Important: Exam dates, fees and policies can change. Verify time-sensitive details on the official Medical Council of Canada website.

Home / Station 23: Driving safety in early dementia

NAC OSCE preparation

Station 23: Driving safety in early dementia

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Driving safety in early dementia

11 minutes

Discipline: Geriatric Medicine
Station type: Counselling + capacity/safety
Setting: Memory clinic

Your task

Discuss the driving concern with the patient and spouse and outline your management.

Information available at entry

Stable vital signsMoCA information is available only if requested; do not rely on one score alone

Coach prompt: Address unsafe driving respectfully, explain next steps and preserve mobility.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 23 of 30

Standardized-patient profile

NameMr. Robert Tremblay

Age76

Pronounshe/him

RolePatient with spouse

Demeanour: Defensive but engages when treated respectfully.

Opening statement: “I have driven for 55 years without a crash. My wife is overreacting.”

History and standardized-patient responses

Driving history

Candidate explores	Standardized-patient response
Recent incidents	Two minor collisions, got lost twice on familiar routes and drove through a red light.
Near misses	Spouse grabbed wheel when he entered opposing lane.
Restrictions	Still drives at night and on highways.
Insight	Attributes all events to other drivers.

Cognition/function

Candidate explores	Standardized-patient response
Diagnosis	Major neurocognitive disorder, probable Alzheimer disease.
Function	Needs help with finances and medications.
Symptoms	Slowed processing and impaired visuospatial judgment.
Other risks	No alcohol; vision corrected; no seizures or syncope.

Impact

Candidate explores	Standardized-patient response
Meaning of driving	Independence, groceries and visiting friends.
Alternatives	Spouse drives but is anxious; community transport not yet explored.
Emotion	Fears isolation and being a burden.

Physical findings

Impaired clock drawing and trail-making.
No focal neurologic deficit.
Vision meets basic screening requirements but cognition/road history remains concerning.

Examiner prompts

Recommendation?

Given multiple collisions, getting lost, poor insight and a near head-on event, advise immediate cessation of driving while formal reporting/assessment proceeds.

Reporting?

Follow the legal requirements of the candidate's province/territory and document the discussion and actions.

Support?

Create a transportation plan and address social isolation.

Differential diagnosis

Dementia-related unsafe driving
Visual impairment
Medication/sedation
Syncope or seizure
Motor impairment

Investigations

Medication review
Vision and neurologic examination
Cognitive and functional assessment
On-road assessment only when clinically/legal appropriate and not as a substitute for immediate safety action

Management

Immediate driving cessation
Comply with provincial/territorial reporting obligations
Secure vehicle access if necessary through collaborative plan
Transportation alternatives, community services and family schedule
Follow-up for dementia treatment, advance planning and caregiver support

Communication behaviours

Use respectful, direct language
Frame the decision around public and patient safety, not punishment
Acknowledge grief and independence concerns

Critical safety actions

Do not allow continued driving after compelling high-risk events
Know and follow local reporting law
Document clearly

Model closing summary

Your years of driving matter, and I understand how much independence it gives you. However, the recent collisions, getting lost, crossing a red light and entering the wrong lane show that driving is no longer safe. I recommend that you stop driving now. I will explain and follow the reporting requirements where we practise, document our plan and work with you and your spouse on reliable transportation so that you remain connected and independent in other ways.

Common pitfalls

Giving vague advice to drive less
Using age alone
Arguing about one cognitive score
Ignoring transport alternatives

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

1. Chest pain in a 58-year-old 2. Acute dyspnea with wheeze 3. Palpitations followed by syncope 4. Upper gastrointestinal bleeding 5. Sudden focal weakness 6. Fever with hypotension 7. Acute right-lower-quadrant abdominal pain 8. Fever on postoperative day five 9. Severe leg pain after tibial fracture 10. Consent for lumbar puncture 11. First-trimester pain and bleeding 12. Postpartum low mood and unusual beliefs 13. Contraception counselling 14. Fever in an eight-week-old infant 15. Child with severe wheeze and respiratory distress 16. Two-year-old with language delay 17. Adolescent confidentiality and sexual health 18. Depression with suicidal thoughts 19. First-episode psychosis 20. Severely agitated patient 21. Older adult with acute confusion 22. Recurrent falls and dizziness 23. Driving safety in early dementia 24. Breaking a new colorectal cancer diagnosis 25. Disclosure of an insulin medication error 26. Refusal of blood transfusion 27. Cardiovascular examination in heart failure 28. Respiratory examination with pleural effusion 29. Focused neurologic examination for stroke 30. Painful swollen knee