Communication skills

(2)
Instructions for candidate
You are working in a busy ED. There are two toddlers in the
department. One has a suspected pneumonia and needs a CXR.
You requested it yourself, but accidentally stuck another childs
name sticker on the card in error.
The other child was meant to have a wrist X-ray, but instead had
a CXR. Please explain to the parents of the child who has had an
unnecessary CXR what has happened, and why they need to go
back to the X-ray department a second time to get the correct Xray done.
Communication

Communication skills
(2)
Instructions for actors
Your child (Billy) fell over in the garden and ever since then has
not been using his wrist, and his forearm looks bent out of shape.
You have seen a doctor, who told you it looked broken and has
sent you round for an X-ray of your childs arm. When you got to
the X-ray department, Billy got very upset and started screaming,
so it was difficult to hear what people were telling you to do. You
had to pin him down to have an X-ray taken, and it was very
upsetting for all of you.
When the candidate/doctor explains that Billy had the wrong type
of X-ray, you are really upset.
You think he is traumatized by the event, and you have read in a
magazine that X-rays cause cancer.
You want to know who is to blame and how to make a complaint.
You also want to know what will happen to poor Billy now. If the
candidate/doctor offers you their apologies, you accept them but
still want to make a formal complaint. You want to make sure this
will not happen again.

Communication skills
(2)
Instructions for examiner
Mark scheme
Introduces self 1
Checks identity 1
Tells parent that wrong X-ray was taken (CXR instead of wrist Xray) 2
Explains honestly why it has happenedhuman error 2
Apologizes 2
Explains that the correct X-ray now needs to be done 1
Checks/offers additional analgesia 1
Addresses concerns adequately 2
Defuses situation 2
Is empathic throughout 2
Offers mechanism to make a complaint 2
Accepts blame/takes responsibility 2

Communication skills

(3)
Instructions for candidate
You are the registrar on duty overnight when a 9-year-old student
(Jane Smith) is brought in by ambulance, having been knocked off
her moped on her way to university. She was unconscious at the
scene and had several severe injuries. About 10 minutes after
arriving in the department, she had a cardiac arrest. Despite full
resuscitation attempts from you and your team, after an hour,
with no return of spontaneous circulation, you stopped
resuscitation and she was pronounced dead. During resuscitation,
she was intubated and ventilated, had bilateral chest drains
inserted, several units of blood transfused, and a pelvic sling
applied.
The girls mother has just arrived in the department and does not
know what has happened. The ED reception staff have put the
girls mother in the relatives room.
Explain to the girls mother that her daughter has died.
Communication
skills 75%

Communication skills
(3)
Instructions for actor
You are Jane Smiths mother. You had a phone call on your mobile
phone about 2 hours ago from an ambulance man who told you
Jane had come off her moped and had been injured. They told you
she was being taken to the nearest hospital and advised you to go
straight there. Your husband, Janes father, is away in Singapore
on a business trip. Jane is an only child.
You have no idea that Jane has been seriously injured. You are
shocked and disbelieving when you are told she is dead. You want
to know why the doctor has given up on her. You are devastated
that your only child is dead. When you are offered the chance to
see Jane, you find the idea very upsetting and refuse.
You know that Jane was not on the organ donor register, and
would not like to discuss this further.
If the candidate suggests phoning someone, you explain that your
husband is away. You eventually are persuaded to phone your
sister, who lives nearby.

Communication skills
(3)

Instructions for examiner

Chooses suitable location (e.g. relatives room, not resus) 1

Ensures bleep/mobile switched off 1
Lets departmental staff know location 1
Asks for a nurse to accompany them 1
Introduces self 1
Checks correct identity 1
Establishes what is already known 1
Explains diagnosis clearly and without delay 2
Uses the words died or dead 1
Asks about other relatives 1
Invites questions/allows suitable pauses for questions 1
Offers pastoral support 1
Introduces idea of organ donation 1
Offers chance to see body 1
Offers nurse to sit with afterwards 1
Answers questions adequately and sensitively 2
Appropriately uses silence 1

Communication scenario
1
Candidate information:
This is a 10 minutes station for communication skills. You will have
4 minutes before the start to read the task.
The examiner will not interfere during this station, he will only
reminds you when 2 minutes are left.

You are a pediatric specialist working in the NICU of a district

general hospital..
You have just reviewed Aly who was born at 28 weeks, now 4
weeks old. he was doing well and was established on full enteral
feeding. He developed necrotizing enterocolitis at 15 days of age.
He was managed conservatively with IV antibiotics and total
parental nutrition.
He is now recovered and ready to be commenced on entral
feeding. His mother is extremely anxious about the feeding being
restarted.

Task: talk to the mother about the decision of restart the feeds
and answer her questions.

Communication scenario (1)

Role player information:

You are Mrs. Samia , mother of baby Aly. (who is your first child).
Your 28 year old teacher. And his father Mr. Mahmoud is 30 years.
Aly was born at 28 weeks , he was admitted to the NICU on
expressed breast milk. He developed a serious infection in his
tummy. For which they stopped feeding for 2 weeks. He was in a
critical condition.
Today the nurses told you that they will start nasogastric tube
feeding.
You are so worried that NEC may recur again.
Also the flow of your breast milk now is decreased. You are not
comfortable with the idea of formula feeding as you read that it
might be one of the factors involved in necrotizing entrocolitis.
The discussion should run about:
- Is it the right time to restart feeding.
- Is he well now?
- You are afraid that they may transfer him to the special care
before being well
- What is the plan for his management?
- Is it possible that NEC may recur again?
- Is there any medicine to enhance breast milk supply?
- You so worried about his condition.

Communication scenario
4
Candidate information:
This is a 10 minutes station for communication skills. You will have
4 minutes before the start to read the task.
The examiner will not interfere during this station, he will only
reminds you when 2 minutes are left.
.
You are a pediatric specialist in a district hospital..
You will be talking to Mrs. Maha mother of baby khaled who is 6
hours old.
Setting: neonatal unit.
Background information:
Khaled is a Newborn, 40 weeks gestation, Normal vagina delivery.
He did not require any resuscitation at birth and there were no
signs of respiratory distress.
Six hours later, the nurse in the postnatal ward found that he
appeared blue but was breathing normally. He was assessed and
immediately transferred to the NICU. Initially his saturation was
65% in room air. In 100% oxygen his saturations were in the low
70s. he is now ventilated. You are suspecting cyanotic heart
disease, you have started prostaglandin E1 infusion, subsequently
saturations became around 85%.
You contacted a tertiary cardiac unit to transfer him.

Task: Explain to the mother the likely diagnosis, current

management and the need for transferring him now.

Communication scenario
4
Role player information:
You are Mrs. Maha, mother of Khaled who was born earlier today.
You are 35 years old house wife. You are a mother of another to
girls ( Doaa and Toka . 3 and 5 years old) . you felt well
throughout your whole pregnancy. All the blood tests and scans
were normal. your delivery went very smoothly. Your baby was
normal but after a while he was transferred to the NICU.they told
you that his oxygen is low.
Your general feelings:
-You are shocked as your baby unexpectedly became unwell and
has been rushed to the NICU.
-You are frightened as you do not know what is wrong with him.
-Why you want to transfer him if he improved on the medicine you
started.
Will he die because of this problem?
You feel alone and you want your husband to be with you.
Why he is on a breathing machine.