Trafficking, exploitation and forced marriage — OSCE

Candidate brief

You are the paediatric registrar in the emergency department. A 15-year-old girl has been assessed privately after a controlling accompanying adult was asked to wait outside. She has a sexually transmitted infection, cannot name her school, and her identity documents were held by the adult. The child-protection team has been consulted, a child-protection report is being made, and a referral to the National Referral Mechanism for possible trafficking is planned. The girl is now alone with you and has asked what is happening. [5] [2]

You have 8 minutes to explain to her, honestly and without promising secrecy, why a report is being made, what support is available, and what will happen next, while maintaining her trust. [13]

Examiner instructions

Assess the candidate's ability to: [5]

• Explain, in plain language, that a child-protection report is being made because the team has a duty to keep her safe — framed as care, not accusation. [5]
• State honestly that they cannot promise secrecy, while explaining what confidentiality does and does not cover, and why. [2]
• Describe what happens next — the role of child protection and the support services, and that the clinical team will continue to care for her. [2]
• Acknowledge her likely fear (of the adult, of authorities, of what happens next) without minimising it or making false promises. [13]
• Avoid pressing for forensic detail, and position the specialist sexual-health and support services as available when she is ready. [5]
• Use plain language, check understanding, and offer a follow-up conversation and a trusted point of contact. [15]

Actor (young person) cues

• Initial reaction: wary and fearful — 'Are you going to make me go back with him?'
• If the candidate promises secrecy or minimises the report, push back: 'So you're not telling anyone?'
• If the candidate is honest and calm, shift to worry: 'What will the police do? Will I get into trouble?'
• If asked about what happened, the young person should give only vague answers and watch whether she is pressured for detail. [5]

Marking schema

Excellent (8–10): Explains the duty honestly and in plain language as an act of care, states clearly that secrecy cannot be promised and why, describes the support pathway and ongoing care, acknowledges fear without false promises, does not press for forensic detail, checks understanding, and offers a trusted contact. [5] [2]

Pass (5–7): Explains the report adequately but may be slightly vague about confidentiality or the pathway, or may press too hard for detail. Maintains a reasonable relationship and covers ongoing care. [13]

Fail (below 5): Promises secrecy the candidate cannot keep, accuses or pressures the young person, cannot describe the pathway, dismisses her fear, or fails to make clear that a report is being made. [15]

Key teaching points

• A child or adolescent in commercial sex is a victim of trafficking regardless of force, fraud, coercion or consent; the report is framed as care and statutory duty, not accusation. [5]
• Honesty about the limits of confidentiality preserves trust; promising secrecy destroys it and endangers the child. [2]
• The clinician's role is recognise–make safe–treat–document–report–refer and arrange continuity, not investigation or rescue. [1]
• Forced marriage, if it arises, is a safeguarding emergency in which family mediation is contraindicated — but in this station the focus is honest communication with the young person herself. [15]