Breaking bad news to a patient might be the most dreaded Multiple Mini Interview (MMI) station during a Medical School Interview. It is really difficult to know how you would do this in real life, let alone in a short station of fewer than ten minutes. The actors are employed to be realistic but also to test you and could overreact to anything you say that gives them a chance.
To succeed in this station, it is essential that you have great communication skills, and have practised how to sensitively approach the topic. Here is some advice on how to approach a breaking bad news MMI station.
Words by Safiya Zaloum
Imagine how you would want a healthcare professional to break bad news to you. Breaking bad news could range from telling an angry patient in A&E that it will be a long time until they are seen, to giving a patient a difficult and life-changing diagnosis, or even having to tell a family member that their loved one has passed away.
Act as sensitively and kindly as if you were talking to a friend, and this will make the patient/family member feel more at ease in your presence.
Pretend this is a real situation and a real patient who is tired and worried. You need to communicate bad news to them, and you don’t want to misinterpret what you are saying. Speak clearly to avoid having to repeat yourself. You want the patient or family member to be as calm as possible when receiving this news and you can do so by not speaking too quickly and being as calm as possible yourself.
If you are anxious or worried they are likely to pick up on this and mirror it, so be confident in yourself and what you are saying and keep calm whilst doing so.
In real life, people need a little time to process and accept what they have heard, especially if it is life-changing news. Try not to overload the patient or family member with non-essential information at first.
Explain the bad news clearly and concisely then let them process it, don’t continue talking and overloading them with information. Once they have indicated they have processed this, move on to more details if appropriate. This indication may be verbal or non-verbal, so try to stay in tune with their body language and facial expressions throughout.
It can be tempting, especially in an MMI station, where time is short, to try to say as much as possible and show the examiner as much you can fit in. However, the most sensible thing to do whilst the patient/family member processes the bad news is to stay quiet but watch them attentively.
Don’t stay silent for too long but perhaps up to 30 seconds is an appropriate amount of time to allow the actor to process what you have just told them.
Everyone reacts differently to bad news and there is no way to predict how the actor will react in your breaking bad news MMI station. If they start speaking or processing what you have told them out loud, listen to them.
Don’t try to interrupt and give a response to every rhetorical question they say, wait until they want you to speak. If they ask you a direct question it is appropriate to answer but give them time to talk it through first. They may not speak for a while, at which point you may want to ask them if they have any questions for you, or give them a bit more information to process.
In real life, breaking bad news in six minutes (or however long your station is) and ensuring the patient/family member is fine, then never seeing them again, would be a big ask. Ideally, you would spend time talking to them about their options and how they want to proceed. However, in an MMI you just don’t always have time to do this in the way you might hope.
Make sure you offer support – not just from yourself but from other services. You could offer counselling, or for them to talk to another member of the team. Try not to leave the breaking bad news MMI station just having broken bad news with no potential follow up or ongoing support for the person.
Breaking bad news is possibly one of the most difficult MMI stations you might face. This is just a guide to some things you might want to consider going into a station like this.
Everyone has a different communication style so adjust accordingly to how you feel you communicate best, particularly for the breaking bad news MMI station. Consider what you would do in real life and be mindful that you need to be sensitive to the patient and speak calmly, in order for the person to take the news as well as possible.
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