Chronic disease self-management OSCE — adolescent adherence and motivational interviewing

Candidate brief

You are the paediatric registrar in the adolescent diabetes clinic. Liam is 16 and has had type 1 diabetes for five years. He has been admitted twice in six months with diabetic ketoacidosis. His HbA1c has risen. His pump download shows wide gaps in bolus insulin. He and his mother both say he takes everything. You have 12 minutes. [1] [4]

Encounter outline

Setting the frame. See Liam alone for part of the visit, explain conditional confidentiality, and open with a non-judgemental, curious stance that invites honesty rather than the answer he thinks you want. [1] [2]

Objective assessment. Move from self-report to objective data: walk through the pump download and the pharmacy refill record together, naming the gaps without blame, and asking what gets in the way. Pair every self-report with an objective marker. [1]

Motivational interviewing. Use OARS to draw out Liam's own reasons to change — what matters to him (sport, going out, sitting exams), how diabetes fits, and what one small step he would be willing to try. Roll with resistance rather than lecture. [2]

Shared goal and action plan. Agree a single SMART goal anchored to his priority, and co-create a written action plan for hypoglycaemia, sick days and a missed bolus that he carries with him. [2] [5]

Family and transition. Coach the parent to shift from manager to coach, with Liam's consent. Introduce the TRAQ to map his self-care gaps, and begin a structured transition plan with a warm link to adult services rather than a transfer cliff. [3] [6]

Marking domains

Communication and rapport (30%). Confidential, non-judgemental frame; sees the young person alone; uses OARS; elicits honest disclosure rather than socially desirable answers. [2] [4]

Clinical assessment (30%). Pairs self-report with objective markers (pump download, refills); screens for the mental-health or social driver of the DKA relapse; re-assesses the diagnosis if the picture is confusing. [1] [5]

Management plan (25%). A single shared SMART goal; a co-created written action plan; a simplified regimen; a defined safety-net with closer follow-up and crisis plan. [2] [5]

Transition and systems (15%). Uses the TRAQ appropriately with stated limits; coaches the family; begins a structured transition with a handover summary and a warm adult link. [3] [6]

Examiner notes

• A candidate who accepts the self-report and simply escalates insulin fails the station. [1]
• A candidate who confronts or shames Liam in the encounter fails the communication domain. [2]
• Strong candidates name the adherence dip as developmental and time-limited, and frame Liam as passing through a hard stretch rather than as a problem patient. [1] [4]