The Ethics & Communication Skills Station in PACES lies between Clinical Skills stations – Station 3 & Station 5. The purpose of this station is to test a candidate’s ability to communicate with the patient.
You don’t need to go to expensive courses- just get a feel for the station by practising with friends. It will be fun!! The best way to get good at this station is to practice.
Here are my ESSENTIAL TIPS for this station.
Tip # 1. Examiners have to agree on what they assess to pass a candidate. Therefore it is very much worth spending a little time studying the calibration sheet and marking sheet available on the MRCP website.
Tip # 2. Read the scenario carefully before going inside the room. Decide the important issues you have to address and what you should stress for a take-home message for the patient. Make sure you note down the important points you want to discuss, otherwise you may forget once you go inside that room.
Tip # 3. Decide which words or letters constitute medical jargon to avoid and think of equivalent words that a layman would easily understand.
Tip # 4. Confirm identity with the patient or relative, as per the case scenario.
Tip # 5. Establish rapport. Lead or direct the interview without being too controlling.
Tip # 6. Check the patient’s prior understanding of their illness.
Tip # 7. Look fluent & professional. If English is not your first language, the examiners will take this into account.
Tip # 8. Avoid jargon. If you have to use technical terms, you should do your best to define them for the patient to understand you. Imagine that you are giving a guidance interview on a radio show.
Tip # 9. Listen attentively, and check the patient’s beliefs, concerns and expectations.
Tip # 10. Reacts to cues. For example, if the patient looks stressed about something you have said, you must not blunder on it regardless. Some patients may even cry & it is a courtesy to offer tissue paper from a box placed on the table.
Tip # 11. Negotiate & select an appropriate management plan. Towards the end of the interaction, you and the patient/patient’s relative may arrive on an agreeable plan.
Tip # 12. Empathy is a very important skill of a doctor. People vary in their nature, cultures & beliefs. You can empathize only if you understand the beliefs, concerns and expectations of your patient.
Tip # 13. Summarize & confirm understanding of the patient, You may have made a mistake in your understanding of your patient situation & it is better to know that before discussion with the examiners. Don’t forget that your examiners will have seen everything you have put on your plate.
Tip # 14. Know patients specific concerns other than what has been told in the scenario. Ask if they have any specific concerns or any information to share with you.
Tip # 15. Address their concerns. If needed, get help from senior colleagues/other speciality colleagues as felt necessary.
Tip # 16. In chronic diseases, offer supportive measures. Offer physiotherapy and occupational therapy. Also, suggest support groups for specific diseases like multiple sclerosis.
Tip # 17. Check the understanding of the patient and ask about any other questions at the end of the discussion.
Tip # 18. It is courteous to ask about how will he/she get back home (if alone and after hearing about a bad diagnosis).
Do your Best & Leave the rest to the Almighty!
Dr Abu Ahmed