Adolescent consultation OSCE — time alone, confidentiality, HEEADSSS and a safety plan

Station objectives

1. Negotiate time alone and explain conditional confidentiality. [2] [4]
2. Conduct a structured HEEADSSS with open, non-judgemental questions. [1]
3. Respond to a positive screen with a same-visit risk assessment and safety plan. [5]
4. Close with a shared plan that protects confidentiality and sets follow-up. [4]

Candidate brief

You are the paediatric doctor in clinic. You have 8 minutes for Station A (triadic start) and 12 minutes for Station B (private assessment and plan). Examiners score process, safety and partnership language. [3] [7]

Station A — Parent resists leaving

Setup: 15-year-old and parent; parent says "we have no secrets." [3] [7]

Expected actions:

• Greet the young person first; set a joint agenda. [3]
• Frame private time as standard developmental care about growing independence, not secrecy. [7]
• Give the parent a defined task and time to step out. [3]
• State the conditional confidentiality line to both. [2] [4]

Station B — Private low-mood disclosure

Setup: Once alone, the adolescent describes two weeks of low mood, sleep change and a passive death wish without a clear active plan; occasional vaping; sexually active with inconsistent condom use. The PHQ-based screen is positive. [5] [6]

Expected actions:

• Complete focused HEEADSSS domains, including Drugs and Sexuality without judgement. [1]
• Same-visit suicide-risk assessment: ideation, plan, intent, means, prior attempts, protective factors, ability to stay safe tonight. [5]
• Decide disposition: crisis pathway if high risk, or early review (1–2 weeks) with a written safety plan for lower risk. Do not file for delayed review. [5]
• Offer brief advice for vaping; arrange sexual-health follow-up and STI testing with confidential results handling. [6] [4]
• Agree the plan with the adolescent, then rejoin the parent for the shared plan, preserving what is confidential. [4]

Marking anchors

Clear pass: secures time alone, correct confidentiality limits stated unprompted, structured HEEADSSS, same-visit suicide assessment, written safety plan, non-judgemental sexual and substance care, and a shared close that protects confidentiality. [1] [4] [5]

Borderline: good rapport but incomplete risk assessment, vague follow-up, or a confidentiality statement given only when prompted. [3]

Fail: no private time; promise of absolute secrecy; ignores suicide risk; lectures only; files the positive screen for delayed review; uses a family member as interpreter if a language need arises. [2] [5] [7]

Debrief pearls

• Time alone is clinical quality, not a courtesy. [3]
• State the confidentiality line before sensitive questions, unprompted. [2]
• The same-visit response to a positive screen is what separates a pass from a fail. [5]
• Open, non-judgemental questions open disclosure; closed, leading ones close it. [1]