Age-adapted history OSCE — toddler fever and adolescent confidentiality

Station objectives

1. Open a multi-party paediatric consultation and gather an age-adapted history. [2]
2. Use professional interpreting appropriately. [5]
3. Open confidential adolescent time with limits of confidentiality. [1]
4. Synthesise a problem representation. [13]
5. Close with teach-back and concrete safety-netting. [7]

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. [2] [7]

Station A — Toddler

Setup: Caregiver and toddler. Language discordance is disclosed at the start. [5] [10]

Expected actions:

• Greet child and caregiver; set agenda. [2]
• Request professional interpreter; do not use a child interpreter. [5] [6]
• Parallel observation while history proceeds. [14]
• Elicit caregiver concern and baseline change. [10]
• Cover intake, wet nappies, lethargy, rash, breathing, immunisations, medications and ability to re-present. [10] [13]
• One-sentence problem representation. [13]
• Teach-back and safety-net if discharge pathway is chosen. [7] [11]

Station B — Adolescent

Setup: Adolescent with parent. Adolescent appears guarded. [1] [2]

Expected actions:

• Explain private time and limits of confidentiality before sensitive questions. [1] [2] [3]
• Use HEADSS or SSHADESS as scaffold, strengths first if using SSHADESS. [1]
• Avoid interrogation tone. [1] [2]
• If imminent harm is disclosed, prioritise safety and appropriate sharing. [3] [15]
• Agree what will be fed back to the caregiver and arrange follow-up. [2] [3]

Marking anchors

Clear pass: age-adapted structure, interpreter safety, confidentiality limits, synthesis, teach-back. [5] [7] Borderline: correct facts but no synthesis or unsafe interpreter choice. [5] Fail: child as interpreter, absolute secrecy promise after suicidal disclosure, ignores caregiver concern, no safety-net. [5] [10] [3]

Debrief pearls

• Caregiver concern is data. [10]
• Professional interpreters are a clinical intervention. [5]
• Confidentiality is real but not absolute when serious harm is imminent. [3]
• Teach-back closes the loop. [7]