RACP DWE Paediatrics common mistakes
RACP DWE Paediatrics · Understand the traps and how to avoid them.
Writing a management plan that jumps straight to investigations and drug doses without first stating the working diagnosis, the differential, and the severity assessment (e.g., 'mild vs moderate vs severe dehydration', 'bronchiolitis vs pneumonia vs sepsis').
Candidates treat the written paper as a recall test for facts and try to list everything they know, because under time pressure listing feels safer than committing to a synthesised problem representation; they have often practised by reading rather than by writing timed answers.
What to do instead
Before writing, spend 60-90 seconds on a one-line problem representation ('3-month-old with fever, irritability and poor feeding; consider UTI, meningitis, sepsis, bronchiolitis'). Start every answer with a short synthesis paragraph, then structure the rest as Assessment-Plan. Practise at least 10 timed written cases with a marking rubric that explicitly rewards a stated diagnosis and differential.
Describing investigations as a shopping list ('FBC, UEC, CRP, blood culture, urine MC&S, CXR') with no indication, no sequencing, and no statement of what result would change management.
Investigation lists are easy to memorise and feel comprehensive, and candidates are anxious about missing an item, so they over-include rather than justify; many have never been asked to explain the pretest probability behind a test.
What to do instead
For each test write one clause on the question it answers and the action triggered by a positive or negative result ('urine MC&S to exclude UTI as a source of fever; if positive, treat per sensitivities and consider renal ultrasound in an infant under 6 months'). Delete any test that would not change management. Rehearse this with a 'test-action' two-column template.
Giving drug therapy without weight-based dosing, a stated weight or weight estimate, route, frequency, duration, and a monitoring or safety plan (e.g., 'give ceftriaxone' with no dose).
Candidates remember drug names from guideline headlines but not the numeric detail, and fear that a wrong number loses more marks than an omitted one; under exam pressure they default to vagueness.
What to do instead
Build a personal one-page dosing card for the high-yield drugs (ceftriaxone, gentamicin, benzylpenicillin, salbutamol, prednisolone, adrenaline, ondansetron, paracetamol, ibuprofen, aciclovir) and rehearse writing doses with the calculation shown ('ceftriaxone 80 mg/kg once daily IV, max 4 g; child 12 kg = 960 mg'). Always state weight source (measured or estimated from age) and any level monitoring (e.g., gentamicin trough).
Failing to recognise and act on red-flag physiology: not escalating a child with hypotension, delayed capillary refill, reduced consciousness, or apnoea to a resuscitation-focused answer, instead continuing a routine diagnostic workup.
Written stations reward breadth, so candidates default to comprehensive clerking; they also under-recognise that paediatric hypotension is a late sign and that compensated shock is the common presentation, so they wait for a low blood pressure before escalating.
What to do instead
Learn and apply a structured primary survey (Airway, Breathing, Circulation, Disability, Exposure) to every acutely unwell child in practice, and in written answers put resuscitation first ('oxygen, IV/IO access, 10-20 mL/kg crystalloid bolus, reassess, early senior and ICU involvement'). Practise identifying compensated shock from tachycardia, cool peripheries and prolonged capillary refill with a normal blood pressure.
Not adapting assessment and management to the child's age and developmental stage: applying adult parameters, missing age-specific differentials (e.g., sepsis in the neonate, intussusception in the infant, appendicitis in the older child), or omitting feeding, growth and developmental review.
Candidates trained largely in adult medicine default to adult frameworks, and age-specific paediatric knowledge is easily memorised as isolated facts rather than integrated into a diagnostic approach; developmental and growth assessment is often treated as optional background rather than core data.
What to do instead
For every case, explicitly state the age-specific differential and the age-specific normal ranges you are using (heart rate, respiratory rate, blood pressure). Include weight, length/height, head circumference and developmental milestones in the history and plan. Build a one-page 'differential by age band' (neonate, infant, toddler, school age, adolescent) for common presentations such as fever, vomiting and limp.
Ignoring the family, social and safety context: not asking about immunisation status, household contacts, safeguarding concerns, parental mental health, housing, or access to medicines, and not planning follow-up, safety-netting or discharge criteria.
Candidates focus on the biomedical puzzle and treat psychosocial history as a separate topic; the written format gives no prompt that these are expected, and candidates often lack a routine framework for asking about them.
What to do instead
Use a fixed psychosocial screen for every case (immunisations, household contacts and illness, smoking, safeguarding, parental capacity and mental health, housing, transport, language). Always close the answer with a disposition plan: discharge criteria, safety-netting advice in plain language, who to see and when, and what to do if worse. Practise writing these in under two minutes.
Providing a single management pathway with no contingency: no 'if not improving in X hours, then...' branch, no escalation criteria, no senior or ICU review trigger, and no consideration of what to do if the diagnosis is wrong.
Candidates answer the question as asked rather than as a real clinical plan, and are used to single-answer multiple-choice thinking; contingency planning requires imagining uncertainty, which is uncomfortable under time pressure.
What to do instead
End every management answer with a short 'review and escalate' paragraph: reassess at a stated interval, define objective failure criteria (e.g., persistent tachycardia, rising oxygen requirement, drowsiness), and name the escalation (registrar, consultant, retrieval service, ICU). Use an 'if...then...' sentence structure deliberately.
Misallocating time: spending too long on the first station or on lengthy prose, leaving later stations thin, or conversely writing bullet fragments so terse that reasoning and justification are absent.
Candidates have not rehearsed under timed conditions and do not know their own writing speed; anxiety about one unfamiliar topic causes over-investment, and the belief that 'more words equals more marks' competes with the opposite habit of note-form shorthand.
What to do instead
Do at least three full-length timed mock papers with a clock, and fix a per-station time budget (allocate marks to minutes). Use a consistent answer architecture (synthesis, assessment, investigations with justification, management with doses, follow-up) so you can write quickly without omitting reasoning. Review mocks against a rubric to see whether terse or verbose answers scored better.
Misreading the question stem: answering 'how would you manage' with a differential only, missing the word 'initial', 'most important', 'contraindicated', or answering a single-part question with a general essay that never states the requested number of items.
Candidates skim stems under time pressure and pattern-match to a familiar topic, and the written format has no option list to anchor the required scope; anxiety increases the tendency to dump all knowledge rather than answer precisely.
What to do instead
Underline the task verb and any quantifier in the stem before writing, and check your answer against them at the end (e.g., 'list three' means exactly three, ranked). Practise a 15-second stem deconstruction drill on 30 past-style stems, writing only the task verb, the required number of items and the setting.
Presenting unsafe or outdated practice confidently: for example routine use of antibiotics for viral bronchiolitis, aspirin in febrile children, cough suppressants in young children, or over-restrictive fluid regimens without justification, rather than stating current evidence-based practice and its rationale.
Candidates rely on anecdotal ward experience, older textbooks, or advice from a single supervisor, and the written exam offers no immediate feedback to correct it; confidence in a familiar habit suppresses the check against current guidelines.
What to do instead
Anchor answers to current national guidelines (e.g., Australian or New Zealand paediatric and therapeutic advisory sources) and state the principle behind the choice ('no role for routine antibiotics in bronchiolitis; supportive care with oxygen and hydration'). Maintain a personal 'evidence traps' list of common myths and review it before the exam; when unsure, say what you would check and why rather than asserting.