Adolescent consent for research and sensitive services — OSCE communication station

Station objectives

1. Present a research study developmentally and obtain age-appropriate assent; recognise when a waiver of parental permission is justified. [2] [6]
2. Run a sensitive-services consent encounter: time alone, conditional confidentiality, bedside capacity assessment. [14] [11]
3. Override confidentiality ethically when a safety threshold is crossed. [11] [10]
4. Protect sensitive content and study data across records, portals and billing. [12] [11]

Candidate brief

You are the paediatric doctor in an adolescent clinic. You have 8 minutes for Station A (research recruitment) and 10 minutes for Station B (sensitive-services consent with a safety disclosure). Examiners score process, safety, capacity reasoning, research-ethics reasoning and partnership language. [1] [4]

Station A — Recruiting a 14-year-old to an anonymous sexual-health survey

Setup: A researcher has ethics approval to run an anonymous school survey of sexual behaviour and substance use, with a waiver of parental permission. A 14-year-old is being asked to take part. [6] [2]

Expected actions:

• Confirm ethics-committee approval and the basis for the waiver of parental permission. [2]
• Create private time; explain the study in plain language — purpose, what it involves, risks, alternatives, voluntariness, and the right to withdraw at any time without penalty. [3] [4]
• Seek age-appropriate assent and check understanding with teach-back. [3]
• Explain how study data are stored and that the same confidentiality limits apply inside the study. [5] [11]

Station B — Sensitive-services request, then an active suicide plan

Setup: A 15-year-old requests contraception and asks that her mother not be told. In the private interview she then describes a specific plan to end her life tonight and begs you to keep it secret. [14] [11]

Expected actions:

• Greet the young person first; create time alone; state conditional confidentiality with honest limits. [11] [10]
• Assess capacity for the contraception decision; confirm STI testing can proceed under statute-based minor consent where applicable. [14] [1]
• On disclosure of the suicide plan, secure immediate safety, do not leave her alone, and escalate to emergency or crisis teams. [11]
• Override ethically: tell her what must be shared and why, share the minimum necessary, involve parent or carer and safeguarding, and document. [11] [10]
• Plan record and portal confidentiality so the sensitive content does not leak via billing or explanation-of-benefit. [12] [11]

Marking anchors

Clear pass: confirms ethics approval and correctly justifies the waiver; presents the study developmentally with assent and teach-back; states conditional confidentiality; structured bedside capacity assessment; lawful, ethical override told to the young person and kept proportionate; same-day safety plan; plans for record and portal confidentiality. [2] [6] [11] Borderline: good rapport but capacity reasoning vague, waiver justification unclear, or override disproportionate or not explained to the young person. Fail: no private time; promises absolute secrecy; ignores the suicide risk; enacts or accepts research without ethics approval; overrides without explanation; or leaks content through an unchecked portal or billing statement. [10] [12] [2]

Debrief pearls

• Capacity is task-specific — assess this decision, not the whole person. [1] [7]
• A waiver of parental permission is granted by the ethics committee for minimal-risk, data-sensitive studies; you still owe assent and data protection. [6] [2]
• An adolescent can withdraw from research at any time without penalty or loss of care. [3] [4]
• An ethical override that is told, proportionate and documented can preserve trust; a silent leak destroys it. [11] [12]