Breaking bad news
PLAB pack: communication OSCE
Theory
Theory 1: Station focus
Breaking bad news tests empathy, warning shot, pauses, information chunking and support.
- Patient's current understanding.
- Permission to share information.
- Emotion response and support plan.
Theory 2: Reasoning path
The priority is communication safety: do not overload the patient or ignore emotion.
- Identify the immediate risk.
- Choose the safest first action.
- Explain why the distractors are weaker.
Theory 3: Expected output
The candidate should use a warning shot, clear language and empathetic follow-up.
- Assess understanding.
- Warning shot and clear news.
- Pause, respond to emotion and plan support.
Vocabulary and model dialogue
Doctor: Can I check what you understand about the tests so far?
Patient: I know it might be serious.
Doctor: I am sorry, the results show cancer. I will pause here.
Practice
Practice 1: Stem analysis
A patient asks for biopsy results that confirm cancer.
Output: Age, timing, symptoms, vital risk and one missing question.Practice 2: First action
Choose the first safe action: Check understanding and give a warning shot before sharing the result.
Output: One action plus clinical reason.Practice 3: Differential
Compare Use a structured empathetic bad-news approach with two alternatives.
Output: Three-line differential table.Practice 4: Exam response
Write the first six lines of the conversation.
Output: Empathetic script.Interactive tasks
Interactive 1: Red-flag sort
Sort findings from "Breaking bad news" into urgent and non-urgent details.
Interactive 2: Distractor removal
Remove the least plausible option from: Give all details rapidly, Avoid the diagnosis word entirely, Leave immediately after the result.
Interactive 3: Timed response
Give a 90-second exam answer using the station output steps.
Quiz
Checking understanding and warning the patient prepares them safely.
The safest answer addresses the immediate clinical risk first.
Exam documentation must record the detail that changes management.
Safe exams include patient understanding and escalation advice.
The station expects a short, defensible clinical chain.