Adolescent contraceptive consult OSCE — confidentiality, 5 Ps, method choice and a coercion disclosure

Station objectives

1. Negotiate private time and explain conditional confidentiality. [3] [8]
2. Take a structured 5 Ps sexual history including a coercion question. [3]
3. Counsel methods LARC-first using Medical Eligibility Criteria principles and agree dual protection. [1] [4] [7]
4. Conduct a safety assessment after a controlling-partner disclosure and plan accordingly. [3]

Candidate brief

You are the paediatric doctor in adolescent clinic. You have 10 minutes for Station A (triadic start with a parent who resists leaving) and 12 minutes for Station B (private history, method counselling and safety plan). Examiners score process, safety and partnership language. [3]

Station A — Parent will not leave

Setup: A 16-year-old requests contraception; her mother says "we share everything." [8]

Expected actions:

• Greet the young person first; set a joint agenda. [3]
• Explain private time as standard youth care, not a secrecy pact. [8]
• State conditional confidentiality aloud with its limits. [3]
• Negotiate the parent stepping out respectfully, offering a parallel parent agenda (periods, vaccines, safety). [3]

Station B — Private disclosure and method counselling

Setup: In private the young person describes a 20-year-old controlling boyfriend, inconsistent condom use, and no regular method; last menstrual period two weeks ago. [3] [5]

Expected actions:

• Complete the 5 Ps, including a direct question about coercion and safety. [3]
• Offer a pregnancy test and STI screen by site, per USPSTF-aligned screening for a young woman under 25. [6]
• Counsel methods LARC-first (implant or IUD), using Medical Eligibility Criteria principles; support the young person's choice. [1] [4]
• Add condoms for dual protection and provide an emergency contraception plan. [7] [5]
• Assess safety around the controlling partner; act on the safeguarding threshold. [3] [8]

Marking anchors

Clear pass: secures private time, correct confidentiality limits, structured 5 Ps, LARC-first counselling with dual protection, same-visit safety assessment and a shared plan with named follow-up. [1] [3] [7] Borderline: good rapport but vague method counselling, no dual protection, or an incomplete safety assessment. Fail: no private time; absolute secrecy promised; ignores the controlling-partner risk; offers only the pill without options. [3] [8]

Debrief pearls

• A pill request opens a full sexual health visit, not a transaction. [3]
• Confidentiality is overridden for serious harm, abuse or exploitation — know the principle, not fake ages. [3]
• No hormonal or intrauterine method prevents STI; dual method is mandatory counselling. [7]