason doesn’t remember. Good inclusion.
Data Gathering	Rule out external triggers: Scary movies, recent stressors or changes in Mason's routine	04:22	Partial	You explored routine changes and stressors but missed asking about media exposure or any frightening content. This would help rule out nightmares.
Data Gathering	Discuss family history of similar episodes, noting Mason's father's history		No	You did not ask about family history or if similar episodes have occurred in any relatives, including the father. A quick question like “Any family history of similar issues?” would’ve sufficed.
Data Gathering	Ask about current health: Any fever, infections, or other illnesses		No	You asked if he has medical conditions (03:08), but didn’t specifically ask about recent infections or illnesses which are important in ruling out organic causes.
Data Gathering	Vaccination: Confirm Mason is up to date with all vaccinations	03:16	Yes	You asked directly and got confirmation. Good.
Data Gathering	Take birth and early history: Pregnancy, delivery, feeding and development		No	You asked about developmental milestones (02:55), but not about birth history, delivery, or early feeding. This is essential for a full paediatric history.
Data Gathering	Differential Diagnosis: Rule out nightmares and infections	04:22	Partial	You ruled out stressors and mentioned a diagnosis of night terrors, but did not sufficiently rule out nightmares or infections like URTI, especially given the screaming.
Data Gathering	ICE (Ideas, Concerns, Expectations): Explore Margo's ideas, concerns, and expectations	03:36	Yes	You asked about her thoughts, concerns and expectations explicitly. Strong point.
Data Gathering	Effects of Symptoms: Discuss how Mason's episodes affect Margo's sleep and peace of mind	04:01	Yes	You explored how this has affected her work, and she expressed emotional distress multiple times.
Data Gathering	Examination: Conduct head-to-toe examination and assess developmental milestones	04:49	Partial	You said you'd examine Mason “head-to-toe” but did not clearly mention developmental milestone assessment though you asked about them in history. It’s better to explicitly mention both.
Data Gathering	Conduct thorough physical and developmental examination of Mason along with vitals	04:49	Partial	You mentioned vitals and head-to-toe check, but there’s no evidence you assessed developmentally or said what you were looking for. A line like "I’d like to assess his motor and speech milestones" would help.
Management	Reassurance and Education: Explain the provisional diagnosis as night terrors and the difference between nightmares and night terrors	05:27	Partial	You explained night terrors well, but missed clearly contrasting them with nightmares. This would help reduce confusion for the parent.
Management	Provide reassurance that these episodes are common and typically outgrown	07:27	Yes	You reassured that the condition would subside with time and management. Well done.
Management	Treatment Plan for Nightmares: Discuss stressors, ensure a relaxing bedtime routine, avoid scary media		No	You focused on night terrors, but missed discussing nightmare management, which should always be considered differentially.
Management	Treatment Plan for Night Terrors: Advise staying calm, avoid waking Mason, maintain a safe environment		No	You didn't advise on practical home management like keeping Mason safe, not waking him, or staying calm during episodes. These are vital.
Management	Follow-Up: Schedule a follow-up appointment in 2 months to review progress		No	You didn’t mention any follow-up plan. Always offer a timeframe for review—2 months is reasonable.
Management	Provide a leaflet with information about managing nightmares and night terrors	06:56	Yes	You mentioned giving a leaflet. Great job.
Management	Safety Netting: Advise to seek help if new symptoms develop (e.g., daytime changes, injury, breathing problems)		No	You did not mention red flags or when to return. Include signs like daytime confusion, injury during episode, etc.
Interpersonal Skills	Effective Communication: Use empathetic and clear language to explain the condition	01:00, 05:27	Partial	You were warm and clear but used some rehearsed lines. To score higher, avoid repetitive stock phrases like “we will find a solution”.
Interpersonal Skills	Validate Margo’s concerns and provide supportive advice	00:58, 04:22	Yes	You frequently acknowledged her distress. Very compassionate approach.
Interpersonal Skills	Patient-Centered Approach: Encourage Margo to share her observations and feelings	00:40, 03:41	Yes	You created a space for her to express herself, and you responded appropriately.
Interpersonal Skills	Involve Margo in the management plan and discuss any concerns she might have	07:39	Partial	You mentioned referring to seniors and support groups, but did not explore what she'd prefer in the plan or if she was happy with it.
Interpersonal Skills	Summarize and Clarify: Summarize the discussion, ensuring Margo understands the management plan		No	You didn’t summarise the discussion or check her understanding. This would’ve been a strong close.
Interpersonal Skills	Invite any further questions and provide comprehensive answers	07:42	Partial	You answered her questions when she asked, but you didn’t actively invite them or ask “any other concerns?” which is standard good practice.

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation	Disorganised structure: missed several essential data gathering items.	✔️
Diagnosis	Differential diagnosis not explored.	✔️
Examination	Developmental milestones not addressed thoroughly.	✔️
Findings
Issues	Did not explore differentials clearly or identify the main management priorities.	✔️
Management	Several core elements of management plan were missing.	✔️
Rapport
Listening
Language
Time	Missed time to deliver key elements like safety netting and follow-up.	✔️