OSCEs are interesting beasts. They are terrifying whilst simultaneously quite good fun, and I personally end up learning as much from doing the OSCE itself as I do revising for it in the first place.
One brand of OSCE station that comes up is Explaining and Communicating, in which one must demonstrates one’s prowess in the task of bringing a patient up to speed on a condition, treatment, test result etc. in as kind, clear and concise way as possible. You can’t drown them in information, but you have to tell them enough, and you can’t be overly reassuring but you equally don’t want to crush their spirit. So what’s the secret?
Not the answer people want to hear the night before an exam, but truly the only way to master a task this demanding is through experience, working out what works best for you and seeing how patients respond. However no amount of practice is going to help if you don’t have a good recipe in the first place, so here’s a summary of what should be done in any explaining station, if you want to be on the right track.
1. You’re a doctor
Or medical student. That means you have to:
- do no harm
- wash your hands
- ensure you have the right paitent!
- don’t say anything that will unnecessarily upset your patient
- protect vulnerable patients (eg children, abused partners, very ill patients)
- respect the patient as an individual
- give them accurate, relevant information
- allow them to make their own decisions
- do right by the patient
- tell them what you would like to know in their position
- try and help the patient
- give options for treatments
- give reassurance where appropriate
- provide emotional support
- ensure they always leave with a plan
Sometimes you may have to hurt the patient (giving bad news, venepuncture, reducing a fracture) but in these circumstances the others (try and help, do right by the patient) are of greater influence. Your job as a medical professional is to decide which are the most important in each situation, based on where the patient’s best interests lie. Clinical judgement. Fun.
2. What do they know already?
This bit is arguably the most useful for you as the explainer. Ask the patient what they’ve been told so far, or what they understand, and what they say will save you huge amounts of time, as you’ll then know:
- at what level to pitch the information
- what they know, and so you don’t need to talk about
- what bits they’re concerned about
The last one is important, because you might think you know what the salient information is in a particular consultation, but only the patient knows what they want to know about, and that’s why they’ve come to talk to you. So ask them and ye shall find.
3. Confidentiality is key
A doctor has a privileged position of being able to keep secrets. Patients should be able to discuss absolutely anything they like with the doctor without fear of embarrassment/repercussion. There are a very few cases where you are required by law to disseminate information to the relevant authorities (knife/gunshot wound (Police), epilepsy (DVLA) (make sure you tell patient to tell them first and say you’ll have to tell the authorities if they don’t) however the vast majority of the time, you should never ever ever share anything anyone has told you outside of the medical team working on the case. So in your explaining station, think:
- Does this person need to know this information?
- (eg parent asking about their infants’s condition vs asking about adolescent’s condition)
- Am I breaking confidentiality by revealing this?
- Should I conduct this conversation with/without patient’s relative/partner/friend in the room?
4. Know your limits
Sometimes you won’t know the answer to their question. Don’t lie, don’t make something up, don’t say “I have no idea”, but say something useful, such as:
- What I’ll do is print you out a leaflet with all the information that you can take home with you
- There is fantastic information on the NHS/Patient websites
- I’ll double check what the current guidelines say and let you know
Half of the time in an OSCE you’re thinking only about what you’re going to say or do next. This is fine (to some extent) in a procedure or an examination, but in an explaining or history-taking station it’s a surefire way to get stuck. Remember:
- The patient/actor has been given a list of answers
- They have been given the important information that you need to elicit, so when they start telling you – actively listen to what they’re saying!
- Thinking about what you’re going to do next can actively lead you astray
- Particularly with history stations, you might be thinking “I have to ask about this” meanwhile the patient is telling you a symptom that completely changes your differential – listening and clarifying things they say (what type of pain/when is it worst/what does the discharge look like? will be much more likely to provide you with your answer)
- If you’re stuck, ask them for help!
- It’s a little more subtle than that, but saying something like ‘Is there anything else you think I should know about/Do you have any thoughts about what it might be?’ can get you out of hot water.
Of course each station will be different, and will require its own emphasis on explaining prognoses/addressing concerns etc but as long as you follow these 5 guides, you’re unlikely to do too badly.
As always – if you disagree or feel I’ve missed anything please comment!