Interpersonal and Communication Skills in the Practice of Osteopathic Medicine
The Interpersonal and Communication Skills domain tests what you actually say, and how, in high-stakes encounters: new serious diagnoses, nonadherence, conflict, limited health literacy, and decisions near the end of life. Level 3 items are usually phrased as 'what is the best next response,' so the correct answer is a specific communication behavior, not a reassuring generality.
Breaking bad news: SPIKES
Setting (private, seated, tissues, asking who should be present); Perception ('what have you been told so far?'); Invitation ('how much detail would you like?'); Knowledge (warning shot, plain language, no jargon, no false reassurance); Emotions (name and validate before returning to facts, as in 'I can see this is shocking'); Strategy and Summary (next steps, follow-up, written plan).
Motivational interviewing
OARS: open questions, affirmations, reflections, and summaries. Evoke change talk and suppress the righting reflex. Roll with resistance rather than confronting it. Use importance and confidence rulers ('on a scale of 1 to 10, why a 3 and not a 1?'). Ask permission before advising ('would it be okay if I shared something?'). The 5 A's structure brief tobacco and alcohol interventions: Ask, Advise, Assess, Assist, Arrange.
Shared decision-making and consent
Lay out the diagnosis, all options including no treatment, risks and benefits, and the patient's values. Confirm understanding with teach-back rather than asking 'do you understand?'.
Language access and health literacy
Use a trained medical interpreter, not a family member, for clinical discussions; speak to the patient in first person, not to the interpreter; avoid idioms. Apply universal literacy precautions with plain language and chunk-and-check pacing.
Disclosure and emotion
Disclose errors fully and early with an apology and a plan, and document the conversation. Use NURSE for emotion: Name, Understand, Respect, Support, Explore. Close every encounter with a plan, a timeframe, and a safety net ('return if...').
Worked example
A 58-year-old man just told he has pancreatic cancer says, 'I don't need treatment, I feel fine.' He has capacity; this is avoidance, not incompetence. Name the emotion, explore his understanding, ask permission before giving facts, then use motivational interviewing: 'What would make it worth talking about options?' Shared decision-making, not confrontation, comes next.
Traps
Answering an emotional statement with a data dump. Promising outcomes. Using a family member as interpreter. Speaking to the interpreter instead of the patient.