You are an FY2 in a GP surgery
Personal Details:
Name: Leo (patient), Mrs Smith (mother)
Age: 3 years
Medical Record:
Past medical history: Diagnosed with Autism Spectrum Disorder.
Notes:
A 30-year-old mother attends to discuss her 3-year-old son, Leo, who has autism. She is concerned about his development.
He is having support from the autism team under the community paediatrician. He is also under the speech and language team.
Task:
Talk to the mother and explore her concerns about her son.
Opening Sentence: “Doctor, I wanted to talk about my son, Leo. I’m so worried about him. He’s not talking, and he just seems to be in his own little world.”
Open History (to give freely): “He was diagnosed with autism a few months ago. He can only say a few words, and he doesn’t play with other children. He just lines up his toys over and over again. I’ve been reading things online, and I’m so confused.”
Cues to give: “He had his first MMR jab when he was one. I’ve read that it can cause autism.”
ICE (Ideas, Concerns, Expectations):
Ideas: “I think the MMR vaccine might have caused his autism.”
Concerns: “Is it because of the MMR? He is due for his second dose soon, and I don’t want to give it to him. Will he need another dose of MMR?”
Expectation: “I want to know if the vaccine caused this and if I should give him the next one.”
How to Act: You are distressed, guilty, and confused. You love your son but are overwhelmed by the diagnosis and the conflicting information you have read online.
More History (only if asked): Leo’s developmental concerns were present before his first MMR vaccine, but you feel they became more obvious afterwards. You are scared of making things worse.
He is having support from the autism team under the community paediatrician. He is also under the speech and language team.
Social History: You are a single mother.
Questions to ask:
“But are you sure there’s no link? I’ve read so many stories from other parents.”
“What happens if he doesn’t get the second dose?”
Opening & Acknowledging Emotion: “Mrs Green, thank you for calling. I can hear how upset and angry you are. This must be an incredibly difficult time for you. I want to listen to your concerns.
Exploring Her Beliefs (Active Listening): You feel that the first MMR vaccine caused Sam’s autism. Can you tell me why you think that? What changes did you see in him?
You mentioned you’ve read about it. What have you read? You said you feel guilty. Why do you feel guilty?
ICE (Ideas, Concerns, Expectations): What is your biggest fear about him having a second dose? Apart from discussing that, is there anything else you are expecting from me today?
Mrs Smith, thank you for coming in to talk about this. It is completely understandable that you are looking for answers and are worried about what is best for Leo. It’s a very difficult and emotional time for you.
Addressing and answering the patient’s ICE:
You’ve read things online linking the MMR vaccine to autism, and you’re worried that it caused Leo’s condition. This is a concern that many parents have, largely due to a single piece of research that was published over 20 years ago. I need to be very clear with you: that research was completely fraudulent, and the paper was retracted. Since then, dozens of huge, international studies involving millions of children have been carried out, and they have all shown, without any doubt, that there is no link between the MMR vaccine and autism.”
Answer her questions:
You asked if he needs the second dose. Yes, it is incredibly important that he does. The first dose gives about 90% protection against measles, mumps, and rubella. The second dose, the booster, is needed to bring that protection up to over 99%. Measles, in particular, is not a mild childhood illness; it can be very serious and can cause pneumonia, brain damage, and even death. For a childlike Leo, it is even more important that he is protected from these preventable diseases.
I know there are many stories online, and it can be very convincing and frightening. But as medical professionals, we have to rely on robust scientific evidence. The evidence is overwhelming that the vaccine is safe and does not cause autism. I can give you some leaflets from the NHS and the National Autistic Society that explain this very clearly. We are here to support you and Leo, and the most important thing we can do for his physical health is to ensure he is fully vaccinated.
Addressing ideas, concerns, and expectations: Directly, firmly, and unequivocally debunk the link between MMR and autism. Explain the history of the fraudulent research and the overwhelming evidence for safety.
Strongly recommend that the child receive his second dose of MMR. Explain the rationale for the booster dose and the dangers of the diseases it prevents, especially measles. Provide reliable sources of information (NHS, National Autistic Society) to counter online misinformation.
What is scenario testing? This is a challenging communication and health promotion station. It tests the candidate’s ability to handle vaccine hesitancy rooted in the MMR/autism myth. The candidate must be empathetic to the mother’s distress but completely unambiguous in their scientific and professional advice. The key is to be both supportive and authoritative.