Health literacy and accessible information OSCE — liquid-medication counselling and complex discharge

Station objectives

1. Apply health literacy universal precautions using plain language and teach-back. [5] [1]
2. Convert an unsafe liquid-medication prescription to millilitres with an oral syringe and pictogram. [2]
3. Meet a language need with a professional interpreter and record it. [12]
4. Confirm understanding of a complex discharge plan with teach-back and a safety-net. [8]

Candidate brief

You are the paediatric registrar in an acute assessment area. You have 12 minutes for Station A and 12 minutes for Station B. Examiners score process, structure and synthesis over encyclopaedic recall. [1] [5]

Station A — Liquid-medication counselling

Setup: Parent and 14-month-old being discharged with a liquid antibiotic written in teaspoons. The parent speaks limited English and nods when asked "do you understand?" [2]

Expected actions:

• Recognise the teaspoon unit as a direct safety risk and represcribe in millilitres with a marked oral syringe and pictogram. [2]
• Use a professional interpreter in person, by phone or by video; record the language and dialect. [12]
• Explain the dose, frequency and duration in plain language, one idea at a time. [5]
• Run teach-back: ask the parent to demonstrate drawing up and giving the dose and to restate the safety-net in their own words. [5] [8]

Station B — Complex discharge

Setup: Parent of a child with medical complexity leaving on five medications and two action plans. The parent is confident and says they have understood everything. [8]

Expected actions:

• Quantify the information load and acknowledge that confidence does not equal understanding. [8]
• Deliver the plan in plain language and run teach-back on each medicine and each warning sign. [5]
• Provide a written, low-reading-level summary and a concrete safety-net with named return triggers. [1] [8]
• Offer the materials in the family's language and format and arrange appropriate follow-up. [10]

Marking anchors

Clear pass: universal-precautions framing, represcription to mL with an oral syringe and pictogram, professional interpreter use, teach-back of dose and safety-net, recorded communication need. [2] [5] Borderline: correct facts but relies on "do you understand?", or fails to represcribe away from teaspoons, or uses a relative as interpreter. [8] [12] Fail: accepts a teaspoon-unit prescription unchanged, relies on a child to interpret, hands over a leaflet without teach-back, or mislabels a genuine values choice as non-compliance. [1] [12]

Debrief pearls

• Information given is not information understood; teach-back closes the loop. [5] [8]
• Millilitres, an oral syringe and a pictogram are treatment, not paperwork. [2]
• Accessibility is broader than literacy — meet the language and format need every time. [10] [12]