Pediatric Vaccine Hesitancy Counseling
6m 51s encounter
This is a real, unedited encounter from the platform — the same read-only feedback page a learner sees after a session.
The scenario
Your role
You are a pediatrics resident conducting a routine 2-month well-child visit.
Your patient, Ava Mitchell, is a healthy full-term infant due for her first routine vaccine series today (DTaP, IPV, Hib, PCV20, Rotavirus, and Hepatitis B). Her growth and development are normal. Her mother, Mrs. Lauren Mitchell, a first-time parent, has read online posts suggesting that 2 months is too young for vaccines and that giving several at once may overwhelm an infant's immune system. She is anxious and protective and is considering delaying or spacing the vaccines, but she is not anti-vaccine and remains open to guidance. This visit is your opportunity to address her concerns, correct misinformation, and facilitate an evidence-based, trust-centered shared decision.
You are speaking one-on-one with Mrs. Lauren Mitchell, a thirty-one-year-old first-time mother who is tired, mildly anxious, and holding her infant daughter close — cautious and uncertain, but persuadable if her concerns are heard.
Objectives
- Build trust with a first-time parent using a non-judgmental approach
- Address vaccine misinformation with evidence-based, accessible language
- Facilitate shared decision-making
- Apply motivational interviewing principles to reduce resistance
Listen to the recording
Hear the full 6m 51s encounter
▶Transcript25
Doctor, she's so little… is it really safe for her to get all of these shots today?
Hi, Lauren. I am Dr. Rissman. I am the pediatrics resident taking care of Ava today. Um, and I hear you have questions, and I wanna see, um, what I can help most with today.
Hi, Dr. Rissman… thank you. I guess my biggest worry is just, is two months really old enough for all of these vaccines? She's so tiny, and I've been reading a lot online, and I just… I want to make sure I'm doing the right thing for her.
Yeah. Of course, I hear the worry, um, in your voice, and I also hear how important it is to protect Ava.
Thank you… that really does mean a lot. I think part of what's scaring me is that it's not just one shot, it's several at once. Can her little body really handle all of that at the same time?
Yeah, take me through, like, what you're reading about, what you're worried about, and how you feel I can help most.
Well… a lot of what I've seen in parenting groups talks about "overloading" the immune system when babies get multiple vaccines at once. And honestly, one of my aunts told me I should wait, or space them out. I guess I just want to understand… why so many at once, and is there real harm in waiting a little?
Yeah, these are really important questions, and it's also really hard when we have access to so many things, and you don't know exactly what's real, what's not real. Um, and so is it okay if I take you a little bit through where these recommendations come from?
Yes… please. I'd really like to understand where it all comes from.
Okay, perfect. So, um, what I can share with you is that the AAP, or American Academy of Pediatrics, recommends these exact same vaccines for all kids at two months, four months, and six months. And it's based on studies and research and, um, and really, and evidence that suggests that these things protect kids from harm rather than causing harm. I just shared a lot, so I wanna pause and see, um, what questions you might have based on what I shared.
Okay… so it's a national recommendation, not just our clinic. That helps. But I guess… what about the immune system part? Like, is there actual evidence that giving several at once doesn't overwhelm her? That's the piece that scares me the most.
Yeah, so great questions again. S- these are the recommendations from big organizations, from a national standard, and these are the vaccines that they recommend at this month, and at this month specifically, um, to help protect her from any of these things, uh, that could potentially cause harm if she got it without the vaccine. Does that make sense?
I think so… so the timing itself is intentional, not just convenience. But I'm still a little stuck on the immune system question — every day she's exposed to so much already, right? Does her body actually handle the vaccines okay alongside all of that?
Absolutely. So, there are risks of getting vaccines, and the risks are really short-term risks, so things like fever, um, or rash, or irritability. Um, but in terms of long-term risks for the immune system, the only thing that it does is actually protects your immune system from these infections.
Okay… so the main things to watch for are fever or fussiness, but no long-term harm. That actually does make me feel better. What should I do if she does get a fever afterward — is that something I should be really worried about?
Great question. So, she could get a fever afterwards, and because she's only two months old, we can't give her ibuprofen, also called Motrin. But we could give her Tylenol or acetaminophen. Those are the same words interchangeably. Um, and so, what we can do is I can write at the end of this, um, call, uh, the exact amount that we can give Ava to protect her from the fevers.
Okay, that would be really helpful, thank you. So Tylenol is okay, just not the ibuprofen yet because she's so young. Um… one more thing I keep coming back to — would it really be so bad to just wait until four months, or space them out a bit? Or is there a real downside to that?
So that's also a great question. Um, and I wanna share with you that my job is not to convince you one way or another, but just to show you the evidence. And so I personally don't know the evidence that supports waiting four months. Can you share with me where you heard, um, we should be waiting for four months?
Yeah… honestly it was mostly my aunt, and then some posts in a mom's group I'm in. People saying their babies seemed too little, or that spacing felt safer. There wasn't really a study or anything, just… other parents sharing what they did.
Yeah, so other parents sharing those things, that's really powerful. Um, and I'm sure that is exactly how they feel. And so, um, I think it, it's... As you figure out what's best and safest for you and for Ava, um, it's really important for you to think through what you're hearing from friends and family, and, and also recognizing that there is a large body of evidence that supports, um, all these vaccines given at this specific visit.
That's a really fair way to put it… I appreciate you not pushing me one way or the other. I think hearing that the timing is backed by real research, and that the risks are mostly short-term things I can manage… it does help me feel more okay about today.
Okay. That, that's beautiful. Um, and I just, I wanna take a second, um, and really thank you for sharing your worries and your hopes with me today.
Thank you for actually listening, and not making me feel silly for asking. I think… I'd like to go ahead with the vaccines today. I feel like I understand it now in a way I didn't before.
Okay. Let's go ahead and do it. Thank you so much for your time.
Thank you, Dr. Rissman. I really appreciate you taking the time with me today.
Feedback
How to read this feedback
Every score is written as value / max, so you can see both the points earned and the points available. A spoken simulation can’t surface everything a real visit would, so when something couldn’t be judged fairly, the feedback labels it instead of holding it against you. Here’s what each label means.
(simulation limitation)The voice/text modality physically can't reveal it
e.g. eye contact, body language, facial affect, physical exam, EHR documentation
(no opportunity)The scenario never created the occasion
e.g. conversation ended before this step; situation never arose
(not applicable)Out of scope for this case
e.g. a domain that doesn't apply here
“Not assessable” never lowers your score. It just means the format didn’t give you a fair chance to show that skill, so it sits to the side rather than counting against you. That’s different from “Not demonstrated,” where the moment was there and the skill didn’t come through. Only the second one reflects on how the encounter went.
For ACGME milestones, some scenarios can only assess a competency up to a certain level — the higher levels turn on behaviors a single spoken encounter can’t surface. When a scenario’s ceiling is below Level 4, that milestone is still shown for its formative value but is “Not in overall grade” — it doesn’t count toward the overall grade, so a case that can’t fully exercise a competency never reads as a shortfall.
Overall impression
- Strengths — Outstanding relational and empathic skill: the learner validated emotion repeatedly, respected the parent's autonomy ("my job is not to convince you one way or another"), normalized her concerns without judgment, and built enough trust that the parent moved from hesitancy to confident consent. Clear introduction and good jargon-free chunking with pauses to invite questions.
- Priority gaps — The parent's central, repeated question — whether multiple vaccines overwhelm the immune system — was never directly answered; the learner fell back on "national recommendations" framing twice instead. The closing also omitted a question-check, anticipatory guidance on post-vaccine warning signs, and follow-up planning.
- Top action items
- Directly answer the immune-overload question with the antigen-exposure explanation, rather than deferring to authority.
- Close with a safety-net: what to watch for, when to call, and the four-month follow-up.
- Explicitly ask "What other questions do you have?" before ending.
- Add a brief biomedical history check (prior reactions, prematurity) early in elicitation.
References
- American Academy of Pediatrics. Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2026. Updated 2026. Available at: https://www.aap.org/immunizationschedule
- Opel DJ, Heritage J, Taylor JA, et al. The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics. 2013;132(6):1037-1046.
- Opel DJ, Mangione-Smith R, Robinson JD, et al. The influence of provider communication behaviors on parental vaccine acceptance and visit experience. Am J Public Health. 2015;105(10):1998-2004.
- Kempe A, Saville AW, Albertin C, et al. Parental hesitancy about routine childhood and influenza vaccines: findings from a national survey. Pediatrics. 2020;146(1):e20193852.