Breaking Bad News in Medical Interviews

Introduction

• Topic: Breaking bad news in medical school interviews.
• Purpose: Test ability to remain calm under pressure and empathize with patients.
• Relevance: Vital skill for doctors who regularly need to break bad news.
• Framework: Introduction to the SPikes framework for delivering bad news.

Importance of the Skill

• Role play scenarios include:
  • Non-clinical (e.g., breaking a social commitment).
  • Clinical (e.g., delivering a terminal cancer diagnosis).
• Emphasizes empathy and active listening.

SPikes Framework

A mnemonic for delivering bad news effectively.

1. Setting (S)

• Create an appropriate setting for discussion.
• Ensure privacy if in a public area.
• Introduce yourself and confirm patient's identity.
• Example: "Hello, my name is David, I'm a junior doctor. Am I speaking with Jane?"

2. Perception (P)

• Ensure mutual understanding of the discussion's purpose.
• Example question: "What is your understanding of why we are meeting today?"

3. Invitation (I)

• Inform patient there is bad news and ask permission to proceed.
• Provides emotional preparation.
• Example: "I have some bad news. Is this an appropriate time to discuss with you?"

4. Knowledge (K)

• Deliver the news clearly, avoiding jargon.
• Explain in a sensitive manner.

5. Emotion (E)

• Allow time for processing and emotional response.
• Encourage patients to express their feelings with open questions.
• Display empathy and active listening.

6. Summary (S)

• Recap the information and discuss next steps.
• Offer to answer further questions.
• Example: "I'm sorry this news has upset you. Is there anything I can do to help?"

Live Example

• Scenario: Dr. Reed informing Mr. Parker, an athlete, that his injury will prevent competing in upcoming games.
• Demonstrates the use of SPikes framework in practice.
• Key points:
  • Dr. Reed sets the scene and confirms identity.
  • Explains the injury and anticipated recovery time.
  • Allows Mr. Parker to express disappointment and explore options.
  • Concludes with an offer for further discussion.

Conclusion

• Encouragement to use SPikes framework in practice.
• Invitation for questions or specific scenario discussions.
• Call to action for video engagement (Like, Subscribe).

Note: This framework can be adapted for both medical and dentistry interviews.