Developmentally appropriate communication OSCE — preschool engagement and adolescent confidentiality

Station objectives

1. Set the environment and match communication register to developmental stage. [1]
2. Engage a preschooler through play and drawing without leading questions. [1]
3. Use a professional interpreter and never a child for clinical content. [3]
4. Open confidential adolescent time and state limits of confidentiality before sensitive questions. [1] [2]
5. Confirm understanding with teach-back and give a concrete, age-appropriate safety-net. [5]

Candidate brief

You are the paediatric doctor in an acute assessment area. You have 12 minutes for Station A and 12 minutes for Station B. Examiners score process, safety and synthesis more than encyclopaedic lists. [1] [5]

Station A — Preschooler with fever and language discordance

Setup: Caregiver and 4-year-old. The child clings and cries. The family's preferred language is not English. [3] [9]

Expected actions:

• Set the environment: eye level, toys, drawing, reduced noise. [1]
• Greet the child first, then the caregiver. [1]
• Decline any child-interpreter offer; book a professional interpreter; brief the interpreter; speak to the family. [3] [4]
• Engage through play and a teddy-bear examination; ask the child to point or draw where it hurts. [1]
• Avoid leading questions; accept "I don't know." [1]
• Explain the plan in plain language; teach-back; concrete time-bounded safety-net. [5]

Station B — Adolescent requesting privacy

Setup: 15-year-old with parent. The adolescent appears guarded and asks to speak alone about low mood and abdominal pain. [1] [2]

Expected actions:

• Explain private time and limits of confidentiality before sensitive questions. [1] [10]
• Invite the caregiver out respectfully. [1]
• Use HEADSS or SSHADESS as a rapport scaffold — strengths and school before risk domains. [1] [2]
• If imminent self-harm is disclosed, act on safety first; share only what duty requires; no absolute secrecy. [6] [10]
• Negotiate what will be shared and how follow-up will work. [1]

Marking anchors

Clear pass: developmentally appropriate engagement, interpreter safety, confidentiality limits stated before sensitive questions, teach-back confirmed, concrete safety-net. [3] [5] Borderline: correct facts but no play engagement, or unsafe interpreter choice, or confidentiality limits stated too late. [3] Fail: child used as interpreter, leading questions that manufacture symptoms, absolute secrecy promise after risk disclosure, no teach-back or safety-net. [3] [5] [6]

Debrief pearls

• Play and drawing are communication tools, not entertainment. [1]
• Leading questions exploit preschool suggestibility and manufacture false symptoms. [1]
• Confidentiality limits must be stated before, not after, sensitive disclosure. [1] [2]
• Teach-back is a dialogue that exposes misunderstanding before discharge. [5]
• Communication failure is a classifiable patient-safety event. [12]