Communication Skills
Communication Skills tests breaking bad news, shared decision-making, motivational interviewing, working with interpreters, disclosing errors, and handling complaints. The exam looks for structure, empathy, and patient-centered language.
Core rules
- SPIKES: setting, perception, invitation, knowledge, empathy, strategy and summary.
- Motivational interviewing uses open questions, affirmation, reflection, and summarization; avoid confrontation.
- Shared decision-making presents options, benefits, harms, and patient preferences.
- Use a trained interpreter, not a family member, for sensitive information.
- Disclose medical errors promptly, apologize, explain, and describe prevention.
Worked example
A 55-year-old smoker with 20 pack-years wants to stop but has failed before. Reasoning: use motivational interviewing. Ask what he knows and what worries him, affirm previous attempts, reflect ambivalence, and offer nicotine replacement and follow-up. Do not lecture or say 'just stop.' Agree on a quit date and a plan.
Traps
- Giving false reassurance ('It will be fine').
- Using jargon such as 'lesion' without explanation.
- Letting a relative interpret bad news.
- Avoiding an apology after an error.