Why Communication Stations Are Tested
Effective communication is the cornerstone of safe clinical practice. Explaining a diagnosis is one of the most common and highest-stakes communication encounters in medicine — done poorly, it leads to poor concordance, patient distress, complaints, and safety incidents. The GMC's Good Medical Practice and the Calgary-Cambridge framework both emphasise patient-centred communication as a core competency.
💡 Tip
Communication stations are not just about what you say — examiners are closely watching how you say it: your body language, use of silence, ability to respond to cues, and whether you genuinely check understanding. A technically perfect explanation delivered without empathy will score poorly.
Common Scenarios for This Station
- Explaining a new diagnosis of type 2 diabetes
- Explaining a new diagnosis of hypertension
- Explaining a new diagnosis of atrial fibrillation
- Explaining a positive biopsy result (cancer diagnosis)
- Explaining the need for anticoagulation
- Explaining a new diagnosis of COPD or asthma
- Explaining the results of an investigation (e.g., CXR showing a lesion)
The Calgary-Cambridge Framework
The Calgary-Cambridge Observation Guide is the most widely used consultation framework in UK medical education. It structures the consultation into five phases:
| Phase | Key Tasks |
|---|---|
| Initiating the session | Greeting, rapport, agenda setting |
| Gathering information | Open questions, exploration of ICE, summarising |
| Physical examination | (May not apply in communication station) |
| Explanation and planning | Chunk and check, use of language, management plan |
| Closing the session | Summary, safety-netting, follow-up |
ICE — Ideas, Concerns, and Expectations
Before explaining, always elicit the patient's perspective using ICE. This prevents talking past the patient's real worries.
| Component | Opening Question |
|---|---|
| Ideas | *"What have you been thinking might be causing your symptoms?"* |
| Concerns | *"Is there anything in particular you're worried about?"* |
| Expectations | *"What were you hoping we might be able to do today?"* |
💡 Tip
Always elicit ICE before explaining the diagnosis. If the patient says *"I'm worried it might be cancer"* and you then tell them they have type 2 diabetes, you must address their concern explicitly: *"I'm glad you mentioned that — from everything we've found, this is not cancer. What you have is..."*
Structure for Explaining a Diagnosis
1. Setting and Introduction
Before starting:
- Ensure privacy and a quiet environment
- Sit down (never stand over the patient)
- Introduce yourself and confirm the patient's identity
- If delivering significant news, offer for someone to accompany the patient: *"Before I explain your results, would you like me to call anyone to be with you?"*
2. Signposting — Warning Shot
Before delivering difficult news, a warning shot prepares the patient:
- *"I have the results of your tests, and I need to share some important information with you."*
- *"I'm afraid the results are more significant than we hoped."*
This is particularly important when explaining a cancer diagnosis or serious condition.
3. Elicit ICE First
*"Before I go through the results, can I ask what has been going through your mind?"*
4. Chunk and Check
Divide information into manageable chunks and check understanding after each:
- Give a small piece of information
- Pause and check: *"Does that make sense so far?"*
- Invite questions: *"What questions do you have about that?"*
- Continue to the next chunk only when the patient is ready
Do not deliver a continuous 3-minute monologue. Break it up.
5. Use Plain Language
Avoid medical jargon. Use analogies where helpful:
| Medical Term | Lay Language |
|---|---|
| Myocardial infarction | Heart attack |
| Hypertension | High blood pressure |
| Malignant | Cancerous |
| Atrial fibrillation | Irregular heartbeat |
| Type 2 diabetes | Diabetes — a condition where the body cannot control blood sugar properly |
| Anticoagulant | Blood thinner |
6. Address Ideas, Concerns, and Expectations
After explaining the diagnosis, return to ICE:
- *"Earlier you mentioned you were worried about [X]. Now that I've explained this, how does that sit with you?"*
- *"Is there anything I haven't addressed that you're still wondering about?"*
7. Shared Decision-Making and Management Plan
Involve the patient in planning:
- *"There are a few options here — can I walk you through them so we can decide together what might suit you best?"*
- Explain treatment options in plain terms with benefits and risks
- Use the option grid or similar decision aid if available
- Respect the patient's autonomy: *"Ultimately this is your decision and I'll support whatever you choose."*
8. Check Understanding — Teach-Back Method
To confirm understanding:
- *"I've given you quite a lot of information today. It would help me to know you've taken it in — could you tell me in your own words what you understand about your diagnosis?"*
- Do not say: *"Do you understand?"* — this is a closed question and patients almost always say yes regardless
9. Written Information and Support
- Offer a leaflet or printed information
- Signpost to reputable online resources: *"Diabetes UK at diabetes.org.uk has excellent information and support"*
- Offer support groups, specialist nurse, or helplines
10. Safety-Netting and Follow-Up
Always close with clear safety-netting:
- *"If you notice [specific symptom], please seek urgent medical attention / call 999."*
- Confirm follow-up: *"I'd like to see you again in [timeframe]. If anything changes or you have questions before then, please don't hesitate to contact the surgery."*
Example Script — Explaining Type 2 Diabetes
*"Mrs Smith, thank you for coming in today. I've got the results of your blood tests, and there are some important things I'd like to go through with you. Before I do that — can I ask what's been on your mind?"*
[Patient responds]
*"Thank you for sharing that. So, your results do show that your blood sugar is higher than normal — this is what we call type 2 diabetes. I know that might sound alarming, so I'd like to explain what that means. Is that okay?"*
[Patient nods]
*"Type 2 diabetes is a condition where the body either doesn't make enough insulin — that's the hormone that controls blood sugar — or doesn't respond to it as well as it should. This means that sugar builds up in the blood rather than being used for energy. Does that make sense so far?"*
[Check for understanding]
*"The good news is that type 2 diabetes is very manageable, and many people live completely normal lives with it. There are things we can do to get your blood sugar under control and prevent complications down the line..."*
Responding to Emotion
When a patient becomes distressed, pause and respond to the emotion before continuing with information:
- Acknowledge: *"I can see this is quite a shock."*
- Normalise: *"It's completely understandable to feel that way."*
- Explore: *"Can you tell me more about what's worrying you most?"*
- Offer support: *"You don't have to face this alone — there are people who can help."*
⚠️ Red Flag
Never continue with medical information when a patient is crying or visibly distressed. Pause the information-giving and address the emotion first. Continuing to talk through tears suggests the doctor is not listening — a mark-losing behaviour.
Non-Verbal Communication
Examiners observe and mark non-verbal communication:
- Eye contact: maintain appropriate eye contact — not a stare, but engaged
- Posture: sit at the same level as the patient, slightly forward to convey engagement
- Silence: use silence after sharing difficult news — do not rush to fill it
- Facial expression: should reflect the tone of the conversation (serious when delivering serious news)
- Nodding and active listening cues
Common Mistakes
- Delivering all information without pausing to check understanding
- Not eliciting ICE before explaining
- Using jargon without explanation
- Not acknowledging emotion before continuing
- Closing without safety-netting or follow-up
- Rushing the consultation due to time pressure (examiners note this)
- Asking *"Do you understand?"* instead of using teach-back
Examiner Tips and Mark Scheme Pointers
Mark schemes typically award points for:
- 1Appropriate introduction and establishing rapport
- 2ICE elicited before diagnosis explained
- 3Warning shot before serious news
- 4Chunk-and-check approach used throughout
- 5Plain language used throughout
- 6Emotion acknowledged and responded to appropriately
- 7Shared decision-making in management plan
- 8Teach-back or equivalent comprehension check
- 9Written information and support resources offered
- 10Clear safety-netting and follow-up arranged
Frequently Asked Questions
"What is the single most important thing to do before explaining a diagnosis in the OSCE?"
Before explaining any diagnosis, you must elicit ICE — the patient's Ideas, Concerns, and Expectations. Ask: "Before I go through the results, can I ask what's been going through your mind?" This prevents talking past the patient's real concerns and is consistently the first clinical mark on the communication mark scheme. If a patient is terrified of cancer and you explain their condition without addressing that fear, you will lose marks for patient-centredness even if your explanation is medically accurate.
"What is the chunk-and-check technique and how do you demonstrate it in the OSCE?"
Chunk-and-check means dividing information into small pieces and verifying comprehension after each before continuing. In practice: share one concept, then pause and ask "Does that make sense so far?" or "What questions do you have about that?" — then only proceed when the patient signals they are ready. This technique is marked directly on most communication OSCEs. Delivering a 3-minute uninterrupted explanation without checking understanding is one of the most common reasons candidates fail communication stations, regardless of the quality of the information given.
"What is the teach-back method and why is it better than asking 'Do you understand?'"
The teach-back method asks the patient to explain back what they have understood in their own words — for example: "I've given you quite a lot of information today. It would help me to know you've taken it in — could you tell me in your own words what you understand about your diagnosis?" This reveals genuine comprehension rather than polite nodding. "Do you understand?" is a closed question that patients almost always answer with "yes" regardless of actual understanding, making it ineffective and a mark-losing substitute for teach-back.
"What is a warning shot and when should you use it in the diagnosis explanation OSCE?"
A warning shot is a short statement that prepares the patient for difficult news before it is delivered: "I'm afraid the results are more significant than we hoped" or "I have some important news to share with you." It gives the patient a moment to brace themselves and signals that something serious follows. Warning shots are essential when delivering a cancer diagnosis, a serious new condition, or any news that is likely to be distressing. Delivering serious news abruptly without a warning shot is non-empathic and is marked as a communication failure.
"How do you respond when a patient starts crying during the explanation?"
When a patient becomes distressed, stop delivering information immediately and respond to the emotion first. Use the NURSE mnemonic: Name the emotion ("I can see this is very upsetting"), Understand ("It's completely understandable to feel that way"), Respect ("You've shown real courage in coming today"), Support ("You don't have to face this alone"), and Explore ("Can you tell me what's worrying you most right now?"). Only resume information-giving when the patient signals they are ready. Continuing to talk through a patient's tears is one of the most heavily penalised behaviours in a communication OSCE.
"What must every explanation station end with to score full marks for safety-netting?"
Safety-netting requires two components: (1) specify which symptoms or changes should prompt the patient to seek urgent medical attention and give a route — "If you develop [symptom], please call 999 / attend A&E / contact the surgery urgently"; and (2) confirm a clear follow-up plan with timeframe — "I'd like to see you again in [X weeks]. If anything changes or you have questions before then, please don't hesitate to call the practice." Also offer written information (a leaflet or website) and support resources. Closing without safety-netting — even after a perfect explanation — consistently loses candidates marks for patient safety.
Related guides: Alcohol History and Brief Intervention OSCE · Breaking Bad News OSCE Guide · Consent and Capacity OSCE · OSCE Communication Mistakes