Working with interpreters and culturally responsive communication OSCE — emergency consent and adolescent confidentiality

Station objectives

1. Select the correct interpreter mode for an urgent encounter and avoid using a child as interpreter. [1] [4]
2. Conduct an interpreter-mediated consent using first-person address, short chunks and teach-back. [4] [5]
3. Protect adolescent confidentiality through interpreter choice and separate adolescent time. [1]
4. Apply a cultural competence framework (LEARN) to negotiate a shared plan. [10] [11]

Candidate brief

You are the paediatric registrar covering 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 — Emergency consent with a child interpreter

Setup: Dari-speaking mother, unwell toddler, and an 8-year-old daughter. A busy registrar has asked the daughter to interpret consent for venesection. [1]

Expected actions:

• Recognise and stop the use of the child as interpreter; explain why confidentiality and consent are compromised. [1] [6]
• Access a professional interpreter by telephone or video; pre-brief them on the goal and content. [4]
• Conduct history and consent in the mother's preferred language, speaking to her in the first person in short chunks. [4]
• Confirm understanding with teach-back, asking the mother to restate the plan in her own words. [5]
• Document the interpreter's name, ID, mode and language and the teach-back completed. [4]

Station B — Adolescent confidentiality

Setup: A 15-year-old migrant girl attends for a confidential consultation. She prefers a non-English language. Her mother wishes to stay and to bring a trusted community interpreter. [1]

Expected actions:

• Offer the adolescent confidential time alone and book a professional interpreter who is neither family nor a community peer. [1] [4]
• Explain to the mother, with her own interpreter, why confidential adolescent time is the standard. [4]
• Use the LEARN model to negotiate the mother's continued involvement on terms the adolescent consents to. [10] [11]
• Document the interpreter, the separate adolescent time offered, the LEARN negotiation and the agreed plan; escalate to social work or safeguarding if coercion or risk surfaces. [2]

Marking anchors

Clear pass: correct interpreter mode, refusal to use a child interpreter, first-person address, teach-back, interpreter choice that protects confidentiality, LEARN negotiation and documentation. [4] [10] Borderline: correct facts but no teach-back, or first-person address not used, or community interpreter accepted for confidential content. [5] [1] Fail: proceeds with a child interpreter, accepts written notes or lip-reading for a Deaf parent, breaches adolescent confidentiality, or misses a safeguarding concern. [1] [6]

Debrief pearls

• A professional interpreter is the standard of care, not a courtesy; telephone interpreting is almost always available. [4] [1]
• Teach-back is the only reliable check for false fluency. [5]
• Interpreter = oral; translator = written; cultural broker = bridges meaning and practice. [4] [10]
• Equity: interpreter and culturally responsive care must reach migrant, refugee, Indigenous and disadvantaged families. [2] [11]