Breaking Bad News – OSCE Station

How to tackle the Breaking Bad News scenario in an OSCE

Breaking Bad News is a common scenario used in Objective Structured Clinical Examinations (OSCEs) and other practical medical assessments. It entails the student (doctor) passing on upsetting information to their patient, and getting scored on how well they do so. If you would like to ensure the best for both yourself and your patients, keep reading to find out how to face breaking bad news effectively.

Tackle any Breaking Bad News scenario by following the 6-Step SPIKES protocol!

1) Setting 

Create the setting by preparing yourself for the interview. Practising will familiarise you with the scenario and therefore reduce some of the situational anxiety. You can also prepare the room beforehand by ensuring privacy and eliminating distractions. Once the interview commences, you may sit with the patient and ask them if they wish to have someone present in the room with them.

Try to connect with the patient by maintaining eye contact and touching them on the arm or shoulder as a way of offering comfort. Offer them your undivided attention by listening and giving them space.

2) Perception – “Before you tell, ask”

Before getting into details about the results, it is important to ask the patient what they know so far. You can then deliver the news based on information provided by the patient.

“What have you been told about your medical situation so far?”

“What is your understanding of the reasons we did an MRI?”

3) Invitation

Each patient is different in the ways they would like to receive information. Some patients want to know every detail about their diagnosis, while others want to know the bare minimum. Therefore, ask the patient how much detail they would like beforehand. If they do not want any details, allow them to ask you some questions.

“How would you like me to give the information about the test results?”

“Would you like me to give you all the information or summarise the results and spend more time discussing the treatment plan?”

4) Knowledge

Letting the patient know that bad news is coming is a more effective strategy than stalling or delivering the news abruptly. It gives the patient time to realise and prepare themselves for what they are about to hear. Explain the news to the patient in manageable chunks by keeping terms simple and avoiding medical jargon. Make sure to check in with the patient often to see if they are understanding the information.

“Unfortunately, I have some bad news…”

“I’m sorry to tell you that…”

5) Emotions

Responding to the patient’s emotions can be the hardest part about breaking bad news. Therefore, it is important to have an appropriate empathic response in place. Start off by observing the patient’s reaction (shock, sadness, silence). You can also identify the emotion by asking the patient what they are feeling/thinking. Explore why the bad news is upsetting them at that moment.

After giving the patient some time to process the news, offer some words of comfort. It will be difficult to discuss the situation further if emotions have not cleared, so continue making empathic responses until the patient becomes calm.

“I know this isn’t what you wanted to hear.”

“I wish the news were better.”

6) Strategy and Summary

Offering a clear plan for the future will make patients less anxious and uncertain. Allow the patient to share their fears and concerns going forward. Even in the case of a poor prognosis, patients may still want ways to alleviate pain, reduce symptoms etc.

Understanding the patient’s goals will allow you to decide what is possible to accomplish regarding treatment.

Put this SPIKES protocol to the test and practise yourself with

Mock-OSCE offers a wide variety of clinical communication scenarios, including breaking bad news. It is a completely remote platform so anyone can sign up from anywhere in the world. Scenarios are conducted live with real simulated patients, so you can rest assured that you’re getting an optimal experience to practise your skills.

Receive both verbal and written feedback along with your scores to top off your learning experience. For more information, visit us on .

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