Inclusive care OSCE — the affirming consultation and the mother's direct question

Station objectives

1. Run an affirming adolescent consultation that establishes confidentiality before any sexuality history. [4] [8]
2. Take a sexual orientation history asking attraction, identity and behaviour separately. [2]
3. Screen mood, suicide risk and safety, and plan behaviour-based sexual health. [6]
4. Respond to a parent's direct question about the young person's orientation without breaching confidentiality. [8]

Candidate brief

You are the paediatrician. You have 8 minutes for Station A (the young person, alone) and 7 minutes for Station B (the mother). Examiners score communication, structured assessment and the handling of confidentiality. [4] [8]

Station A — The affirming consultation

Setup: A 15-year-old girl attends with her mother for a "check-up." Once you speak with her alone, she discloses she has a girlfriend, has been called slurs at school for months, and has had fleeting thoughts of ending her life. [6]

Expected actions:

• Establish confidentiality and its limits before the history, in plain language; confirm a private one-to-one space. [8]
• Use her words and pronouns; signal safety through inclusive, non-judgemental language. [4]
• Ask attraction, identity and behaviour as three separate questions. [2]
• Take a structured suicide-risk assessment — ideation, intent, plan, means, protective factors, past attempts. [6]
• Screen mood (PHQ-A), anxiety, substance use, and safety (bullying, home, school). [9]
• Co-create a safety plan, reduce means access, arrange crisis or mental-health referral, and connect to affirming supports. [3]

Station B — The mother's question

Setup: Her mother, in the waiting room, asks you directly: "Is my daughter gay?". [8]

Expected actions:

• Do not disclose the young person's orientation without her consent. [8]
• Acknowledge the mother's concern and share general adolescent-health and support information. [8]
• Hold confidentiality within its limits (serious risk, mandatory reporting), and explain those limits consistently. [6]
• Offer the mother support and education, and — with the young person's consent — begin family-acceptance work. [3]
• Document the encounter and your confidentiality reasoning. [9]

Marking anchors

Clear pass: affirming, confidential consultation; attraction/identity/behaviour asked separately; structured suicide-risk assessment with a safety plan and referral; confidentiality held and its limits explained; family-acceptance work offered with consent. [4] [6] Borderline: correct intent but assumes orientation from one question, or delivers affirmation without a suicide-risk assessment, or hedges the confidentiality question vaguely. [8] Fail: discloses orientation to the mother without consent; asks only one component of orientation; omits suicide-risk assessment despite disclosure of suicidal thoughts; judgemental or pathologising language. [8] [3]

Debrief pearls

• An affirming encounter is a protective intervention, not a courtesy — name the affirmation out loud. [3]
• Confidentiality is therapeutic; involuntary outing can precipitate the crisis. [8]
• Screen by behaviour and anatomy, never assumed orientation. [2]
• Family acceptance is the strongest buffer you can broker. [3]