Shared decision-making and assent OSCE — imaging choice and chronic-disease disagreement

Station objectives

1. Diagnose a preference-sensitive decision and run a three-talk shared decision-making conversation. [4]
2. Distinguish consent, assent and shared decision-making at the bedside. [1]
3. Use a validated decision aid appropriately as a tool, not a substitute for the values conversation. [9] [11]
4. Assess an adolescent's decision-specific capacity and manage disagreement constructively. [5]

Candidate brief

You are the paediatric registrar in an acute assessment area. You have 12 minutes for Station A and 12 minutes for Station B. Examiners score process, structure and synthesis over encyclopaedic recall. [4] [1]

Station A — Minor head injury imaging

Setup: Parent and well-appearing 5-year-old. No imaging-rule trigger. Parent is anxious and asks for a scan. [9]

Expected actions:

• Team talk: name that a decision has arrived (observe versus scan) and offer a partnership role. [4]
• Option talk: present observation and CT with honest benefits, harms and uncertainties in plain language. [9]
• Use or summarise the validated head CT choice decision aid; explain it reduced CT use without missed injuries. [9] [11]
• Decision talk: elicit the parent's values, check understanding with teach-back, agree a choice. [4]
• Seek simple age-appropriate assent from the child; give a concrete safety-net and review plan. [1] [10]

Station B — Adolescent biologic disagreement

Setup: Competent 15-year-old with inflammatory bowel disease, parent present. She wants diet alone and is wary of the biologic the team recommends. [5]

Expected actions:

• Assess decision-specific capacity using the mature-minor standard and document it. [1] [2]
• Elicit her values (control, body image, fear of injections) and her parents' values (disease control, future risk) without dismissing either. [4] [5]
• Offer a values-concordant option such as a time-limited trial of optimised therapy with defined review criteria. [4]
• Document dissent if she refuses a recommended life-preserving option; escalate to ethics, second opinion and the local legal pathway. [1]

Marking anchors

Clear pass: three-talk structure, consent-versus-assent clarity, appropriate decision-aid use, capacity assessment, values elicitation, documented plan. [4] [9] Borderline: correct facts but no values elicitation, or a single-option presentation presented as shared. [5] Fail: pretends there is only one option, ignores the child's view, demands assent in an emergency, or fails to escalate a life-saving refusal. [1] [9]

Debrief pearls

• A decision aid is a tool, not the conversation. [9] [4]
• Assent is a separate good from consent; record the child's view, including dissent. [1] [10]
• In an emergency, implied consent governs; explain and seek assent once stable. [1] [3]