Delivering a new diagnosis — OSCE

Station brief (8–10 minutes)

Break the news of a likely new diagnosis of leukaemia to the parents using a structured approach. Address their emotion and arrange appropriate follow-up. Do not invent local statutory wording or specific survival statistics. [1]

Tasks for the candidate

1. Prepare the setting: private space, right people, interpreter, time. [1] [3]
2. Assess perception and invitation before sharing information. [1]
3. Give a warning shot and share the news in plain language with pauses. [1] [3]
4. Respond to emotion using NURSE and tolerate silence. [1] [2]
5. Agree a plan, check understanding with teach-back, and arrange follow-up and a written summary. [3] [14]

Expected performance

Must hit. Private setting prepared; perception and invitation assessed; warning shot then clear plain-language headline; NURSE response to emotion with silence tolerated; teach-back of understanding; written summary and a named follow-up contact; interpreter used. [1] [3] [14]

Merit. Names SPIKES explicitly; explores realistic hope without false reassurance; offers to include the child developmentally; plans a team debrief. [2] [8]

Fail. Delivers the diagnosis standing in a corridor; information-dumps without checking readiness; ignores emotion and fills every silence; no teach-back, summary or follow-up. [1]

Sample candidate structure

“Thank you both for coming in. I want to sit down with you properly — this is a private conversation and we have time. First, tell me what you have understood so far about why [child] came into hospital. … I'm afraid the blood tests have shown something serious. The cells we are seeing are consistent with leukaemia. I know this is a huge amount to take in. What questions do you have right now? We will face this together, and I will write down what we have agreed and see you again this afternoon.” [1] [3] [8]