MRCGP SCA Consultation Skills Course
Station 2 · Feverish child
Telephone consultation (audio only) · Infants, children and young people · Urgent and unscheduled care · Circuit 1 · 09:40–11:00 · 13-minute station
A mother rings about her feverish two-year-old; she has no car, a baby asleep, and a husband away.
Candidate brief
Read this as you would in the exam. One to two minutes' reading, then ten minutes. You may ask the patient for examination findings; there is no reference material.
| Caller | Chloe Barnes, 27, mother of Oscar Barnes, 2 years 3 months. Telephone — duty-doctor list: "child with fever, day 2" |
| Patient PMH | Term birth. Immunisations up to date. One previous bronchiolitis admission at 8 months. No regular medication. Allergies: none |
| Recent entries | Nil in the last 12 months. Household: mother, father (HGV driver, away three nights a week), Oscar, and a 6-week-old sister |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (607 words)
Persona and manner
- Young, tired, trying to sound calm; a baby can be heard occasionally. She is sensible but frightened by the last admission and does not want to 'waste anyone's time'.
- Answers accurately if asked precise questions; over-reassures herself ('he's probably fine') between them.
Opening line — say this verbatim
- "Hi, it's about Oscar, my two-year-old — he's had a temperature since yesterday afternoon and he's really not himself today. I've given him Calpol. I just wanted to check what I should be doing."
Volunteer freely if given the space
- Temperature 39.2 on the ear thermometer an hour ago, before Calpol; it was 38.8 last night.
- Off his food; drinking 'a bit' — half his usual; two wet nappies today by lunchtime (usually five or six).
- 'Clingy and whingy', wanted to sleep on her all morning, not interested in the television, which is 'not like him'.
Only if asked
- Cough since yesterday, not barking; breathing 'a bit fast' when he sleeps; no noise on breathing; no sucking-in under the ribs that she has noticed — if asked to look, 'maybe a little bit at the bottom of his chest'.
- Respiratory rate if asked to count for 30 seconds: 24 in 30 seconds (48 per minute).
- Colour: 'pale, but he's always pale'; lips normal; no mottling; hands and feet cool.
- No rash. No stiff neck; he moved his head to look at the baby. No vomiting; one loose stool. No pulling at ears. No pain on passing urine that she can tell.
- He woke and smiled once at his sister this afternoon; 'it took a bit to get him to smile'.
- Calpol at 08:00 and 14:00; no ibuprofen — she was told once not to; he has no asthma.
- The baby, Freya, is six weeks old and well; feeding; Chloe is breastfeeding.
- No car; her husband has the car and is in Scotland until Thursday; her mum is in Kent; a neighbour 'might' help; a taxi would be £15 she does not have until Friday. Nearest walk-in is a 40-minute bus ride with two children.
- The previous bronchiolitis admission was 'terrifying'; she does not want to go to hospital 'unless I really have to'.
Ideas, concerns and expectations
- Idea: 'a virus; it's going round nursery'.
- Concern: meningitis ('you hear things') and the last admission; also 'being told I'm overreacting'.
- Expectation: advice; she has not considered that he might need to be seen today.
Cues to deliver, timed
- Minute 1: 'I don't want to waste your time.'
- Minute 3: baby cries in the background; she apologises — 'sorry, I've got the baby too'.
- Minute 6: if the doctor suggests coming in: 'I haven't got the car… I'll see if someone can bring us' — vague, because she has no one.
How to respond to the doctor's plan
- If the doctor works through the traffic-light features, recognises amber features (reduced wet nappies, raised respiratory rate, reduced activity, possible recession) and decides Oscar needs same-day face-to-face assessment, explains why calmly, then solves the transport (a face-to-face appointment today with a taxi arranged or funded by the practice, or a home visit, or 999/ambulance if any red feature) and gives clear red-flag advice (999 if breathing hard, blue, floppy, non-blanching rash, cannot rouse): she is relieved to be told what to do and asks 'what do I do about the baby?'.
- If the doctor gives telephone advice only ('fluids and Calpol, ring back if worse'): accept it quietly — 'OK, thank you' — the examiner will not.
- If the doctor says 'take him to A&E now' without acknowledging the transport problem: 'I can't… I've no car and I've got the baby' — then silence.
Do not
- Report red features; there are none (he can be roused, no rash, no grunting, no cyanosis).
- Offer the transport problem before minute 6 unless asked how she would get there.
Mark scheme
Delegates: open after your consultation. Examiner-observers: open during it.
Generic mark scheme — identical at every station
Domain grades
| Domain | CF (0) | F (1) | P (2) | CP (3) | Points |
|---|---|---|---|---|---|
| Data Gathering and Diagnosis | ☐ | ☐ | ☐ | ☐ | /3 |
| Clinical Management and Medical Complexity (×1.5) | ☐ | ☐ | ☐ | ☐ | /4.5 |
| Relating to Others | ☐ | ☐ | ☐ | ☐ | /3 |
| Total | /10.5 |
Global rating: ☐ Fail ☐ Bare Fail ☐ Bare Pass ☐ Pass (CF Clear Fail · F Fail · P Pass · CP Clear Pass)
Feedback statement(s) — tick the one (at most two) you would attach
| Domain 1 | Domain 2 | Domain 3 |
|---|---|---|
| ☐ 1.1 Insufficient data | ☐ 2.1 Referral | ☐ 3.1 Cues / listening / formulaic |
| ☐ 1.2 Notes not used | ☐ 2.2 Prescribing | ☐ 3.2 Agenda / beliefs |
| ☐ 1.3 Psychosocial | ☐ 2.3 Investigations | ☐ 3.3 Circumstances / culture |
| ☐ 1.4 Unsystematic | ☐ 2.4 Prevention | ☐ 3.4 Explanations |
| ☐ 1.5 Prioritisation | ☐ 2.5 Risk management | ☐ 3.5 Judgemental |
| ☐ 1.6 Implications of findings | ☐ 2.6 Co-morbidity | ☐ 3.6 Respect / sensitivity |
| ☐ 1.7 Differentials | ☐ 2.7 Uncertainty | ☐ 3.7 Ownership |
| ☐ 1.8 Diagnosis / decision | ☐ 2.8 Follow-up / safety-net | ☐ 3.8 Teamwork |
| ☐ 2.9 Time management | ☐ 3.9 Safeguarding |
Timing checkpoints (Observer)
| Checkpoint (10-minute frame) | Done | Minute |
|---|---|---|
| Patient allowed to open without interruption (≈1 min) | ☐ | |
| ICE and psychosocial context elicited by 3:30 | ☐ | |
| Red flags covered; examination findings requested by 5:00 | ☐ | |
| Working diagnosis verbalised; gear change by 5:00–5:30 | ☐ | |
| Options shared; patient's preference used | ☐ | |
| Specific safety-net and follow-up by 9:30 | ☐ | |
| Understanding checked; finished inside 10:00 | ☐ |
Key points for this station — customised standard
Key points for this station
| Domain | Pass requires | Clear Pass adds | Fail if |
|---|---|---|---|
| Data Gathering & Diagnosis |
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| Clinical Management & Medical Complexity |
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| Relating to Others |
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Global rating guide: Pass = amber features recognised by telephone, same-day assessment secured with a workable route, red flags given. Telephone-only advice fails Clinical Management.
Teaching points
- NICE NG143 fever in under 5s: amber features (pallor reported by parent, not responding normally, reduced activity, RR >40 in over-12-months, reduced urine output, poor feeding) require face-to-face assessment; red features require emergency care.
- By telephone, make the parent your examiner: count breaths for 30 seconds, look at the chest, describe the colour, press a glass on any rash.
- The barrier to attendance is a clinical risk. Ask 'how would you get here?' before you say 'come in'.
Guidelines for this station
Your reflection
Record your grades, the statement attached, what you will keep and change, and your own reflection. Your entry is emailed to you as a record of this station; this page stays live so you can revisit the full case during revision.
Write my reflection for Station 2
Revision link for this case: mdacumen.com/sca-station2-feverish-child
Editorial stamp · MRCGP SCA Consultation Skills Course · Station pages v1.0 · 11 September 2026 · Prof Rajesh Varma, Course Director · MD Acumen. Formative training material; not a prediction of exam performance. Not for onward distribution.