Student BMJ article

Breaking bad news in a multiple mini interview: advice

from an admissions dean
These stations are a test of your honesty and integrity, not your acting skills

By: Angela Kubacki Published: 21 December 2016

Multiple mini interview scenario

Imagine you have been asked to look after your neighbour’s budgie while they are on holiday
for two weeks. Although you remember to feed the bird for a few days, you soon forget
because you are preoccupied with something else. Unfortunately, the budgie dies the day
before your neighbour is due to return. You now need to explain to your neighbour what has
happened.

This scenario is an example of a common situation that you might face at one of your
multiple mini interview stations at a medical school interview. In this article I provide some
general advice on how you can approach a multiple mini interview station where you have to
communicate some bad news to an actor.

What you’re being tested on

Contrary to popular belief, multiple mini interview scenarios like the one above are not
testing your ability to break bad news to patients nor your acting skills. We are not looking
for an Oscar winning performance or an accomplished clinical approach (advanced skills for
breaking bad news are not taught until the final year at St George’s). What these types of
stations are testing is how you deal with uncertainty,[1] as well as how you show respect,
insight, integrity, and compassion. These qualities are integral to the duties of a doctor
registered with the General Medical Council[2] because they are the core values of the NHS.
[3]

Although these interviews assess your general communication skills, we are more interested
in assessing your behaviours and attitudes to difficult situations. It’s not just about being able
to say the right things but showing that you can take responsibility, apologise, and recognise
how your actions have impacted on another person.

Some tips on how to approach a breaking bad news station

Although it might seem that you are pressed for time, take a moment to consider how you are
going to approach the situation with the actor. Before engaging in the role play, think about
how you would feel in the scenario you have been given, what the actor might be feeling in
the role they are playing, and what you might say to them during the station. Once the role
play begins, listen carefully to what the actor says and pay attention to their body language.
Be flexible in your approach by listening and responding to what the actor is telling you and
how your responses acknowledge their concerns and feelings. Although this is an interview
situation, be yourself and react as you would do in real life.

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Student BMJ article

Here are my tips for how to approach a multiple mini interview station where you have to
break some bad news.

1. Accept responsibility. If the scenario states that you have done something wrong,
don’t lie or blame someone else. Explain what has happened, accept that you have
made a mistake, and consider how you are going to try to make it right. This will
require you to think on your feet, listen carefully, consider the emotions of the other
person, and communicate your response clearly.
2. Show integrity. Honesty and sincerity are key aspects of integrity and they are
important qualities for a doctor. Before your interview, consider what integrity means
to you and how you would show it. It could be argued that integrity is an inherent
quality, not something you can rehearse. We know that students can learn techniques
for giving difficult news, but what we want to see is that you sincerely believe that
being truthful with people is important in a difficult situation.
3. Be empathic. See things from the other person’s point of view and be aware of their
feelings and emotions. Don’t overload them with too much information or excuses;
give them time to take it in. Don’t underestimate the power of silence when faced
with a difficult situation. Sometimes silence can be more empathic than a plethora of
stock phrases.

In summary

A good candidate is one who remains calm, takes a situation seriously, and maintains a
professional approach. You will develop these skills once you’re at medical school, but we
want to see if you have the foundations of being an effective communicator and a genuine
respect for others, which is a fundamental value that all staff recruited to the NHS must
possess.

Angela Kubacki, senior lecturer in clinical communication and associate dean for
admissions St George’s University of London, UK.

References

1. Medical Schools Council. Statement on the core values and attributes needed to study
medicine. 2014. www.medschools.ac.uk/SiteCollectionDocuments/Statement-on-
core-values-and-attributes.pdf.
2. General Medical Council. Good medical practice. 2013.
www.gmc-uk.org/guidance/good_medical_practice.asp.
3. Department of Health. The NHS constitution for England. 2015.
www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-
constitution-for-england.

https://www.youtube.com/watch?v=lJN6g0V5Q-U – Good example

https://www.youtube.com/watch?v=_uOS7hfKkVI – Excellent example

https://www.youtube.com/watch?v=HWAZnhCuAeE – What not to do

https://www.youtube.com/watch?v=qHGvjv_7PLU – Example of bad and good