Tobacco, vaping and nicotine dependence OSCE — dependence assessment, brief intervention and the cessation plan

Station objectives

1. Secure time alone and state conditional confidentiality with its limits. [5] [4]
2. Screen for and quantify use across all nicotine products, not only cigarettes. [4]
3. Grade dependence with DSM-5 criteria and a validated tool (Hooked on Nicotine Checklist). [2]
4. Deliver a motivational-interviewing brief intervention matched to readiness. [4]
5. Assemble an evidence-based cessation plan and recognise EVALI as a safety override. [3] [1]

Candidate brief

You are the paediatric doctor in a youth-friendly clinic. You have 10 minutes for Station A (private dependence assessment, brief intervention and a cessation plan) and 8 minutes for Station B (an emergency presentation requiring immediate recognition and escalation). Examiners score process, safety, partnership language, and the quality of the cessation plan. [4] [5]

Station A — Daily pod-device vaper who wants to quit

Setup: A 16-year-old, seen alone, has used a pod vaping device daily for nine months. They describe craving on waking, irritability without it, and two failed attempts to stop. They want help quitting and ask about medication. They have no acute symptoms. [4]

Expected actions:

• Confirm time alone and state conditional confidentiality with its limits. [5]
• Take a product-specific history: product (pod device), age of initiation, frequency, triggers, withdrawal symptoms, failed quit attempts. [4]
• Quantify use and grade dependence with DSM-5 criteria and the Hooked on Nicotine Checklist. [2]
• Explain that dependence is a biological process that can begin before daily use; normalise their experience. [6]
• Deliver a motivational-interviewing brief intervention; set a quit date and build a trigger-and-coping plan. [4]
• Offer pharmacotherapy: nicotine replacement therapy first-line (patch plus short-acting form); mention bupropion or varenicline as second-line with regional licensing caution. [3]
• Offer a digital or text-message cessation program. [7]
• Arrange follow-up within one to two weeks and frame relapse as part of the process. [5]

Station B — Emergency presentation

Setup: A 16-year-old presents with three days of progressive dyspnoea, cough, fever and gastrointestinal symptoms after two weeks of vaping a modified cartridge. They are breathless and their oxygen saturation is low. [1]

Expected actions:

• Recognise suspected EVALI: respiratory distress with recent vaping. [1]
• Assess and stabilise airway, breathing and circulation; give supplemental oxygen. [1]
• Arrange chest imaging, inflammatory markers and an infectious work-up to exclude alternatives. [1]
• Arrange emergency assessment, admission or transfer for progressive respiratory failure. [1]
• Ask what was in the device (vitamin E acetate and THC-containing products were strongly linked to the outbreak). [1]
• Counsel immediate cessation and report as required. [1]

Marking anchors

Clear pass: secures time alone and conditional confidentiality; screens for all products; grades dependence with DSM-5 and a validated tool; delivers a non-judgemental motivational-interviewing brief intervention; offers NRT first-line with correct second-line reasoning; arranges close follow-up and frames relapse as practice; immediately recognises and escalates suspected EVALI in Station B. [4] [5] [1] Borderline: good rapport but screens only for cigarettes, vague follow-up, or a cessation plan limited to advice without pharmacotherapy or structured support. Fail: no private time; dismisses "occasional" use as harmless; demands total abstinence before offering help; misses EVALI behind a diagnosis of infection; punitive or judgemental stance. [2] [1]

Debrief pearls

• Adolescent nicotine dependence is a biological process, not a choice or a moral failing. [6]
• Ask about all products at every visit; never assume "occasional" means "not dependent." [4]
• Relapse is part of quitting — frame every attempt as practice. [5]
• Suspect EVALI in any respiratory illness with recent vaping; exclude infection and escalate. [1]