Explaining a positive hepatitis B result and the household plan — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the refugee-health clinic. A six-year-old girl who arrived two months ago had her comprehensive post-arrival infection screen last week. She is growing normally and feels well. Her hepatitis B surface antigen test has come back positive and you have confirmed it on a repeat sample in your own laboratory. The family has a trained interpreter present. [9]

Your tasks are: [8]

1. Explain to her parents, through the interpreter, what a positive hepatitis B surface antigen means and what it does not mean — that she is not sick today, but that she is carrying the virus and needs monitoring. [8]
2. Outline the further tests needed to stage the infection and the plan to test and vaccinate the household contacts. [4]
3. Hold the family's trust, acknowledge their worry, and frame the result as a manageable, monitored condition with a clear safety-net, rather than a crisis or a sentence. [7]

You are not expected to give detailed antiviral dosing, to discuss liver transplant, or to manage acute liver failure. [9]

Examiner prompt to the actor (parent)

"The doctor said the blood test is positive for hepatitis B. Is she sick? Did we bring this with us? Will it hurt her liver? Her father is asking whether the whole family needs testing — he is worried about the younger brother. And what does it mean that she will carry it — is she going to be unwell?" [8]

Marking domains

• Accuracy and honesty (3): explains correctly that a positive hepatitis B surface antigen means the child is carrying the virus and may have chronic infection, that it does not mean she is sick today, and that further tests stage the infection and guide whether treatment is needed; does not falsely reassure, does not over-state the risk, and does not cause panic. [8]
• Household-contact plan (4): states clearly that the household contacts, especially the younger brother, must be tested and, if not immune, vaccinated against hepatitis B; explains that hepatitis B is spread by blood and body fluids and that vaccination protects the family; confirms a clear plan to arrange the contact testing. [4]
• Communication (3): uses the trained interpreter throughout, uses plain language, acknowledges the parents' and father's worry, holds a calm and trustworthy tone, checks understanding, and frames the result as manageable and monitored rather than a crisis. [9]

Model answer — the explanatory script

"Thank you for coming in, and I understand this is worrying, especially with the word 'hepatitis'. I want to be clear and honest with you about what this result means and what we are going to do next." [9]

"The result shows that your daughter is carrying the hepatitis B virus. I want to reassure you of two things straight away. First, she is not sick today — she is growing well and she feels well, and that is exactly why we did the blood test, to find this before it ever causes harm. Second, this is a condition we can monitor and, if ever needed, treat — it is not a crisis today. The reason we found it is that the virus can sit quietly in the liver for years without causing symptoms, and the post-arrival blood test is designed to find exactly these silent carriers." [8]

"Here is what happens next. We will do a few more blood tests to understand the infection better — how active the virus is, how her liver is coping, and whether she has picked up any other infections alongside it. That tells us whether she needs any treatment now or simply monitoring over time. Most children who carry hepatitis B like this are monitored regularly, stay well for years, and only a small number ever need treatment. We will see her back and keep a close eye on her liver." [7]

"Your husband's question about the family is exactly the right one. Hepatitis B is passed through blood and body fluids, so the most important thing we do now is protect the rest of the family. We will arrange for everyone in the household — especially her younger brother — to have a blood test to check whether they have the virus or are already protected, and anyone who is not protected will be offered the hepatitis B vaccine, which is very effective at keeping them safe. That is the single most useful thing we can do for the family." [4]

"I know this is a lot to take in. I would like to reassure your husband that we are taking this seriously, that we found it because we looked, and that the plan is monitoring and protecting the family — not an emergency. I will give you a written summary in your language, and you will have a named doctor here who knows your daughter and who you can come back to with any question. Is there anything you would like me to go over again?" [9]