Communication Station

Strategy

Skills Assessed

• Ability to listen to patient, pause, connect and build trust

• Communicate complex medical terms simply

• Clinical knowledge is usually assessed elsewhere- do not try and impress the examiner with +++ of clinical knowledge

This station is a test of your soft skills- e.g. communication and professionalism. It is not primarily a test of your clinical knowledge and  however from the list below you can note having the basic clinical knowledge can be essential. Many of the scenarios aim to test a range of core themes. 

Often the actors will have a core concern that they'll only reveal upon direct answering. Questions around how this impacts their activities of daily living and their ideas, concerns and expectations are key. 

Timings

• 5 minute preparatory reading

• 10 minutes station: 10 minutes discussion with patient (nil examiner discussion)

Patient Discussion

Introduction

• Warmly introduce yourself- name and Dr +- wash hands & their name, establish patient permission to speak to family

• Identify purpose of consultation & patients ICE (ideas, concerns, expectations)

• Identify and address emotion early- 'I can see you are unhappy, I'm sorry about this' 

Middle

• Allow pauses for the examinee to helpfully direct your station in the correct trajectory

• Patient focused: impact on job, relationships, mental state, mobility, driving

• Involve the MDT, wider services, aids

• Signpost and summarise to give structure

• Any questions not asked

Conclusion

• Warmth, thank for time, any further questions

• Leaflets, websites, follow up, investigations/ plan, how to contact 

• Summarise

Top Tips

• There is often a hidden concern the actor will only reveal if you ask specifically about this, this often is impact on QoL or function at work/ relationship

• Practice in 2s- discussing common scenarios

• Confidence is the illusion of competence, communicate competence to your examiner!

• Often the scenarios will involve multipe domains- e.g. capacity + confidentiality

• Some of the scenarios rely upon a reasonable knowledge base, however it is important to state how you would look this up or who you would ask when not sure, very reasonable 

• The scenarios are often those commonly occurred within medical practice

• Pause- let patient lead scenario

Core Themes

Core Themes

1. Breaking bad news

2. Explanation of conditions, investigations or management

3. Complaints

4. Capacity and consent

5. Confidentiality

6. Mistake and duty of candour

Common examples

1. Breaking bad news

   1. Explain finding of a new lump on CT scan ?cancer

   2. Explain unsuccessful CPR for mother overnight, to daughter

   3. Found ethanol on blood test in ALD at transplant centre

   4. Discussion around stopping active ward care for an inpatient- diabetic foot ulcer/ sepsis/ CHF/ COPD/ ILD

2. New diagnosis of: 

   1. Diabetes- explanation and counsel

   2. Asthma or COPD

   3. First seizure/ epilepsy

   4. Stroke / TIA

   5. Rheumatoid arthritis

3. Explanation & consent for bedside procedures

   1. Lumbar puncture, ascitic drain, chest drain

   2. BBV tests

   3. CPR - consent for DNR with family

4. Capacity, informed consent & PoA/ NOK

   1. Mother being admitted for a lumber puncture ?SAH who has young children at home

   2. Lady with dementia declining treatment for sepsis with daughter who has PoA

5. Complaints & duty of candour

   1. Dealing with a family complaint about their mother receiving  chest drain in the wrong lung

   2. Explain you've made a prescription error to a patient

   3. Angry family member unhappy about blood transfusion given to father (Jehovah's Witness)

   4. Abusive patient about long wait for mother in acute medical receiving

6. Confidentiality

   1. Partner doesn't want to tell their wife they have HIV

   2. Wife doesn't want to tell abusive husband she is in hospital

   3. Husband doesn't want son to know the cause of his death, related to poison overdose

Common Topics

Breaking Bad News

SPIKES

• Introductions

• Ask any questions relevant prior to breaking bad news as won't be able to easily afterwards- e.g. clarify their understanding;

• Warning shot & ask if they would like someone to be present with them

• Break the bad news- relatively quickly and simply

• Pause, take it slow, allow patient to dictate, be kind/ polite, tissues/ cup of tea, tissues, 

• Acknowledge cues - will raise them twice but not a third

• Explain next steps simply, avoid jargon

Explanation of condition

• Introductions and clarify their understanding

• Explain simply and allow patient to direct

• Avoid too much information and too technical

• Next steps

• Identify uncertainty as uncertainty

• Take it slow and don't over burden with information

Capacity, Consent & POA/ NOK

• Capacity is ability to understand, weigh up, retain and communicate risks and benefits, including no action

• Informed consent can only be given with adequate information & capacity

• Consent is written or verbal

• A PoA is only relevant when the patient doesn't have capacity

• When the patient doesn't have capacity, a PoA can consent as if they are the patient; including declining treatment

• If the medical team disagree with the PoA they must take them to court to attempt to overule

• Consent is assumed over the age of 16 and Gillick Competence 12-16yrs

• NOK has no legal basis in clinical decision making, however has right to be updated and to a second opinion

• The NOK & POA has to be updated for DNR decisions but has no decision making status

• Advanced directives should be respected where possible 

Complaints & Duty of Candour

Discussion

• Identify the mistake, the cause, family concerns and give a fair assessment, 

Duty of candour

• Ensure patient is stable and safe

• Explain to patient/ family

• Apologise

• Explain what will be learned- individual and system changes

Complaints

• PALS

  • Informal complaint: verbal explanation

  • Formal complaint: written explanation

• Ombudsman (national) legal party- review, outcomes

  • Financial

  • Change in policy

  • Apologise

Confidentiality

Indications to break: 

• Informed consent with capacity

• Risk to public

  • Notifiable disease- inform Public health

  • Serious crime e.g. murder/ terroism [police]; 

  • Serious infectious disease HIV- responsibility

  • DVLA if patient drives despite medical advice

  • Social work: domestic violence, child abuse

  • Public knowledge: e.g. a patient passing away

• Risk to self

  • Suicide/ delibrate self harm

  • Lacks capacity- update family e.g.

Indications not to break:

• Refused consent with capacity & nil risk to self, person or public

• STI- encourage to tell partner but don't break confidentiality

• Mild drug use isn't required to be reported to police

• Confidentiality persists after death, e.g. cause of death (HIV)

• Majority of information is shared amongst healthcare workers with implied consent

How to break confidentiality

• Inform patient

• Minimum information required

• Maintain anonymity where possible

• Explain to patient why is necessary

• Ideally tell patient required to break confidentiality before they disclose the information

Example Scenarios

• Discuss withdrawing treatment of an individual on long term life support, family POA- would like to continue care

Ethical Principles

• Autonomy

• Justice

• Beneficence

• Maleficence

Autonomy is the patient ability to make their own decisions, if they've got capacity. Particularly, their ability to give informed consent once they've understood, weighed up, retained and communicated the risks and benefits of each decision option, including doing nothing. Patients have the ability to make decisions against the medical advice. 

Justice describes the fair allocation of limited resources. Particular examples include organ transplantation, where the reality of one patient receiving an organ, means another patient cannot. Therefore, there is a responsibility to ensure these resources are used to maximal benefit and shared fairly across society. 

Beneficence is the principle of doing good. For example, when a patient has no capacity or NOK, doctors should try to acting in the patients best interests. 

Malficence similarly is the idea of not causing harm. This is important when starting medications or interventions, as they always have risks and the ability to cause harm. 

Landmark UK Cases

Discussion

Right to die

As of April 2026, there is no right to die in the UK and such acts are unlawful. 

Written in 2026