Paediatric mental state examination OSCE — observing, interviewing alone, and a same-visit safety assessment

Station objectives

1. Set the conditions for a mental state examination and observe before interviewing. [7] [8]
2. Secure time alone with an adolescent and state conditional confidentiality. [8]
3. Walk the seven domains and integrate a brief validated screen. [1] [2] [5]
4. Deliver a same-visit suicide-risk assessment and a disposition matched to risk. [5] [6]

Candidate brief

You are the paediatric doctor in clinic. You have 8 minutes for Station A (triadic start and time alone) and 12 minutes for Station B (private assessment and safety plan). Examiners score process, safety, and partnership language. [7] [8]

Station A — Securing time alone

Setup: 15-year-old and parent; parent says "I will stay, there is nothing we do not discuss." [8]

Expected actions:

• Greet the young person first and observe appearance and behaviour from entry. [7]
• Explain that part of the visit is private and normal at this age, framing it around growing independence rather than secrecy. [8]
• Give the parent a defined task and a clear time, staying warm and firm. [8]
• State a conditional confidentiality line with its limits to both. [8]

Station B — Positive screen and safety assessment

Setup: Once alone, the adolescent describes two weeks of low mood, sleep change, and passive thoughts of death without a clear plan; the PHQ-based screen is positive. [2] [5]

Expected actions:

• Complete the relevant domains, approaching mood, thought content, and perception gently. [7]
• Perform a same-visit suicide-risk assessment: ideation, plan, intent, means, prior attempts, protective factors, ability to stay safe tonight. [5] [6]
• Decide crisis pathway versus early review with a written safety plan, and do not rely on a delayed referral. [5]
• Agree the plan with the adolescent first, decide what stays confidential, and make a warm hand-off. [6]

Marking anchors

Clear pass: observes before interviewing, secures time alone with a resistant parent, correct confidentiality limits stated unprompted, seven domains walked, a same-visit suicide-risk assessment, a written safety plan, and a disposition matched to risk. [7] [5] [6]

Borderline: good rapport but an incomplete risk assessment, a vague follow-up interval, or a confidentiality statement given only when prompted. [8]

Fail: no private time; the whole MSE taken in front of the parent; ignores the positive screen or files it for later; lectures rather than asks; uses a family member as interpreter for sensitive content. [8] [5]

Debrief pearls

• Observe before you interview — the first seconds are the most honest data. [7]
• A parent-dominated adolescent MSE is a false negative. [8]
• The same-visit response to a positive screen is the pass-or-fail discriminator. [5]
• Record the MSE descriptively; keep the formulation separate. [7]