Communication Skills for the AMC OSCE
Breaking Bad News | Informed Consent | Motivational Interviewing
A Complete Framework Guide for IMGs
Communication skills stations are among the highest-weighted and most frequently failed sections of the AMC OSCE. Many IMGs enter the exam with strong clinical knowledge but underestimate how differently Australian patients, examiners, and healthcare culture expect doctors to communicate.
This guide covers the three most tested communication station types – breaking bad news, obtaining informed consent, and motivational interviewing – alongside the key frameworks you must know: SPIKES, ICE, the Calgary-Cambridge model, and Australian cultural considerations that examiners specifically look for.
If you trained outside Australia, the way you communicate with patients may need adjustment – not because your communication is wrong, but because Australian healthcare culture has specific expectations that the AMC OSCE directly tests.
What IMGs Often Do | What Australian Examiners Expect |
Tell the patient what will happen | Involve the patient in shared decision-making |
Use medical jargon to appear knowledgeable | Use plain English and check understanding regularly |
Focus exclusively on physical symptoms | Explore the patient’s ideas, concerns, and expectations (ICE) |
Minimise or soften bad news to protect the patient | Deliver information clearly, honestly, and with compassion |
Make lifestyle recommendations as instructions | Use motivational techniques to support patient autonomy |
Avoid discussing uncertainty or prognosis | Acknowledge uncertainty openly and honestly |
Limit family involvement without discussion | Ask the patient who they would like involved in their care |
💡 Examiner Tip: Australian healthcare is built on patient-centred care and shared decision-making. Every communication station in the AMC OSCE rewards you for treating the patient as a partner, not a recipient of your decisions.
The Calgary-Cambridge Model – Your Overall Consultation Structure
The Calgary-Cambridge model is the gold standard consultation framework used in Australian medical education. It provides the overarching structure for every communication station, regardless of the topic. It has five phases:
# | Phase | What This Looks Like in the OSCE |
1 | Initiating the Session | Greet warmly, confirm identity, introduce yourself, establish rapport, open with an open-ended question |
2 | Gathering Information | Explore the biomedical perspective (symptoms, history) AND the patient’s perspective (ICE – ideas, concerns, expectations) |
3 | Physical Examination | In pure communication stations, this phase may be skipped – the focus is on the conversation |
4 | Explanation & Planning | Share information clearly, check understanding, involve the patient in decisions, establish a shared plan |
5 | Closing the Session | Summarise the plan, confirm patient understanding, provide safety netting, state follow-up clearly |
The ICE Model – Exploring the Patient’s Perspective
ICE stands for Ideas, Concerns, and Expectations. This is the most important patient-centred communication tool in the AMC OSCE. Examiners look for explicit ICE exploration in almost every communication station.
Letter | Meaning | What to Ask | Why It Matters |
I | Ideas | “What do you think might be causing this?” | Reveals patient beliefs – uncovers misconceptions you can address |
C | Concerns | “What worries you most about this?” | Identifies the patient’s deepest fear – often different from their presenting complaint |
E | Expectations | “What were you hoping we could do for you today?” | Aligns your plan with the patient’s goals – avoids a mismatch between what you offer and what they need |
💡 Examiner Tip: ICE is not a checklist to rush through. Ask one ICE question, listen to the full answer, respond with empathy, then move to the next. Examiners can tell when you are ticking boxes versus genuinely engaging.
STATION 1: Breaking Bad News
Breaking bad news is one of the most emotionally demanding and technically difficult communication stations in the AMC OSCE. Common scenarios include delivering a new cancer diagnosis, informing a patient of a terminal prognosis, telling someone their test results indicate a serious illness, or disclosing an unexpected death.
The SPIKES protocol is the internationally recognised framework for this station and is explicitly aligned with Australian clinical practice expectations.
Letter | Step | What to Do and Say |
S | Setting Up | Find a private space. Sit down at eye level. Offer to have a support person present. Turn off your phone. Introduce yourself and your role. Confirm the patient’s identity. |
P | Perception | Before delivering news, find out what the patient already knows. Ask: “Before we begin, can you tell me what you already know about your condition?” This prevents you from over- or under-explaining. |
I | Invitation | Ask the patient how much information they want to receive. Ask: “Some people like all the details, while others prefer an overview first – what would suit you?” Respect their answer. |
K | Knowledge | Deliver the news clearly and in plain English. Use a warning shot first: “I’m afraid the results weren’t what we had hoped for.” Then pause. Then deliver the news concisely without jargon. |
E | Emotions – Empathy | After delivering the news, stop talking. Allow silence. Acknowledge the patient’s emotional response explicitly. Use empathic statements: “This is clearly very difficult news.” Do not rush past this step. |
S | Strategy & Summary | Once the patient is ready, outline the next steps. Check their understanding. Provide written information if available. Arrange follow-up. Offer a contact number. Ask if they have anyone who can be with them. |
✓ | Step | What Examiners Are Looking For |
☐ | Setting | Private room, sit down, eye contact, silence phone, offer support person |
☐ | Introduce & ID | Confirm patient name, introduce yourself and role, establish rapport |
☐ | Warning Shot | Use a transitional phrase before the news: “I have some difficult news to share with you” |
☐ | Assess Prior Knowledge | “What have you been told so far?” – adjust your explanation to what they already know |
☐ | Check Information Preference | “Would you like me to walk you through everything in detail, or would you prefer an overview first?” |
☐ | Deliver the News Clearly | Use plain English. Say the word (cancer, terminal, death) – do not use euphemisms that confuse. Pause after delivering. |
☐ | Silence & Space | Allow the patient to react without interruption. Do not fill silence with information. |
☐ | Acknowledge Emotion | Name the emotion: “I can see this is devastating news.” Normalise it: “It’s completely understandable to feel this way.” |
☐ | Explore ICE | Ask what they are thinking, what worries them most, and what they were hoping would happen |
☐ | Avoid False Hope | Do not minimise the seriousness. Do not say ‘everything will be fine’ – it undermines trust if it is not true. |
☐ | Next Steps | Outline the plan clearly. Arrange specialist referral, follow-up appointment, support services |
☐ | Written Information | Offer written resources, pamphlets, or reputable websites (e.g. Cancer Council Australia) |
☐ | Safety Netting | “If you have any questions after today, please call us. Here is our number.” |
☐ | Support Person | Ask if they have someone who can be with them. Offer to call someone if needed. |
☐ | Summarise & Close | Summarise the key points. Confirm understanding. Thank the patient for their time. |
Warning shot: I’m afraid I have some news that is quite difficult to share with you.
Delivering the diagnosis: The results of your biopsy have shown that the lump is cancer. I’m so sorry to have to tell you this.
Acknowledging emotion: I can see this has come as a real shock. Take all the time you need. I’m here.
Checking understanding: This has been a lot of information. Before we talk about next steps, can I ask what you have taken from our conversation today?
Closing with support: I want to make sure you are not alone with this. Is there someone we can call to be with you right now?
💡 Examiner Tip: Use the word ‘cancer’ or ‘terminal’ if that is the diagnosis. Examiners penalise vague language like ‘it’s not good news’ without a clear explanation – it leaves patients confused and is not considered compassionate in Australian practice.
💡 Examiner Tip: Silence is a clinical skill. After delivering bad news, stop talking. Examiners watch whether you can tolerate silence and allow the patient to process. Candidates who immediately fill silence with more information lose marks.
💡 Examiner Tip: The emotional step (E in SPIKES) is where most IMGs lose the most marks. Do not rush to ‘Strategy’ before you have fully acknowledged and responded to the
⚠️ Common Mistake: Delivering bad news while standing up or before sitting down – this signals haste and is penalised in Australian OSCE marking.
⚠️ Common Mistake: Using medical jargon such as ‘malignant neoplasm’ or ‘metastatic carcinoma’ without plain English explanation – patients need clarity, not terminology.
⚠️ Common Mistake: Moving straight from the diagnosis to the management plan without allowing space for the patient to react emotionally.
⚠️ Common Mistake: Giving false reassurance: ‘Don’t worry, many people survive this’ – this is patronising and undermines trust if the prognosis is poor.
STATION 2: Obtaining Informed Consent
Informed consent is both a legal requirement and an ethical cornerstone of Australian medical practice. In the AMC OSCE, consent stations test your ability to provide patients with enough information to make a voluntary, informed, and competent decision – not simply to get them to sign a form.
Common OSCE scenarios include consenting a patient for surgery, an invasive investigation such as a colonoscopy or angiogram, a blood transfusion, or commencing a new medication with significant side effects.
- In Australia, informed consent is based on the ‘reasonable patient standard’ – you must disclose what a reasonable patient in that situation would want to know, not just what a reasonable doctor thinks are relevant
- Consent must be voluntary – free from pressure or coercion
- The patient must have capacity – they must understand the information, retain it, weigh it up, and communicate a decision
- Consent is a process, not a signature – a signature on a form is not evidence of informed consent if the discussion was inadequate
- Patients have the right to refuse treatment, even if that refusal may harm them, provided they have capacity
💡 Examiner Tip: The landmark Australian case of Rogers v Whitaker (1992) established that doctors must disclose risks that a reasonable patient would consider significant – not just common risks. Mentioning this framing in a consent station signals strong Australian law knowledge.
Element of Consent | What to Cover |
Nature of the procedure | What will be done, in plain language |
Purpose / indication | Why this procedure is being recommended for this patient |
Benefits | What the patient stands to gain – be specific |
Risks – common | Risks that occur frequently, even if minor (e.g. bruising, infection) |
Risks – serious | Risks that are rare but serious or life-altering (e.g. stroke, paralysis, death) |
Alternatives | What other options exist, including doing nothing |
Consequences of not proceeding | What may happen if the patient declines |
Anaesthetic / sedation | Type used, separate risks, who will perform it |
Questions & understanding | Check comprehension, invite questions, allow time to decide |
Right to withdraw | The patient can change their mind at any time before or during the procedure |
✓ | Step | What Examiners Are Looking For |
☐ | Introduce & ID | Confirm patient identity and introduce yourself. Establish a relaxed, private setting. |
☐ | Establish Purpose | “I’d like to talk to you about the procedure we’re planning, so you have all the information you need to make your decision.” |
☐ | Assess Prior Knowledge | “What have you already been told about this procedure?” – build on what they know |
☐ | Explain the Procedure | Describe what will happen in plain English. Use diagrams or gestures if helpful. |
☐ | Explain the Purpose | Why is this procedure being recommended? What problem does it solve? |
☐ | Explain the Benefits | Be specific about what the patient will gain from proceeding. |
☐ | Explain Common Risks | Name the risks that happen frequently, even if minor (infection, bleeding, bruising, pain). |
☐ | Explain Serious Risks | Name rare but serious risks clearly: ‘There is a small but real risk of… which could result in…’ |
☐ | Explain Alternatives | What else could be done? Including watchful waiting or no treatment. |
☐ | Consequences of Declining | What may happen if they choose not to proceed – without pressuring. |
☐ | Anaesthetic Discussion | Explain the type of anaesthetic and mention the anaesthetist will also speak with them separately. |
☐ | Check Understanding | Use teach-back: “Just so I know I’ve explained this clearly, could you tell me in your own words what the procedure involves?” |
☐ | Invite Questions | Allow adequate time. Do not rush. Answer questions honestly. |
☐ | Confirm Voluntariness | Ensure the decision is free from pressure: ‘This is entirely your choice. There is no right or wrong answer.’ |
☐ | Right to Withdraw | Remind the patient they can change their mind at any time before the procedure begins. |
☐ | Safety Netting | Provide a number to call if they think of questions after leaving. Arrange follow-up if needed. |
Before obtaining consent, you must be satisfied that the patient has decision-making capacity. In the OSCE, if the examiner raises a capacity concern, use the four-part test:
- Can the patient understand the information provided?
- Can they retain and recall that information?
- Can they weigh up the information to make a decision?
- Can they communicate their decision clearly?
If capacity is in doubt, document your assessment, involve a senior colleague, and if the patient lacks capacity, consider substitute decision-makers (next of kin, guardian) or the patient’s previously expressed wishes (advance care directive).
Opening: I’d like to take some time to go through the procedure with you so you have all the information you need. There are no silly questions, please stop me at any time.
Explaining a serious risk: There is a small risk – around 1 in 200 cases – of damage to the surrounding structures, which in rare circumstances could affect your bowel function. It’s uncommon, but I want you to be aware of it.
Exploring alternatives: There are a couple of other options we could consider. We could manage this with medication alone, or take a watch-and-wait approach. I’d like to talk through what each of those would mean for you.
Teach-back check: I’ve given you a lot of information today. To make sure I’ve explained it clearly, would you mind telling me in your own words what you understand about the procedure and the main risks?
Affirming autonomy: Ultimately, this is your decision. Whatever you decide, we will support you. There is no pressure to proceed today.
💡 Examiner Tip: Always explore alternatives, including no treatment. Examiners commonly subtract marks from candidates who present a procedure as the only option.
💡 Examiner Tip: Use the teach-back method to check understanding – it is explicit best practice in Australian consent guidelines and examiners look for it specifically.
💡 Examiner Tip: Do not read from a consent form. The consent form should be a record of a conversation, not the conversation itself.
⚠️ Common Mistake: Listing risks so rapidly that the patient cannot process them – give each significant risk its own sentence and pause.
⚠️ Common Mistake: Failing to mention alternatives or the option of declining – this is a breach of informed consent and a major mark deduction.
⚠️ Common Mistake: Assuming the patient understands without checking – always use a teach-back or comprehension check.
⚠️ Common Mistake: Applying pressure: ‘I really think you should have this done’ – this undermines voluntariness and is penalised.
STATION 3: Motivational Interviewing & Lifestyle Counselling
Motivational interviewing (MI) is a patient-centred counselling technique designed to help patients explore and resolve their ambivalence about behaviour change. In the AMC OSCE, this station commonly involves alcohol reduction, smoking cessation, weight management, physical activity, medication adherence, or management of type 2 diabetes.
The key principle of MI is that change must come from the patient – your role is to guide, not instruct. Examiners specifically look for whether you avoid lecturing and instead draw out the patient’s own motivation.
R | Resist the righting reflex | Resist the urge to tell the patient what to do. Lecturing triggers resistance and shuts down conversation. |
U | Understand the patient’s motivation | Explore what matters to the patient – their values, their goals, their reasons to change (or not change). |
L | Listen with empathy | Use reflective listening. Acknowledge what the patient is saying without judgement. Validate their experience. |
E | Empower the patient | Support the patient’s self-efficacy. Reinforce that change is possible and that they are capable. Celebrate small steps. |
OARS describes the four core communication techniques used in motivational interviewing:
- Open Questions: Ask open-ended questions that invite reflection rather than yes/no answers
- Affirmations: Reflect back what the patient has said to show you have heard them and to deepen their own thinking
- Reflective Listening: Acknowledge the patient’s strengths and efforts – this builds the therapeutic relationship and self-efficacy
- Summaries: Periodically summarise what has been discussed – this shows active listening and helps the patient hear their own ambivalence reflected back
Stage | What the Patient Sounds Like | Your MI Response |
Pre-contemplation | “I don’t have a problem” | Explore the issue gently. Raise awareness without confrontation. |
Contemplation | “I know I should change, but…” | Explore ambivalence. Elicit pros and cons. Don’t push. |
Preparation | “I’m thinking about making a change soon” | Help them plan. Identify barriers and supports. |
Action | “I’ve started making changes” | Affirm progress. Reinforce self-efficacy. Problem-solve barriers. |
Maintenance | “I’ve been doing well for a while” | Praise success. Relapse prevention planning. |
Relapse | “I slipped back into old habits” | Normalise setbacks. Reconnect to motivation. Avoid shame. |
💡 Examiner Tip: In the OSCE, identify the patient’s stage of change in the first 60 seconds and tailor your approach accordingly. A patient in pre-contemplation needs very different communication from one in preparation.
The readiness ruler is a quick, evidence-based MI tool that works well in OSCE time constraints. Ask the patient:
Importance question: “On a scale of 0 to 10, how important is it to you personally to make this change?”
Confidence question: “On a scale of 0 to 10, how confident are you that you could make this change if you decided to?”
Whatever number they give, ask: “Why did you choose that number and not a lower one?” This elicits the patient’s own reasons for change – known as ‘change talk’ – which is the most powerful driver of behaviour change in MI.
✓ | Step | What Examiners Are Looking For |
☐ | Introduce & Establish Rapport | Warm greeting, confirm identity, create a non-judgmental atmosphere |
☐ | Open with a Neutral Question | “What brings you in today?” or “I understand you wanted to talk about your smoking – what would you like to get out of our conversation today?” |
☐ | Explore Current Behaviour | Ask about the behaviour in a non-judgmental way. Understand the context, frequency, and triggers. |
☐ | Assess Stage of Change | Listen for readiness cues. Is the patient in pre-contemplation, contemplation, or preparation? |
☐ | Explore ICE | Understand their ideas about the behaviour, what concerns them, and what they are hoping from today |
☐ | Elicit Change Talk | “What would be different in your life if you made this change?” “What are the good things about changing?” |
☐ | Explore Ambivalence | “It sounds like part of you wants to change but part of you isn’t sure. Can you tell me more about that?” |
☐ | Use the Readiness Ruler | Importance and confidence scores – then ask why not lower to elicit self-motivating statements |
☐ | Reflect & Summarise | Reflect back what you have heard – including the ambivalence – to show you have understood |
☐ | Provide Information (if asked) | Only give advice if the patient invites it: ‘Would it be okay if I shared some information about what works for most people?’ |
☐ | Collaboratively Set a Goal | Ask the patient what change they feel ready to make. Keep it small, specific, and achievable. |
☐ | Identify Barriers & Supports | What might get in the way? Who could help? What has worked before? |
☐ | Affirm & Encourage | Acknowledge their courage in discussing this and their capacity to change |
☐ | Arrange Follow-up | Book a review appointment. Provide written resources (e.g. Quitline, Hello Sunday Morning, My Healthy Balance) |
☐ | Safety Net | Know when to escalate – if lifestyle change is insufficient, discuss pharmacological options or specialist referral |
Non-judgmental opener: Thank you for bringing this up today. This is a really common issue and you’re definitely not alone in finding it difficult.
Eliciting change talk: What would your life look like in five years if things carried on the way they are now? And what could it look like if you made the changes you’re thinking about?
Responding to resistance: It sounds like you’re not quite ready to make that change yet, and that’s completely okay. Can I ask what would need to be different for you to feel more ready?
Asking permission to share advice: Would it be okay if I shared some information about what tends to help people in similar situations? You can decide what feels right for you.
Closing with affirmation: I want to say – the fact that you came in today and had this conversation takes real courage. Whatever you decide to do, we are here to support you.
- Quitline (13 7848) – for smoking cessation support
- Hello Sunday Morning – app-based alcohol reduction support
- MyFitnessPal / Get Healthy NSW – lifestyle and weight management
- National Diabetes Services Scheme (NDSS) – for diabetes lifestyle support
- RACGP Guidelines for Preventive Activities in General Practice (the Red Book) – framework for lifestyle counselling in Australian primary care
💡 Examiner Tip: Never tell a patient to ‘just stop’ drinking, smoking, or overeating. This triggers resistance and is the opposite of MI. Examiners penalise directive, advice-giving approaches in MI stations.
💡 Examiner Tip: Normalise ambivalence: ‘It’s very common to feel torn about this – wanting to change but also finding reasons to stay the same.’ This validates the patient and opens up the conversation.
💡 Examiner Tip: If the patient seems resistant, roll with it rather than pushing back. Say: ‘I hear you – it sounds like now isn’t the right time. What would have to change for you to feel differently?’ This is advanced MI technique that impresses examiners.
⚠️ Common Mistake: Giving unsolicited advice: launching into health education without the patient asking – this is directive, not MI. Always ask permission before sharing information.
⚠️ Common Mistake: Focusing only on the negative consequences of the behaviour – this can increase shame and resistance. Always balance risks with exploration of the patient’s own reasons to change.
⚠️ Common Mistake: Setting goals for the patient rather than with them – goals must come from the patient to be sustainable.
⚠️ Common Mistake: Not following up – motivational interviewing is a process, not a single conversation. Always arrange a review appointment.
Australian Cultural Considerations in AMC OSCE Communication
The AMC OSCE is set in an Australian healthcare context. Examiners expect you to demonstrate awareness of Australian cultural norms, patient rights, and healthcare values – not just clinical knowledge.
Cultural Consideration | What to Do in the OSCE |
First Nations patients | Always ask about cultural background sensitively. Offer an Aboriginal Liaison Officer or community health worker. Be aware of family and community decision-making. Avoid assumptions. |
Shared decision-making | Never make a decision for the patient. Present options, explain pros and cons, and ask what they prefer. |
Health literacy | Always check understanding using teach-back. Avoid jargon. Use diagrams or written summaries if available. |
Interpreter services | If a patient has limited English, offer a professional interpreter. Never ask family members to interpret for medical consultations – this is against Australian best practice. |
Advance care planning | For serious illness discussions, ask if the patient has an Advance Care Directive or if they have thought about their future wishes. |
LGBTQIA+ inclusivity | Use gender-neutral language until the patient indicates their preference. Do not assume relationship status or family structure. |
Mandatory reporting | In Australia, doctors have a mandatory duty to report if a patient discloses child abuse, elder abuse, or certain notifiable diseases. Be aware of this obligation. |
Privacy (My Health Record) | Patients have the right to control their My Health Record. Mention this in relevant consultations. |
💡 Examiner Tip: If you are unsure about a patient’s cultural background or preferences, simply ask: ‘Is there anything about your background, culture, or beliefs that you would like me to take into account in your care?’ This question alone demonstrates cultural safety and gains marks.
How Oyamed Helps You Master Communication Skills
Communication skill stations are where exams are won and lost. At Oyamed.com, we have developed a communication skills programme that goes beyond frameworks – we prepare you for the emotional, cultural, and interpersonal demands of Australian OSCE stations.
- Full mock OSCE communication stations with trained actor patients, timed to exam conditions
- Video examples of high-scoring and low-scoring responses to the same station – so you can see exactly what makes the difference
- Framework summaries: SPIKES, ICE, Calgary-Cambridge, OARS, and the Stages of Change – all in one place
- Culturally specific guidance on Australian patient expectations, medical law, and healthcare values
- Personalised feedback from experienced AMC OSCE tutors after every practice station
- A dedicated question bank of communication scenarios including breaking bad news, consent, MI, angry patients, and cross-cultural consultations
🚀 Ready to master AMC Communication SKill Stations?
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