A structure that fits 8 minutes
| Stage | Time | What to do |
|---|---|---|
| Open | 30 seconds | Introduce yourself, confirm the patient's name, explain your role, ask an open question and listen without interrupting |
| Explore | 2 to 4 minutes | Follow the patient's story, then focus; find out their ideas, concerns and expectations |
| Task | 2 to 4 minutes | Complete the specific task: examination, explanation, management or counselling |
| Close | 30 to 60 seconds | Summarise, check understanding, agree a plan, safety-net and arrange follow-up |
Adjust the timings to the tasks in the candidate instructions. If 5 minutes are allocated to history, use all 5 to gather information.
Ideas, concerns and expectations
Many stations hinge on a concern the patient raises in the opening statement or hints at through behaviour. Ask about it directly:
- Ideas: "What do you think might be causing this?"
- Concerns: "Is there anything in particular that worries you about it?"
- Expectations: "What were you hoping we could do today?"
Then show that you heard it. If the patient fears cancer, address cancer by name. Examiners list "not addressing the concerns or questions of the patient" as a common reason for failure.
Explaining in plain language
- Use short sentences and everyday words: "the heart's blood supply is blocked" rather than "myocardial ischaemia".
- Give information in small pieces and pause after each one.
- Check understanding with teach-back: "So that I know I have explained it clearly, can you tell me what you will do if the pain comes back?"
- If you draw a diagram, explain it as you draw; an unexplained diagram does not count as an explanation.
- Prioritise: two or three key messages the patient leaves with are better than ten they forget.
Breaking bad news
A widely taught framework is SPIKES:
| Step | In practice |
|---|---|
| Setting | Privacy, sit down, offer to include a support person |
| Perception | "What have you been told so far about the tests?" |
| Invitation | "Would it be all right if I go through the results with you now?" |
| Knowledge | A warning shot, then the news in plain words, using the word cancer if it is cancer |
| Emotions | Pause, acknowledge the reaction, allow silence |
| Strategy and summary | The next steps, support available and a follow-up plan |
Avoid euphemisms and false reassurance. "You will be well looked after" is not enough on its own.
Consent, capacity and difficult conversations
- Consent: explain what is proposed, why, the material risks, the alternatives including doing nothing, and invite questions.
- Capacity: check the patient can understand, retain, weigh and communicate a decision. A competent adult can refuse treatment.
- Angry patients: acknowledge the feeling, apologise for the experience without blaming colleagues, and focus on what you can do now.
- Adverse events: follow open disclosure principles: an apology, the facts as known, what will happen next and how the patient will be kept informed.
- Adolescents: see them alone for part of the consultation, explain confidentiality and its limits, and use a psychosocial screen such as HEADSS.
Cultural safety and interpreters
Australian practice expects you to adapt to the person in front of you, including Aboriginal and Torres Strait Islander patients and people from culturally and linguistically diverse backgrounds.
- Ask how the patient would like to be addressed, and whether they would like family or an Aboriginal health worker involved.
- Use a professional interpreter rather than family members for clinical conversations. The Translating and Interpreting Service (TIS National) provides interpreting for doctors, including a free priority line for medical practitioners.
- Speak to the patient, not the interpreter, and keep sentences short.
- Check what the patient already understands and believes about the condition before giving advice.
Telephone, telehealth and colleague stations
Some stations replace a face-to-face patient with a phone call, a video consultation or a conversation with another health professional. The same skills apply, with a few adjustments.
- Telephone and telehealth: confirm identity and location, check the person can talk privately, and say out loud what you would otherwise show with body language.
- Handover or referral to a colleague: use a structure such as ISBAR (identify, situation, background, assessment, recommendation) and state clearly what you are asking for.
- A concerned relative: check what the patient has consented to share before discussing details, and focus on what you can tell them and how they can help.
- An impaired or unsafe colleague: stay respectful but clear about patient safety, and know the duty to notify in serious cases.
How to practise communication
- Work in threes: candidate, role-player and examiner, rotating each station.
- Record practice stations on your phone and watch them back for jargon, interruptions and pace.
- For every station, write down the patient's main concern before you start, and check at the end whether you addressed it.
- Practise the close aloud until summarising and safety-netting take under a minute.
How communication is weighed against the other domains is explained in how the AMC Clinical is marked.
Common questions
Is there a separate communication station in the AMC Clinical?
No. Communication is assessed across stations, mainly through the approach to the patient and counselling domains.
What framework should I use to break bad news?
SPIKES is widely taught: setting, perception, invitation, knowledge, emotions, and strategy and summary. Use plain words and avoid euphemisms.
Should I use medical terms with the examiner?
Speak plainly to the patient. Use precise terminology when you give commentary or findings to the examiner.
What should I do if the role-player is angry?
Acknowledge the emotion, apologise for the experience without blaming others, listen, and move to what can be done now.