Clinical Skills and Communication (Interview and Physical Examination)
This domain tests interview structure, examination technique, and communication behaviour, usually through written vignettes or observed encounters. Marks are lost by skipping steps, not by lacking knowledge.
Core rules
- Calgary–Cambridge structure: initiate (greet, confirm consent, negotiate the agenda), gather information (open then closed questions; elicit ideas, concerns, expectations), build the relationship (non-verbal cues, empathy), explain and plan, and close with a summary and safety net.
- Physical examination: JVP measured as vertical height above the sternal angle with the patient at 45°; shifting dullness and fluid thrill for ascites; handgrip increases mitral regurgitation and VSD murmurs; squaring the shoulders relieves dynamic left ventricular outflow obstruction in hypertrophic cardiomyopathy.
- Breaking bad news (SPIKES): Setting, Perception, Invitation, Knowledge, Empathy, Strategy and summary.
- Informed consent and shared decision-making require capacity, voluntariness, disclosure of material risks and alternatives, and documentation.
- Health literacy: use professional interpreters, avoid jargon, and confirm understanding with teach-back.
Worked example
A patient with newly diagnosed pancreatic cancer asks, "Am I going to die?" Reasoning: first explore what the patient already understands and how much they want to know ("What have you been told so far?"). Give information in small chunks, respond with empathy ("I can see this is frightening"), and agree the next step together. Do not volunteer a survival figure before assessing their information preference.
Traps
- Premature reassurance ("Don't worry") that closes down disclosure.
- Asking only closed questions and never discovering the patient's real agenda.
- Explaining in jargon without checking understanding.
- Skipping the summary and safety net at the end of the consultation.