Explaining a treatment's risks and benefits — OSCE

Station brief (8–10 minutes)

Help the parents decide whether to start the preventive medication by communicating the benefit and the rare harm accurately. Address their concern about the online "50%" figure and their numeracy and language needs. Do not invent jurisdiction-specific thresholds or specific survival statistics. [1]

Tasks for the candidate

1. Assess what the family already understands and their numeracy and language needs. [14]
2. Reframe the "50%" figure with the absolute baseline and absolute risk reduction. [1] [10]
3. Present benefit and harm in natural frequencies with a consistent denominator and a pictograph or drug-facts box. [4] [6]
4. Name the uncertainty honestly and balance the framing in both directions. [4] [13]
5. Confirm understanding with teach-back, agree a plan, and arrange follow-up and a written summary. [13] [14]

Expected performance

Must hit. Baseline understanding and numeracy assessed; absolute baseline stated before any relative figure; natural frequencies with one consistent denominator plus a pictograph or drug-facts box; benefits and harms balanced bidirectionally; uncertainty named; teach-back confirms understanding; written summary and follow-up arranged; trained interpreter used. [1] [4] [14]

Merit. Acknowledges the online figure without dismissing the parent; uses a validated decision aid for the preference-sensitive choice; gives a range rather than false precision; includes the child developmentally where appropriate. [6] [13]

Fail. Quotes the 50% relative figure alone; switches denominators; frames only the benefit; offers a single false-precise estimate; no teach-back, summary or follow-up; uses a family member as interpreter. [1] [14]

Sample candidate structure

“Thank you both for coming in, and I'll use the interpreter throughout so we're all clear. First, tell me what you have read about this medicine and what you understand so far. … The '50%' figure you saw is a relative reduction, and on its own it can look bigger than it is. Let me show you the actual numbers. Out of 1000 children like yours, about 2 would have this problem without the medicine, and about 1 with it — that is the real size of the benefit. Here is a picture of it. There is also a rare side effect, and I want to show you that side by side, in the same terms, so you can weigh them together. What questions do you have? Let's check we're together: can you tell me, in your own words, what the benefit and the risk look like to you?” [1] [4] [6]