You are an FY2 in the paediatric department
Personal Details:
Name: Baby Miller (patient), Ms Miller (mother)
Age: 6 months
Medical Record:
Past medical history: Normal birth and development.
Notes:
A 30-year-old mother has brought her 6-month-old baby to the hospital with a swollen arm, which she noticed this morning. Mother says he fell off the sofa. The mechanism of injury does not seem consistent with the fracture pattern. An X-ray has been performed.
X-ray Report: Spiral fracture of the humerus.
You have a strong suspicion of a non-accidental injury.
Task:
1. Talk to the mother and explain the X-ray finding.
2. Discuss the management plan
Opening Sentence: “Doctor, have you got the X-ray result? Is his arm broken? I don’t understand how it could have happened.”
Open History (to give freely): “I just noticed it this morning when I was dressing him. It was all swollen, and he cried when I touched it. He was on the sofa but fell off, and I picked him up when he was constantly crying.
Cues to give: “My boyfriend was up with him a bit last night because he was being fussy. Could he have rolled over on it in the cot?”
ICE (Ideas, Concerns, Expectations):
Ideas: “I have no idea how this happened.”
Concerns: “Is his arm badly broken? Will he be okay?”
(After safeguarding is mentioned) “What do you mean, social services? Are you accusing me of hurting my baby?”
Expectation: “I expect you to just fix his arm.”
How to Act: You start off as a concerned mother. When safeguarding is mentioned, you become very defensive, angry, and scared. You feel you are being accused.
More History (only if asked): Your boyfriend works in a bar and sometimes gets stressed. He drinks, and some nights he is drunk. He has never hurt you or the baby before. You are not in contact with the baby’s biological father.
Social History: Lives with boyfriend.
Questions to ask:
“What’s a spiral fracture?”
“Why do you have to call social services? I haven’t done anything wrong.”
“Are you going to take my baby away from me?”
Opening & Delivering Initial Information:
Hello, I’m Dr. [Name]. I’m one of the doctors. I can see how worried you are.
The X-ray does show a break in Ben’s arm. We are giving him painkillers, and the bone doctors will manage the fracture.
Exploring the History (Gently): To make sure we have the full picture, can you tell me again, in your own words, exactly what happened? Where were you when it happened? Who else was in the house at the time?
Raising Concerns (Directly but Empathetically): I need to be very open with you. I have some concerns. The type of break he has is called a spiral fracture. This type of fracture is unusual and doesn’t typically happen from a simple fall from a sofa. It’s usually caused by a twisting movement. We have a duty to think about other possibilities, including the possibility that the injury was not an accident.
ICE (Ideas, Concerns, Expectations): What are your thoughts on what I’ve just said? You feel like a bad mother. Why do you say that? What are you most worried about right now?
Because of what has happened, I have to follow a very clear process. My priority, which I am sure is your priority too, is your baby’s safety. I will speak to my senior, and we have to inform Children’s Social Services about our concerns. This is a standard, routine procedure in all hospitals whenever an injury like this occurs. It is not about accusing you or anyone else, but about protecting the child and finding out what has happened.
Your baby will be admitted to the children’s ward today. I will ask the orthopaedic specialist to see him, as they might need to put his arm in a cast to make it comfortable.
A social worker will also come to the ward to speak with you and your partner to try to understand the situation better.
I know this is incredibly scary and upsetting to hear, but it’s all to make sure that your baby is safe and protected from being at risk of having a similar thing in the future. We cannot let him go home until we are certain that he is safe from further harm. The social worker’s job is to support families and to make sure children are safe, not to take babies away unnecessarily.
Addressing ideas, concerns, and expectations: Be prepared for an angry, defensive reaction. Remain calm and professional. Emphasise that this is a standard procedure focused on the child’s safety, not on blame. Do not get drawn into an argument.
The management is a clear safeguarding protocol: 1. Involve a senior paediatrician. 2. Admit the child to the ward. 3. Make a formal referral to Children’s Social Services. The communication is about informing the parent of these steps, not negotiating them.
What is scenario testing? This is one of the most challenging PLAB 2 stations. It tests the candidate’s ability to handle a highly emotive and confrontational safeguarding situation. The candidate must demonstrate that they can prioritise the child’s safety above all else, follow a rigid protocol, and communicate these difficult steps to a parent in a calm, professional, and non-accusatory manner.