Breaking bad news in an OSCE: a safe structure (SPIKES)

Breaking-bad-news stations frighten candidates, but they're very scoreable because a good structure carries you. The widely-taught SPIKES framework is a reliable backbone.

SPIKES, step by step

• S — Setting: ensure privacy, sit down, confirm who you're speaking to, minimise interruptions.
• P — Perception: find out what they already understand ("What have you been told so far?").
• I — Invitation: ask how much they'd like to know.
• K — Knowledge: give a brief warning shot ("I'm afraid I have some difficult news"), then the news in plain language. Pause.
• E — Emotions: respond to their reaction with empathy. Silence is allowed and often right.
• S — Strategy & summary: agree next steps, safety-net, and offer support and a point of contact.

What examiners reward

Pace, warmth, plain language, and responding to emotion rather than rushing past it. You are not expected to fix everything in 8 minutes — you're expected to do it humanely.

Rehearse the hard ones

These stations improve dramatically with practice. Try a station free and get feedback on your communication.

General communication-skills guidance for exam practice — not medical advice.