Counsel the family of an athlete disqualified from competitive sport for hypertrophic cardiomyopathy — OSCE

Candidate brief (5 minutes to read)

You are the paediatric registrar in the cardiology clinic. The 16-year-old elite school rugby player, his parents, and his coach are in the room. An echocardiogram performed after exertional chest pain during a match has confirmed hypertrophic cardiomyopathy. The athlete wants to keep playing; the parents are frightened he will die suddenly; the coach is pressuring for a clearance for the finals. In eight minutes, counsel the family: explain the diagnosis and the competitive sport disqualification and its rationale, what activity remains possible, the surveillance and treatment plan, the family screening, and the psychosocial support. [3] [12]

Marking criteria

Communication and relationship (6 marks)

• Explores each party's understanding, fears, and values before delivering information; uses open questions and checks understanding. [10]
• Acknowledges the grief and identity loss of competitive disqualification before moving to planning; does not minimise. [11]
• Delivers the disqualification decision honestly and clearly without softening it into vagueness, while holding the family's distress.

Content — clinical (8 marks)

• Explains hypertrophic cardiomyopathy in plain language and why it is the diagnosis that disqualifies from competitive sport: the risk of sudden cardiac death during exertion is substantially elevated and not abolished by treatment. [3]
• States clearly that competitive rugby is excluded; addresses the coach directly and professionally. [3]
• Offers what remains: leisure activity within the lesion's limits is encouraged; emphasises the principle of the greatest safe activity rather than a blanket ban. [11]
• Outlines the surveillance and treatment plan: regular cardiology review, echocardiography, Holter monitoring, disease-specific therapy, and the possible role of an implantable defibrillator — while stressing a defibrillator is not a licence to compete. [3]
• Raises cascade screening of first-degree relatives and genetic counselling. [10]

Safety netting and venue (4 marks)

• Counsels on red-flag symptoms that need urgent review: syncope, chest pain, palpitations. [12]
• Confirms the school and any venue have a written emergency action plan and an accessible AED regardless of his clearance status, as the secondary line of defence. [9]

Shared decision and closure (2 marks)

• Summarises the plan with the family, confirms understanding, agrees follow-up, and offers ongoing psychosocial support and a named contact. [11]

Examiner notes

The discriminating candidate separates the disqualification (firm, non-negotiable, evidence-based) from the activity prescription (generous within limits, framed as health-positive). Candidates who over-restrict all activity, or who sign a clearance to spare the family's feelings, fail the content domain. The candidate who addresses the coach's pressure directly, and who raises venue safety unprompted, demonstrates the systems thinking the station is designed to test. [3] [9]