Breaking bad news is one of the most common high-stakes MMI role play scenarios. Panels are not testing whether you can diagnose — they assess whether you can communicate honestly, respond to emotion, and support someone through distress while staying professional.
SPIKES is the framework most candidates use for these stations. It structures the conversation so you do not rush to information before the person is ready to receive it.
The SPIKES Framework
- S — Setting — Privacy, sit down, minimise interruptions, ensure the person is not alone unless they wish to be
- P — Perception — Ask what they already understand: "What have you been told so far?"
- I — Invitation — Check how much detail they want: "Would you like me to explain everything now, or step by step?"
- K — Knowledge — Deliver clear, honest information in plain language — no jargon, no false reassurance
- E — Empathy — Pause and respond to emotion before continuing
- S — Strategy & Summary — Agree next steps, support, and follow-up; summarise what was discussed
See SPIKES in the framework reference on the question bank page.
When To Use SPIKES Vs EMP
Use EMP (Explore, Mirror, Partner) for general upset patients, complaints, or frustration without serious news.
Use SPIKES when the scenario involves:
- Delivering a difficult diagnosis or test result
- Breaking news of treatment failure or complication
- Discussing prognosis with a patient or relative
- Responding to acute grief or shock
Many stations blend both — SPIKES for structure, EMP within the empathy step.
Worked Example: Abnormal Test Result
Setting — "Is this a good time to talk? Let's find somewhere quiet. Would you like anyone with you?"
Perception — "Before I explain the results, can you tell me what you understand about why we ran these tests?"
Invitation — "I have the results. Would you like the full detail now, or shall I go through it gradually?"
Knowledge — "The scan shows something we need to investigate further. It is not a final diagnosis, but we will need more tests. I know that is frightening to hear."
Empathy — Pause. "I can see this is a shock. Take your time — I am here with you."
Strategy — "The next step is a referral within two weeks. I will arrange that today. Here is who you can contact if questions come up before then. Shall we talk through what that appointment will involve?"
Worked Example: Relative Asking For Information
An actor may play a family member demanding answers. SPIKES still applies, with confidentiality boundaries:
- Setting — Calm, private if possible
- Perception — "What have you heard about your relative's condition?"
- Invitation — "I can share what I am able to. Is your relative happy for us to discuss this with you?"
- Knowledge — Share only what is appropriate; explain limits honestly if consent is unclear
- Empathy — "I understand how worrying it is not to have answers."
- Strategy — "The best next step is to speak together with the clinical team when your relative is present."
Role Play Tips Specific To SPIKES
- Stay in role — you are a future doctor, not an examiner
- Silence after bad news is appropriate; do not fill every pause
- Do not say "everything will be fine" — honesty with hope is better
- Check understanding: "What questions do you have?"
- Watch the clock — hit Setting and Perception quickly, then develop Knowledge and Empathy
Common Mistakes
- Launching into medical detail without asking what they know
- Using jargon with a shocked or grieving person
- Rushing Strategy because time is short — panels notice skipped support
- Breaking character or apologising for the scenario
- Matching anger with defensiveness instead of acknowledging emotion
Related Prep
- Empathy and compassion questions — EMP for emotional scenarios
- Communication questions — rapport and clarity
- MMI role play tips — practical station advice
What To Do Next
- Browse empathy and communication questions in the question bank — outline SPIKES responses for bad-news scenarios
- Practise each step aloud with a timer — Perception and Invitation should take under 60 seconds combined
- When your outlines feel solid, practise out loud on the homepage with Go Doctor's AI interviewer — voice-to-voice role play with follow-ups based on what you actually say