Communication stations test your ability to handle difficult conversations with patients, their next of kin, or colleagues while working as a trainee in NHS. This scenario shows you how this interview station can play out. Use it as a learning and reflection tool for your own practice.
Scenario:
The patient, Mr. Button, is a 25-year-old male with a history of intravenous drug use (IVDU). Mr Button was admitted with right groin bleeding; a CT scan revealed that he had developed a pseudoaneurysm. The on-call vascular team performed a ligation of his CFA. During a ward round review the next day, it was discovered that Mr. Button’ leg was ischaemic and non-viable, necessitating an above-knee amputation.
You have been asked to inform the father about his son’s condition. Additionally, Mr. Button has consented to the disclosure of his intravenous drug use to his father. His father is unaware of his son’s drug use and the severity of the condition.
Response:
Panellist:
So the next patient’s communication scenario, so in front of you, you should have the brief, which I’ll read to you.
Mr. Button is a 25-year-old male intravenous drug user who’s been injecting into his groin. He’s been admitted with a bleed in his groin, and a CT scan showed a false aneurysm.
He undergoes ligation of his common femoral artery for this. At review on the ward round the next day, it’s evident that Mr Button has a non-viable leg, which needs an above-knee amputation. Mr Button has asked you to speak to his father, who’s coming to visit him.
Mr. Button tells you that his father was unaware of his drug use but consents to sharing details with his father about his condition.
So, you’re not being assessed on your clinical knowledge of this condition but on your communication skills. Mr W, will act as Mr. Button’s father.
Candidate:
Okay. Good afternoon.
Could I just confirm your name?
Panellist:
My name is Mr Button.
Candidate:
Okay. It’s a pleasure meeting you, Mr Button.
I am Johnathan. I’m one of the surgical doctors. I’m here to speak to you about your son and the condition that he has.
Is this a good place and time to speak?
Panellist:
Yes, please.
Candidate:
Is there anybody else you’d like with you or you’re fine for us to continue?
Panellist:
Just happy for us to continue as we are.
Candidate:
Thank you. All right.
As you understand, your son has been with us in the hospital. Do you have any knowledge of the condition that he has?
Panellist:
I know it’s a problem with his leg. I don’t think he’s had problems with his leg before, so I presume he’s fallen or hurt himself. I can only presume that’s what’s happening.
Candidate:
Well, I’m afraid Mr Button, your son’s situation is a bit more complex than that, and I have some bad news that I’d like to explain to you.
Your son has two issues. One is he came in with a swelling in his groin, and in order for us to be able to treat him and save his life, we did an operation that involved us tying one of the arteries that supplies the lower limb.
On later on reviewing and seeing how the limb is, it turns out that the limb currently is not viable, meaning it’s dead and will need to be amputated.
Panellist:
Sorry, dead, did you say?
Candidate:
The limb itself, the lower leg, is not viable, yes. The limb is dead and will need to be amputated.
Panellist:
As in, sorry, the leg is dead, so as in the toes need amputated?
Candidate:
Not just the toes, the entire leg, just above the knee. So everything, everything else below that will need to come out.
Panellist:
Why can’t he just take his toes away or his foot? If his foot’s bad, why does the leg need to come off?
Candidate:
Okay, the issue is according to our review and the investigations that we’ve done, we’re able to see that he does not have blood supply to that segment of his lower limb. Therefore, we are unable to save anything below that point, and if he was to stay without the operation, then this limb would be at risk of causing harm and injury to the rest of his body.
It can get infected and can lead to infections spreading to the rest of his body, and this would be harmful and may even lead to actual death.
Panellist:
That sounds terrible. What’s caused this? Why has he got swelling in his groin? Is that like a hernia?
Candidate:
Okay, so the cause is also concerning, and what we’ve been able to find out is that your son has for a while now been using IV drugs, intravenous drugs.
Yeah, I know this is tough and you may not be aware of this. I’m sorry about that.
Panellist:
This is definitely not my son. My son has never used drugs before, never used drugs!
Candidate:
Yeah, I’m sorry. This news might be a bit shocking, and I’m sure he has not disclosed this to you, but he would like us to disclose this to you.
So, yes, he has been using IV drugs, and he’s been injecting the drugs through the groin, and that’s what actually caused his initial injury and swelling in the groin, and that’s what’s led to the condition that he has.
Panellist:
I know, but he’s got a car, and he’s got a job, he’s got a house with stairs. What’s going to happen? How can he ever do any of these things again?
Candidate:
Yeah, I’m very sorry about it.
What our main concern at the moment is his health safety in general. We’d like to ensure that we do the amputation, and that we’re able to save his life.
Additionally, there are other things we’d like to support him with in future.
He’ll still be able to be active. We’ll involve, our orthotics team. This is a team that is able to come and look at him and see which prosthetics he will need to be fitted, and he can have occupational therapy that would help him to have a prosthetic limb, and this would still be useful for his activity moving forward.
In addition to that, we will provide other support services. We have a counselling team that is able to provide support for his drug use, and I’ll organize more information for you, give you some documentation, and offer as much support as we can as a hospital to help him overcome the drug use.
Panellist:
Who’s going to help him get the wooden leg and the house and all these things?
Candidate:
Yeah, so I’m going to contact all these teams. I’m going to talk to, together with the nursing team, and do a referral for the orthotics team, as well as the occupational and physiotherapy team that would be able to assist him, and I’ll provide you with all the information that you need, and your son as well.
I know this might be a lot to take at the moment, so I can give you some time and come back a bit later with more information, and we can have further discussion after that.
Panellist:
And can he come home and then get his leg amputated so that we can at least sort out, I can try and get him to stop taking drugs, and we can sort out his house and his work and things?
Candidate:
Well, like I said, the main issue that we’d like to do is be able to save your son’s life and ensure that he’s safe, and in order for us to do that, he cannot go home prior to the amputation being done.
The amputation is an emergency procedure that we need to do in order for us to be able to save his life.
Panellist:
I’m quite worried that he’s going to continue using drugs. What can we do? I don’t know if he’s going to stop his other leg or his arms or other places.
Candidate:
Well, I understand your concern, and that’s a possibility if he continues using the drugs. And we would like to be able to provide you with as much support as you can and direct you to the right people who will be able to help him.
And if you, yourself and the family as well, feel like you’re able to support him and have him live with you at home and provide him enough support, I think all these things together is what will make your son be in a situation where this doesn’t happen again.
So we’ll have to work together with you, with the hospital team, with the support teams that I’ll introduce you to in order for us to be able to help your son and prevent this from happening in the future.
Panellist:
Okay. Well, it’s a huge shock, but thank you for the explanation.
Candidate:
Yeah. I’m so sorry about the news.
I’d just like to break it down again to ensure that we’re on the same page. So, as I mentioned, the priority right now is to save his life. And in order for us to save his life, we have to do the amputation.
But after the amputation is done, there’s a lot of support that we’re going to give for him to have a prosthetic as well as occupational therapy for him to get back to his life.
But as well, we’ll provide more support in terms of his IV drug use. And with your help, we’ll work together as a team to prevent this from happening again.
Panellist:
Okay. Thank you very much.
Candidate:
Thank you so much.
Panellist:
Okay. Anything else you want to add at all?
Candidate:
Yeah, probably I’ll bring over some leaflets as well.
Panellist:
Okay.
Score:
| Communication Scenario | Score out of 5 |
| Empathy | 5 |
| Interaction with patient/ relative | 4 |
| Listening to patient/ relative | 5 |
| Fluency | 5 |
| Aggregate score: | 95% |
| Panellist comments: 1. Responded to questions well. 2. Clear communication. 3. Impressive communication skills. 4. Spoke to relative with empathy, compassion and kindness. | |
Detailed Feedback and Learning Points:
1. Empathy
Strengths:
- The candidate demonstrated strong empathy throughout the conversation, acknowledging the difficult emotions Mr. Button’s father might be experiencing. The use of phrases like “I’m so sorry about the news” and offering time for the father to process the information shows a compassionate approach.
- The candidate effectively balanced delivering bad news with a supportive tone, ensuring the father felt cared for during a distressing time.
Weaknesses:
- While the candidate expressed empathy well, there could be more personalization in responses.
- The candidate could have more explicitly validated the father’s shock and disbelief, especially when the father expressed that his son had “never used drugs before.” Acknowledging these feelings more directly could have reinforced the empathetic bond.
2. Interaction with Patient/Relative
Strengths:
- The candidate ensured that the father was comfortable before proceeding with the conversation, asking if it was a good time to speak and if he wanted anyone else present.
- The candidate handled the interaction respectfully, providing clear explanations and repeatedly checking in with the father to ensure he understood the situation.
Weaknesses:
- The interaction could have benefitted from a more gradual approach when introducing the son’s drug use. Given the father’s shock, a more delicate lead-in to this information might have softened the impact.
- The candidate might have missed an opportunity to offer additional support immediately, such as asking if the father needed someone to talk to or offering a moment to collect his thoughts before continuing. This could have made the interaction feel more patient-centered.
3. Listening to Patient/Relative
Strengths:
- The candidate demonstrated excellent listening skills, responding to the father’s concerns and questions thoroughly. The responses were tailored to the father’s immediate concerns, such as the extent of the amputation and the son’s drug use.
- The candidate also reassured the father by summarizing key points and confirming understanding, which shows an attentive and responsive communication style.
Weaknesses:
- Although the candidate listened well, there could have been more reflective listening. For example, when the father expressed disbelief about his son’s drug use, the candidate could have echoed his words more (“I hear that this is completely unexpected for you”) to show deeper understanding.
- The candidate could also have explored the father’s concerns further, perhaps asking more open-ended questions like, “Is there anything specific you’re most worried about right now?” This might have encouraged the father to express more of his thoughts and feelings.
4. Fluency
Strengths:
- The candidate spoke fluently and clearly, ensuring that the father understood the medical situation without using jargon. The communication was well-paced, allowing the father to absorb the information.
- The candidate effectively managed the flow of the conversation, balancing the need to deliver complex information with maintaining a compassionate and calm tone.
Weaknesses:
- While fluency was strong, there were moments where the delivery of complex medical information could have been simplified further. For example, the explanation of why the entire leg needed to be amputated could have been broken down more clearly to avoid confusion.
- The candidate might also consider slightly slowing down the delivery at key emotional moments to give the father more time to process the information. This would also enhance the empathetic tone of the conversation.
Mastering the communication station in the ST3 interview requires a blend of clinical knowledge and exceptional interpersonal skills. This scenario highlights the importance of delivering difficult news with empathy, ensuring clear and compassionate communication, and being attuned to the emotional state of the patient’s relatives. By reflecting and practising on examples like this, candidates can learn to handle such conversations for both the interviews and clinical practice. Continuous practice and feedback are essential to improve these skills.