1. COMMUNICATION FOR FINALS TOM CUFFLIN AND ANNE-MARIE SIMONS

2. Types of Stations History Explanation Breaking Bad News

3. Possible Stations History – Depression (+/- Alcohol) – Menorrhagia – Teen weight loss – Post-Menopausal Bleeding – Anxiety – Schizophrenia – Mania – Haematemesis – Haemoptysis – Asthma – Non-Accidental Injury – Nocturnal Enuresis

4. Remember the basics… Consent and Confidentiality Avoid Jargon Summarise Open to Closed Question cones Clinical Reasoning Direct consultation as appropriate - Signposting

5. Sample History Station You are the GP, a patient comes to see you expressing low mood since her daughter moved to University, she has two other sons who live away and works part-time at the local supermarket. She is recently divorced and says her life is not worth living without my children at home Please proceed with the consultation as if you were the GP.

6. Explanation Stations Explanation – Counselling and management of asthma with antibiotics – Treatment of Temporal Arteriitis (Side effects of Steroids) – MMR Vaccination – Pregnant Smoker – Persuasion – Hypertension – Management – Dementia

7. How to approach Explanation stations Assessing the baseline What do they want to know + what do they need to know? Chunking and checking Written aids Avoid premature reassurance

8. Sample Explanation Station You are the GP. A 24 year old female is requesting the combined oral contraceptive pill (COCP) as she does not want to become pregnant. Please explain the risks/benefits of the COCP and any other information you feel may be relevant.

9. Breaking Bad News Stations Breaking bad news – Dyskaryosis on smear – Breast lump – May be not be explicit – may say Explain

10. S.P.I.K.E.S. A system for breaking bad news S – Setting – (environment) – Open body language, maintaining eye contact, use of touch (!), P- Perception – assess the baseline I – Invitation – How much the patient wants to know K – Knowledge – Chunk and Check E – Explore – Acknowledge emotional responses S – Strategy and Summary – Negotiating a way forward

11. Sample Breaking Bad News Station You are the respiratory consultant a patient has come to see you regarding the results of a lung biopsy. The results show T2 N1 M1 tumour in the right lung. This is inoperable. The patient is aware he has a suspicious mass which needed further evaluation but has not been told it is malignant. Please explain the results accordingly

12. Anne Maries tips… Smile and be nice Approach every station with S.P.I.K.E.S – Could it be BBN? Dont just rush to one diagnosis – exclude others Past stations may subtly change features quite heavily – remember to risk assess New Station - New Marks

13. GOOD LUCK