Psychological impact of chronic illness and disability OSCE — assessment, stepped plan and safeguarding

Station A — 14-year-old with type 1 diabetes, rising HbA1c and school absence (8 minutes)

A 14-year-old girl with type 1 diabetes has a rising HbA1c, has missed three months of school, and is withdrawn. Her mother is convinced the insulin dose is wrong and wants it increased. She is alone in the room with you. [4]

Candidate tasks:

1. Take a focused biopsychosocial history, seeing the young person alone, including a direct suicide-risk question. [4]
2. Explain the gate question that distinguishes an adjustment reaction from a depressive disorder. [5]
3. Agree the first steps of a stepped, family-centred, school-inclusive plan with the young person. [3] [6]

Examiner marking points:

• Frames the problem as psychological impact, not a metabolic failure; does not simply increase the dose. [4]
• Uses the biopsychosocial model; sees the young person alone; runs an adapted HEEADSSS; asks directly about mood, sleep, coping, body image, peers, bullying, school, adherence and suicidal ideation. [4] [3]
• Names screening instruments (SDQ, PHQ-A, GAD-7, PedsQL) and the gate question (does it meet DSM-5-TR criteria? — anhedonia, hopelessness, ≥2 weeks, functional decline). [5]
• Builds a tiered plan with the young person: universal support (validate, psychoeducate, coordinate), targeted intervention (CBT/coping skills, graded return, school liaison), and specialist referral if criteria are met; convenes the school and puts a written plan in place. [3] [6]

Station B — Non-verbal adolescent with cerebral palsy and a behaviour change (8 minutes)

A non-verbal 15-year-old with severe cerebral palsy, previously settled, has become agitated, sleeps poorly, and has disengaged at school. The carers say "it's just her disability." A junior colleague asks you what to do. [1]

Candidate tasks:

1. Identify the key risk concept and explain why the carers' framing is dangerous. [1] [2]
2. Outline the assessment, adapted for impaired communication, and the differential you must not miss. [2] [4]

Examiner marking points:

• Names diagnostic overshadowing — attributing a new presentation to the disability and missing a treatable disorder; states the safeguard that every new symptom gets the full differential. [1]
• Adapts assessment for communication: structured observation, informant report, behaviour, and any available self-report; looks for treatable physical causes first (pain — hip, reflux, constipation, dental, UTI — seizures, medication side-effect), then psychological causes (depression, anxiety, procedural trauma), then social causes. [2] [4]
• Does not anchor on the disability; investigates the targeted differential and refers for specialist support if distress persists, coordinating with the disability team. [2]