NZREX Communication and Professionalism — Questions and Answers
Question 1: In the NZREX examination, what communication framework is recommended for breaking bad news?
- The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary (Correct answer)
- Simply state the diagnosis directly without any preamble
- Write the diagnosis on paper and hand it to the patient
- Ask the nurse to deliver the bad news instead
Correct answer: The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary
The SPIKES framework is widely used in NZ medical practice for breaking bad news: Set up the interview (privacy, sit down), assess the patient's Perception, obtain Invitation (how much they want to know), give Knowledge/information, address Emotions with empathy, and provide Strategy/summary.
Question 2: In NZ medical practice, what is the correct approach when a patient requests a treatment you believe is not in their best interest?
- Explain your clinical reasoning, discuss the evidence, explore the patient's perspective, but ultimately respect their autonomy while documenting the discussion (Correct answer)
- Refuse the request without explanation
- Agree to the request to avoid conflict
- Report the patient to the Medical Council
Correct answer: Explain your clinical reasoning, discuss the evidence, explore the patient's perspective, but ultimately respect their autonomy while documenting the discussion
NZ medical ethics requires doctors to provide clear clinical reasoning and evidence, explore the patient's values and concerns, and ultimately respect patient autonomy. The discussion, including any disagreement, should be thoroughly documented.
Question 3: In the NZREX, how should a candidate handle a situation where they do not know the answer to a clinical question?
- Honestly acknowledge the limits of their knowledge, state what they do know, and explain how they would seek the information (guidelines, senior colleague, specialist referral) (Correct answer)
- Guess an answer to appear confident
- Change the subject to something they know more about
- Remain silent until the examiner moves on
Correct answer: Honestly acknowledge the limits of their knowledge, state what they do know, and explain how they would seek the information (guidelines, senior colleague, specialist referral)
The NZREX values honesty and safety. Candidates should acknowledge when they don't know something, demonstrate what they do know, and show they would seek appropriate help — this reflects safe clinical practice in NZ.
Question 4: In NZ, what is the appropriate response when a patient's family requests that you do not tell the patient their diagnosis?
- Explore the family's concerns, but explain that the patient has the right to be informed under the Code of Rights, and work to find a culturally appropriate way to share the information (Correct answer)
- Agree to the family's request and withhold the diagnosis from the patient
- Tell the patient immediately without speaking to the family
- Ask the hospital administrator to decide
Correct answer: Explore the family's concerns, but explain that the patient has the right to be informed under the Code of Rights, and work to find a culturally appropriate way to share the information
Under Right 6 of the NZ Code of Rights, patients have the right to be fully informed. While the family's concerns should be explored with sensitivity and cultural awareness, the patient's right to information generally takes precedence. A culturally appropriate approach should be negotiated.
Question 5: What is the ISBAR communication tool used in NZ healthcare, and when is it used?
- Introduction, Situation, Background, Assessment, Recommendation — used for clinical handover, escalation, and referral between healthcare professionals (Correct answer)
- A medication dosage calculator
- A patient satisfaction survey tool
- A hospital billing system
Correct answer: Introduction, Situation, Background, Assessment, Recommendation — used for clinical handover, escalation, and referral between healthcare professionals
ISBAR is the standard structured communication framework used across NZ healthcare for clinical handover, escalation of deteriorating patients, and referrals. It ensures critical clinical information is communicated clearly and completely.
Question 6: In NZ, what is open disclosure and when should it be used?
- An honest, transparent discussion with patients and whānau when an adverse event or error has occurred during their care (Correct answer)
- A method for disclosing financial information about the hospital
- Publishing all patient records online for transparency
- A technique for opening difficult conversations about billing
Correct answer: An honest, transparent discussion with patients and whānau when an adverse event or error has occurred during their care
Open disclosure is the NZ standard requiring honest, transparent communication with patients and their whānau/family when an adverse event, near miss, or error occurs during care. It includes an apology, explanation of what happened, and steps to prevent recurrence.
NZREX Communication and Professionalism
In the NZREX examination, what communication framework is recommended for breaking bad news?