Consent and confidential care for adolescents — OSCE communication station

Station objectives

1. Negotiate time alone and state conditional confidentiality with honest limits. [2] [4]
2. Assess adolescent decision-making capacity at the bedside. [6] [7]
3. Obtain valid informed consent (capacity, information, voluntariness). [5]
4. Override confidentiality lawfully and ethically when a safety threshold is crossed. [4]
5. Recognise and prevent electronic-record confidentiality hazards. [8]

Candidate brief

You are the paediatric doctor in adolescent clinic. You have 8 minutes for Station A (contraceptive request with a parent present) and 10 minutes for Station B (private disclosure of an active suicide plan). Examiners score process, safety, capacity reasoning and partnership language. [3] [4]

Station A — Contraceptive request, "please don't tell mum"

Setup: 15-year-old attends with her mother for a "general check"; in private she requests the contraceptive implant and asks that her mother not be told. [3] [5]

Expected actions:

• Greet the young person first; set a joint agenda; create time alone. [3]
• State conditional confidentiality with clear limits. [4] [2]
• Assess capacity for this decision — understands, retains, weighs, communicates — using teach-back. [6] [7]
• Give information matched to her stage; confirm understanding before accepting consent. [5]
• Check voluntariness and screen for coercion. [4]
• Encourage parent involvement where safe and she agrees, without making it a condition of care. [3]
• Plan how the implant and any follow-up will be kept confidential in the record and portal. [8]

Station B — Active suicide plan disclosed in private

Setup: In the same private interview she describes a specific plan to end her life tonight and begs you to keep it secret. [4]

Expected actions:

• Stay with her; secure immediate safety; remove means if safe. [4]
• Assess risk in detail — ideation, plan, intent, means, prior attempts, protective factors. [4]
• Explain the lawful limit honestly: safety overrides confidentiality. [4] [2]
• Share the minimum necessary with the people who need it; involve parent or carer and crisis or safeguarding services. [4]
• Arrange same-day ED or crisis pathway; do not discharge on hope alone. [4]
• Document capacity, the override decision, who was informed, and the safety plan. [5] [4]

Marking anchors

Clear pass: secures time alone; correct confidentiality limits; structured bedside capacity assessment with teach-back; lawful, ethical override told to the young person and kept proportionate; same-day safety plan; plans for record and portal confidentiality. [4] [6] [5] Borderline: good rapport but capacity reasoning vague, or override disproportionate or not explained to the young person. Fail: no private time; promises absolute secrecy; ignores the suicide risk; overrides without explanation; or leaks content through an unchecked portal. [2] [4] [8]

Debrief pearls

• Capacity is task-specific — assess this decision, not the whole person. [6] [7]
• An ethical override preserves the relationship when it is told and proportionate. [1] [4]
• Confidentiality and family involvement are both goals where it is safe. [3]