OSCE-Aid Revision Workshops:

Communication and Explanation

Communication and Explanation Stations

Overview:

This is a role-play exercise based on a typical OSCE communication and

explanation station. In a typical scenario, the students will be asked to take a brief
history then explain a new diagnosis or a procedure. Two example scenarios have
been provided colonoscopy and diabetes mellitus although there is likely to be
time only for one scenario during the session.

Format of the exercise:

Ask one student to be the actor and one to be the OSCE finalist. Provide the
actor with their brief and the student with the scenario instructions (both
overleaf).
Ask the student to read the instructions to the group. Check for questions.
The student should proceed to manage the actor allow 10 minutes only.
Any questions should be directed towards the actor. The examiner should
only volunteer answers to specific questions as detailed below and should
provide examination and investigation findings when specifically asked by the
student.
Afterwards, gather feedback. Start with the student then open it up to the
group.
Finally, provide your own feedback to the student. Try not to focus on the
clinical information theyve provided (except to point out whole sections they
might have missed out). Instead, think of the following:
Structure: did they cover all the main areas (see model answer)? Did
they jump back and forth between topics or was there a coherent
flow? Too much information or not enough? Too much of one topic at
the expense of another?
Patient focus: did they allow the patient to shape the content by
eliciting and responding to concerns? Was there space for the patient
to confirm they understood and ask questions?
Style. Comment on speech (rate and tone), empathy and body
language.

Extending the session:

If theres time available, you may want to initiate some group work after the scenario:

A generic outline suitable for most explaining stations has been provided
(below) together with model answers for each scenario. If there is time after
the feedback session, you can brainstorm a model answer of another
scenario with the group, focusing on the structure they want to use and the
information they think is important. Remember the structure should
accommodate both conditions (like RA, Crohns etc.) and procedures
(endoscopy etc.). You can then re-run the scenario with the format youve

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

brainstormed write it on the board and let them to refer to it as they go along
and ask the group to comment on any differences second time around.

Key learning points for the students:

Have a format. This ensures you touch on all the main point scoring areas
within the topic.
Keep it simple. You dont have to provide a comprehensive list of treatments,
side effects etc. Just a few examples will get you the points.
Respond to the cues youre given. Acknowledge questions and concerns
(verbally, if possible) and shape your information based on the patients
agenda.
Chunk and check really works, but dont go overboard. Practice wrapping up
each sub topic with a question: Does that make sense? Is there anything you
want to ask me about diagnosis/treatment/management?
Deploy open questions wisely. They cost you time but are vital for eliciting
patient ideas and concerns.
Always offer written literature for the patient to go home with.

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

Scenario 1: Explaining Diabetes Mellitus

Student brief

To be read out loud by the student to the group

A 58 year old clerical assistant has come to the GP to discuss the results of blood
tests which were ordered after s/he presented with weight loss and increased urinary
frequency. You are an FY2 on a General Practice rotation. Please take a brief history
to confirm your diagnosis before discussing the results. Answer any questions they
may have on their condition.

Results:

Fasting glucose 8 mmol/L

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

Scenario 1: Explaining Diabetes Mellitus

Actor brief

You are a 58 year old part time clerical assistant and have come to the GP for the
results of a blood test. In the last two months youve been experiencing some weight
loss and have had to pass water more often. You have noticed that you are thirsty a
lot of the time as well. You are aware that you are a little overweight at the moment
and keep meaning to go on a diet. At work you are mostly at a desk and there are
often chocolates and biscuits in the office. You have hypertension, for which you
take amlodipine, but no other medical problems. You have smoked 10 cigarettes a
day for 30 years.

You have heard of diabetes. You know that people who are overweight get it and
that you may have to inject yourself with insulin every day. You are concerned that
you will have to do this.

Only volunteer specific information about symptoms, concerns and your past medical
history when asked the relevant and specific questions by the student. If any
questions cannot be answered with the above information, please answer no or
dont know.

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

Scenario 1: Explaining a diagnosis of diabetes mellitus

Model answer

The prompts below (in bold) can be applied to just about any conditions or
procedures youre asked to explain. The examples in italics relate to discussing a
diagnosis of diabetes mellitus.

1. Introduce yourself and gain consent. Its often helpful to paraphrase the task
from the brief.
Hello. My name is Dr Clarkson. May I ask your name please? I understand you have
recently had a blood test looking at your sugar is that right? Ive been asked to go
through the results of this test and answer any questions you might have. Are you
happy for us to do that today?

2. Give the patient the opportunity to influence the agenda.

Is there anything else you were hoping to cover today?... OK Ill make sure we
discuss that, but please feel free to interrupt and ask questions as we go along
especially if anythings unclear.

3. Briefly summarise their issue. If youve been asked to take a history, now is the
time to expand on what youve already been told. It shouldnt be exhaustive this
isnt a history station but you will have to follow up on any positives. Ask a few
questions and move on.
I understand you have been having problems such as having to pass urine
frequently and you have lost weight. Is that right? Is there anything else you have
noticed recently that you have been worried about?

4. Establish their other risk factors for cardiovascular disease. Here you can
assess their existing risk of cardiovascular disease and any other lifestyle/ medical
problems, which will need to be addressed, as well as the diabetes. You may ask
about past medical history/ family history/ smoking and alcohol. However do not
focus on this for too long, as the patient will be keen to receive their diagnosis.
I just need to find out a little more about your health before we move on if this is ok?

5. Establish their ideas and concerns pre-diagnosis/procedure. This is a chance

for the patient to air any preconceived ideas about their condition and its causes.
What do you understand about what we were looking for on your blood test? Is there
anything you are particularly worried about?

6. Warning shot! Give them time after the shot to collect their thoughts before you
carry on. In some OSCE scenarios the patient will already be aware of their
diagnosis or the need for a procedure in which case you can skip this. It is important
that you have a serious tone here - it can feel awkward giving a warning shot but if
done professionally then it is an effective way of preparing the patient for the news
Before I go through the results in more detail I wanted to warn you that we have
found an abnormal result

7. Name the condition/procedure and find out what they know

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

Together with the symptoms you described, your test results show that you have
diabetes. You have a type of diabetes known as type 2 diabetes which develops
later in life. What do you know about diabetes?

8. Describe the condition (WHAT and COMPLICATIONS): Fill in the gaps from
what theyve told you already but keep it simple and focussed on the patient. Tell
them WHAT the disease is and WHY its happening to them.
WHAT: Normally the level of sugar in the blood is controlled by a hormone known as
insulin. In diabetes, the body tissues lose their response to insulin. This means that
the sugar level is not controlled. Diabetes is an increasingly common condition. You
may not notice any symptoms with it or you may find that it makes you pass urine
more often, that you are thirsty or tired.
COMPLICATIONS: The high level of sugar in the blood can damage the blood
vessels. This can cause complications if the damage occurs in the eyes, nerves,
heart or kidneys. It is because of these complications that we think it is important to
get on top of your sugar control as quickly as possible. Diabetes can put you at an
increased risk of heart attacks or strokes. However if you control your sugar well,
you can reduce your risk.

9. Describe the goals of treatment: Is it curative or is long-term management the

goal?
There is no curative treatment but there are things WE can do, and things YOU can
do to control the disease. The main aim is to keep the sugar level in the normal
range.

10. Management (WE and YOU): For most conditions/procedures youll be

expected to cover what the medical profession can do (WE) and what the patient can
do (YOU). Chunk and check as you go.
YOU:
You may be able to manage your diabetes on your own by making changes to your
diet and increasing the amount of exercise you do. By doing more exercise you can
use the sugar in your blood. It is important that you do at least 20 mins of exercise
at least three times a week. In terms of diet, you need to cut out sweet things such
as cake, chocolates and biscuits and reduce alcohol intake. You can do other things
to cut down your risk of serious complications by stopping smoking. Although you
need to make these changes, we are here to support you and give you advise on
how to make changes.
WHAT WE DO: Medical/General, Pharmacological and Surgical interventions
- GENERAL: Every year you will have various check ups to look for any signs of the
complications we talked about. We will test your vision and your feet to look for
nerve disease. We will also regularly check your sugar control
- PHARMACOLOGICAL: if you are not able to control you sugar levels by making
changes to your lifestyle alone, you may need to start taking medications which
either help the body to release more insulin or become more sensitive to the insulin
that you are making. If the sugar level is still not controlled you may need to try
different tablets or in some cases begin insulin injections.

11. Take a breather

Ive given you a lot of new information. Is theres anything youd like to ask, or
anything I can make more clear?

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

12. Flush out their worries if theyve not voiced them already. They almost
certainly have a secret worry you need to illicit and sometime you have to ask
directly.
Is there anything in particular your worried or concerned about?

13. Recap
Just to recap; Ive explained that you have diabetes. Youve told me that youre keen
to try to make changes to your diet and lifestyle but are not sure how.

14. What happens next Discuss follow up, referral and other sources of information.
I think now its important for you to go home and digest what we have discussed. Im
sure you will think of lots of new questions when you get home. Please feel free to
make an appointment whenever so that we can go through any concerns you have.
Im giving you some leaflets that give information about diabetes and lifestyle
changes so that you can read them in your own time. Im also going to get you to
come in to see our practice nurse who can give advise on diet and stopping
smoking.

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

Scenario 2: Explaining a Colonoscopy

Student brief

To be read out loud by the student to the group

A 75 year old retired accountant has been advised to have a colonoscopy by your
GP, and has come back to the GP clinic to discuss the matter further before deciding
whether to proceed. You are an FY2 doctor on a GP rotation and have been asked
by your consultant to explain the procedure. Please take a brief history before
explaining the procedure. You are not expected to gain signed consent today.

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

Scenario 2: Explaining a Colonoscopy

Actor brief

You are a 67 year old retired social worker and have been experiencing episodes of
constipation and diarrhoea in the last 3 months. In the last month you think that you
have lost around 2kg in weight. You are otherwise in good health. You take
amlodipine for hypertension (which is well controlled) and paracetamol with
ibuprofen gel regularly for joint pain.

You are apprehensive about having a colonoscopy as you have heard from your
friend that it can be quite uncomfortable. Your uncle had bowel cancer in later life
and you think that he had this test. You are worried that you are being sent for this
test as the doctor thinks you have cancer.

Only volunteer specific information about symptoms, concerns and your past medical
history when asked the relevant and specific questions by the student. If any
questions cannot be answered with the above information, please answer no or
dont know.

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

Scenario 2: Explaining a Colonoscopy

Model answer
The prompts below (in bold) can be applied to just about any conditions or
procedures youre asked to explain. The examples in italics describe a colonoscopy

1. Introduce yourself and gain consent. Its often helpful to paraphrase the task
from the brief.
Hello. My name is Dr Clarkson. May I ask your name please? I understand your GP
has recommended that you have an investigation called a colonoscopy is that
right? Ive been asked to explain the procedure and answer any questions you might
have. Are you happy for us to do that today?

2. Give the patient the opportunity to influence the agenda.

Is there anything else you were hoping to cover today?... OK Ill make sure we
discuss that, but please do ask questions as we go along especially if anythings
unclear.

3. Briefly summarise their issue. If youve been asked to take a history, now is the
time to expand on what youve already been told. It shouldnt be exhaustive this
isnt a history station but you will have to follow up on any positives. Ask a few
questions and move on.
Before I go on to explain the procedure I just wanted to get an idea of what problems
you have been having

4. Establish their ideas and concerns about the procedure. This is a chance for
the patient to air any preconceived ideas about their condition and its causes.
What do you already know about having a colonoscopy? Is there anything you are
particularly worried about?

5. Briefly explain the procedure

A colonoscopy is a special camera test that allows us to look inside the bowel.

6. Describe the procedure. WHY and WHAT Before/During/After: Explain why

you are doing the procedure and what it will involve
WHY: A colonoscopy gives us information about the bowel lining. It can help find the
cause for the symptoms you have been having and help us to decide on any further
tests or treatment you might need
WHAT: Im now going to explain what happens before, during and after the
procedure.
BEFORE: Your bowel needs to be empty for us to be able to see its walls clearly. To
do this we will give you laxatives to take the night before your colonoscopy. These
can make you go to the toilet many times so it is a good idea to plan to be at home
the evening before. On the day we will ask you to change into a hospital gown. We
may offer you a medication, which will make you more relaxed during the procedure
but will not put you to sleep
DURING: The procedure itself lasts about 15-20 minutes. A thin tube with a camera
on the end will be passed through your back passage to look into the bowel. The
doctor will be able to look at the cameras image on a screen
AFTER: You will be taken to the recovery room where you can stay until you feel
ready to go home. The doctor may be able to give you some information about what

2016 www.osce-aid.co.uk
OSCE-Aid Revision Workshops:
Communication and Explanation

he has seen. We recommend that you bring someone with you as you may feel
drowsy afterwards and will not be able to drive home after taking a sedative. The
test results will then be sent to your GP and you may be asked to come back for a
clinic appointment at the hospital

7. Describe the risks of procedure: Both the common and rarer but more serious
risks
All procedures have some associated risks. Some patients experience some
temporary discomfort and bloating afterwards. Rarely the camera may cause some
bleeding of the bowel wall and in a very small number of cases the camera may
make a small hole in the bowel wall. It is important that if you have severe pain or
lots of blood from rectum, that you go to doctor. You have been recommended this
test because we feel that the risks are outweighed by the advantages of having it. If
you need more time to think about the test that is ok.

8. Recheck for any worries you may not have covered. They almost certainly
have a secret worry you need to illicit and sometime you have to ask directly.
Now that I have gone through the procedure, is there anything in particular your
worried or concerned about?
I understand how your uncles diagnosis would make you worry. Let me reassure
you that these symptoms are not uncommon and in most people there is not sinister
cause for them. However by doing this test early we can pick up any more serious
causes at an earlier stage and begin any treatment needed early on.

9. Recap and offer written literature

We have gone through a lot of information today. Can you tell me what you
understand about the procedure so that I can check I havent missed anything? I
have a leaflet here with written information that you can look over in your own time at
home. Feel free to come back if you think of any more questions in the meantime.

10. Wrap up
Thank you for taking the time to go through this today. If you feel you need to ask
any more questions dont hesitate to make another appointment. Thanks

Please note: these resources are copyright of the authors and OSCE-Aid unless otherwise
stated. Please refer to our website terms & conditions at: http://www.osce-
aid.co.uk/terms&conditions.php. All resources can be printed and shared for personal use only.
No amendment or alteration to these resources is allowed, unless otherwise agreed by the
OSCE-Aid team. For any queries, please contact the team at: contact@osce-aid.co.uk

2016 www.osce-aid.co.uk