How to break bad news in an OSCE (the SPIKES framework)
To break bad news in an OSCE, use the SPIKES framework: set up the encounter, find out what the patient already knows, ask how much they want to know, give the information simply with a warning shot, respond to emotion with empathy, and agree a clear next step. Examiners reward warning the patient, pausing after the news, and following the patient's cues rather than reeling off facts.
S — Setting
Ensure privacy, sit down, introduce yourself, and check who the patient is. Silence your distractions and signpost that you have something important to discuss.
P — Perception
Find out what the patient already understands: "What have you been told so far?" This calibrates where to start.
I — Invitation
Ask how much they want to know: "Would it help if I explained what we've found?" Some patients want everything; some want it in stages.
K — Knowledge
Give a warning shot ("I'm afraid the results are not what we hoped"), pause, then deliver the news in plain language — one chunk at a time, no jargon.
E — Emotions
Stop and respond to emotion before facts. Name it ("I can see this is a shock"), allow silence, and show empathy. This is where most marks are won or lost.
S — Strategy & summary
Agree a concrete next step, check understanding, offer support and written information, and safety-net. Summarise and ask if they have questions.
Frequently asked questions
What is the most common mistake when breaking bad news in an OSCE?
Delivering the information too fast without a warning shot and then talking over the patient's emotional reaction. Pause after the news and respond to emotion before giving any more detail.
Should you give a prognosis if asked?
Acknowledge the question honestly, give a realistic but non-specific answer, and avoid precise timeframes you can't support. Examiners look for honesty paired with sensitivity, not false reassurance.
How do you practise breaking bad news on your own?
Rehearse out loud against a simulated patient that reacts emotionally, so you build the habit of pausing and responding to cues. MedMock lets you run these stations repeatedly with instant feedback.
Practise this in a real station
Rehearse these skills out loud with MedMock's AI patient and examiner in the exams this matters for: