NAC OSCE Communication Skills — Questions and Answers
Question 1: A patient has just been diagnosed with cancer. Using the SPIKES protocol, what is the FIRST step before delivering the bad news?
- Immediately tell the patient the diagnosis
- Setting up the interview — ensuring privacy, sitting down, making eye contact, and minimizing interruptions (Correct answer)
- Ask the patient how much they want to know
- Provide a treatment plan
Correct answer: Setting up the interview — ensuring privacy, sitting down, making eye contact, and minimizing interruptions
The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary) begins with Setting up the interview. This means ensuring privacy, involving significant others if the patient wishes, sitting down at the patient's level, maintaining eye contact, and ensuring no interruptions. A proper setting demonstrates respect and creates a safe space for the difficult conversation.
Question 2: When obtaining informed consent for a surgical procedure, which element is MOST commonly omitted by physicians?
- The name of the procedure
- A discussion of reasonable alternatives to the proposed treatment, including the option of no treatment (Correct answer)
- The surgeon's name and qualifications
- The date of the procedure
Correct answer: A discussion of reasonable alternatives to the proposed treatment, including the option of no treatment
Informed consent requires discussing the nature of the procedure, risks, benefits, and reasonable alternatives — including the option of doing nothing. Physicians often focus on explaining the proposed treatment and its risks but fail to adequately discuss alternatives. Valid consent requires the patient to understand all their options to make a truly informed decision.
Question 3: A patient is angry because they waited 3 hours to see you. What is the MOST effective initial response?
- Explain that you were busy with other patients
- Acknowledge their frustration empathetically — 'I can see you've been waiting a long time and I understand that's frustrating. I apologize for the delay.' (Correct answer)
- Ignore the anger and proceed with the medical history
- Tell them they can leave if they are not happy
Correct answer: Acknowledge their frustration empathetically — 'I can see you've been waiting a long time and I understand that's frustrating. I apologize for the delay.'
Acknowledging the patient's emotion and validating their experience is the most effective de-escalation technique. This demonstrates empathy and respect. Once the patient feels heard, they are more likely to engage constructively. Defensiveness, dismissal, or ignoring the emotion typically escalates the situation. The NAC OSCE specifically assesses empathetic responses to emotion.
Question 4: When explaining a complex medical condition to a patient with limited health literacy, which communication technique is MOST effective?
- Use medical terminology to be precise
- Use plain language, the 'teach-back' method (asking the patient to explain what they understood), visual aids, and limit information to 2-3 key points per visit (Correct answer)
- Give the patient a medical textbook to read
- Speak louder and more slowly
Correct answer: Use plain language, the 'teach-back' method (asking the patient to explain what they understood), visual aids, and limit information to 2-3 key points per visit
Effective communication with patients who have limited health literacy requires plain language (avoiding or explaining medical jargon), the teach-back method (confirming understanding by asking patients to repeat the information in their own words), visual aids, and limiting key messages. Studies show that patients retain only 40-80% of medical information, and nearly half of what is recalled is incorrect.
Question 5: During a NAC OSCE station, a patient asks you 'Am I going to die, doctor?' How should you respond?
- Avoid the question and change the subject
- Acknowledge the question with empathy, explore what prompted it, provide honest information appropriate to the clinical situation, and address the patient's underlying fears and concerns (Correct answer)
- Say 'Everyone dies eventually' to deflect
- Provide a precise statistical probability of survival
Correct answer: Acknowledge the question with empathy, explore what prompted it, provide honest information appropriate to the clinical situation, and address the patient's underlying fears and concerns
This question requires empathy, honesty, and exploration. First, acknowledge the gravity of the question ('That's an important question, and I can see this is really worrying you'). Explore what prompted it. Provide honest, balanced information appropriate to the situation. Address the underlying fear — often patients are asking about suffering, family impact, or loss of control rather than seeking a precise prognosis.
Question 6: What is the role of 'motivational interviewing' techniques in a NAC OSCE encounter?
- To convince the patient to follow the doctor's recommendations
- To help the patient explore and resolve ambivalence about behaviour change by using open-ended questions, affirmations, reflections, and summaries (OARS) (Correct answer)
- To motivate the patient to exercise more
- To interview the patient about their career goals
Correct answer: To help the patient explore and resolve ambivalence about behaviour change by using open-ended questions, affirmations, reflections, and summaries (OARS)
Motivational interviewing (MI) is a collaborative, patient-centred approach to behaviour change. The OARS framework (Open-ended questions, Affirmations, Reflections, Summaries) helps patients explore their own motivations for change. It avoids confrontation, rolls with resistance, and supports self-efficacy. In the NAC OSCE, MI is relevant when counselling on smoking, alcohol, diet, or medication adherence.
NAC OSCE Communication Skills
A patient has just been diagnosed with cancer.
Using the SPIKES protocol, what is the FIRST step before delivering the bad news?