What is the information-giving station and how is it different?
In your clinical years in UK medical schools, you will begin to encounter more difficult and varied OSCE (objective structured clinical examination) stations. Whilst preclinical stations may be mainly focused on examination and basic history-taking or eliciting the patient’s ideas, concerns and expectations (ICE), as a clinical student you will have enough knowledge to advise patients on common conditions and procedures.
This might involve being asked to communicate information to patients, as you would in consultations, and can be under a number of sub-sections such as explaining a procedure before gaining consent to carry it out, explaining how to use a simple medical device such as an inhaler or an EpiPen, explaining a new diagnosis and treatment plan or providing lifestyle advice in areas such as smoking cessation, alcohol help, or weight loss.
This station is important, as we know that communicating information effectively to patients allows them to make informed decisions and participate fully in their care so that medicine is no longer paternalistic and care plans are made through shared decision making. Delivering information appropriately and sensitively can also strengthen the rapport and relationship between doctor and patient, and through providing all the facts can help to reduce patient anxiety around things like procedures or diagnoses. You should remember however, that doctors may not consent for procedures which they are unable to perform, and this should usually be the role of a senior doctor rather than an FY1. It can also be important to be mindful of how much information the patient wants to know so that you can tailor the process to this, in order to avoid unnecessary mental turmoil for example regarding prognoses.
How do you approach it?
There are a few methods you can use to approach information-giving but the underlying principles remain the same. As with any scenario surrounding communication, you should be sensitive to the individual clinical context and needs of the patient. It is important to ensure that you yourself fully understand what you are trying to explain before you do so – in an OSCE this could involve writing important information down on your scrap paper during the reading time so that you remember to include this. If in a real clinical setting you could go away and read about anything you are unsure of as well as looking at the patient’s past history.
You should always begin by introducing yourself, including your full name and role to avoid confusion, making sure the patient is comfortable and happy to speak with you, explaining briefly why you have come to speak to them, and of course not forgetting the all-important few marks you always pick up for washing your hands. You should try to pick up marks for rapport and communication from the beginning, for example starting off by asking them how they are today or offering a chair.
For most stations you can then apply the BUCES framework:
B – Brief History
U – Understanding
C – Concerns
E – Explanation
S – Summarise and leaflet
This allows you to remember to take a very brief history to understand the patient’s journey and needs, then elicit their understanding by asking for example ‘what do you already know about this condition/procedure?’ or ‘in your last consultation did they talk about what the investigations might be looking for’. Following that you can elicit their concerns or their ICE, by asking something like ‘is there anything about this that has been particularly worrying you?’. Acknowledging any strong emotions associated with the subject that come out here can be important, allowing you to empathise with the patient.
Following this you can signpost what you are going to explain and discuss the steps. Whilst explaining it is important to break it down into sizeable chunks and adopt the ‘chunk and check’ method, clarifying whether they have understood what has been said thus far or asking them to repeat the information back to you. In order to sound less patronising you can preface this with something like ‘I know I am giving you a lot of information, so I just want to check I am explaining it well’. Ensure the patient knows they can interrupt or question you anytime, and be aware of non-verbal cues such as changes in facial emotion signifying that they feel upset or overwhelmed. Try also to link it back to things you found out earlier for example, if a patient mentions they knew they had an issue with their breathing, you can discuss this as a reason for the use of an inhaler. It is also important to ensure you avoid medical jargon in order to not confuse the patient or actor.
There are a few structures you can use to help with information giving, which I find personally extremely helpful.
For conditions: what is normal, what has gone wrong, why/causes/risk factors, what symptoms they will experience, the possible progression of their disease, the prognosis, management and support options, and safety net if required.
For procedures: what is the reason for the procedure and its aims, the risks and benefits, including any complications that may arise, what happens before the procedure, during the procedure, and after the procedure, and safety net if required.
For medications you can use the ATHLETICS framework – action, timing, how to use it, length of time, effects, tests, important SEs, contraindications. Again remember to safety net if relevant and to warn them against suddenly stopping medications if relevant.
To wrap up and summarise, thank the patient for their time, offer them another opportunity to ask questions or give them a way to reach you to do so, and offer supporting leaflets, website links or links to other organisations. Always remember to offer a leaflet and if relevant, offer additional psychological or other support.
What are they looking for?
In information giving stations the examiner will be analysing your ability to follow a structure but without being rigid, and being able to flexibly adapt this to the needs and concerns of the patient. You will be marked highly if you are able to be sensitive and empathetic to the patient/actor and ensure to include them throughout the process.
How can you prepare for them?
The best way to prepare for information giving stations is firstly to produce a list of common and possible stations based on the clinical material that you have covered and what your medical school commonly assesses or values. Following this, practising by yourself or with a small group of friends will allow you to prepare what you would say in each of these situations and practice being adaptable to whatever may be thrown at you. Once you have tried each station once or twice you will be able to explain it adequately in the station and can focus on being flexible to patient needs.