MRCEM/FRCEM OSCE( Breaking Bad News )

structured approach for the Breaking Bad News station in the MRCEM OSCE exam:

⸻

1. Preparation (before entering the station) 

• Read the scenario carefully. 

• Understand the key facts, diagnosis, and your role. 

• Identify the patient’s relationship to the patient (relative, parent, etc.).

⸻

2. Introduction 

• Wash hands, introduce yourself with name and role. 

• Confirm who the person is and their relationship to the patient. 

• Ensure privacy and create a quiet, non-rushed environment. 

• Ask: “Is it okay if we sit down and talk for a few minutes?”

⸻

3. Setting the Agenda / Warning Shot 

• Gently lead into the conversation: 

• “I’m afraid I have some difficult news.” 

• “Things are not as we had hoped.”

⸻

4. Delivering the News (SPIKES model adapted)

S – Setting 

• Ensure a calm, private setting (already done above).

P – Perception 

• Ask what they already know: 

• “Can you tell me what you understand about what’s happened so far?”

I – Invitation 

• Check how much they want to know: 

• “Would you like me to explain what’s been going on?”

K – Knowledge 

• Deliver the news clearly and sensitively: 

• Avoid jargon. 

• Use short, clear sentences. 

• Pause frequently to allow processing. 

• Example: “I’m very sorry to tell you that despite all our efforts, we were not able to save your husband. He has died.”

E – Emotions • Acknowledge and respond to emotion with empathy: • “I can see this is very upsetting.” 

• “I’m so sorry for your loss.” 

• Give them time to react.

S – Summary and Support 

• Summarize what happened in simple terms. 

• Offer support (chaplain, bereavement services, police if needed). 

• Answer any questions honestly. 

• Provide next steps (e.g., viewing the body, speaking with other staff).

⸻

5. Closure • Ask if they have any questions. 

• Offer to stay with them or call someone. 

• Thank them for their time and reassure them of support.

⸻

Tips for OSCE Success 

• Be calm, composed, and compassionate. 

• Use silence effectively. 

• Show empathy non-verbally (gentle tone, eye contact). 

• Avoid delivering all information at once—pace it. 

• Practice scenarios involving death, missed diagnoses, or serious illness.Stay tuned for upcoming exams Tips

_{Khaled Khalifa}

_{Consultant Emergency Medicine}

_{Manchester University NHS Foundation Trust ,Uk}

_{Wythenshawe Hospital}