Health & care · Clinical Skills Exam
Breaking bad news role play: tell Margaret her biopsy results
Use a structure such as SPIKES: find a private setting, ask what the patient already understands and how much they want to know, give a warning shot, then say the diagnosis in plain words and stop. Respond to the emotion before you talk about next steps, avoid jargon, and let silence happen. Practice the station with Margaret Ellison, about 70, who is waiting for her biopsy results.
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Updated October 2026
Who it's for
Who this practice is for
- Medical students practicing for an OSCE station on breaking bad news.
- Nursing and PA students learning to talk through a cancer diagnosis.
- Residents in communication-skills courses who want feedback on empathy.
- Anyone rehearsing the SPIKES steps out loud before a real patient conversation.
What happens
How a session goes
- Margaret Ellison speaks first. She is anxious and may say she is sure it is nothing.
- You respond. You can type instead of talking at any time. She reacts to what you say.
- At the bell, Margaret says whether her main concern was addressed.
Real lines from a test session
What Margaret Ellison said in a test session
“I've been looking things up online all week. I'm sure it's nothing, right?”
“Well, I mean, the first thing is I need to tell my grandkids. … How do I even begin to explain this to them?”
“That would help me so much. They need to hear it from someone who really knows what they're talking about.”
From a test session of this practice in the app, lightly trimmed. Your session goes its own way: the character reacts to what you say.
The scorecard
What the scorecard looked like for Breaking Bad News
“Oh, that's... well, children are resilient, you know? They'll be fine. You just sit them down and tell them.”
You dismissed her deepest concern about the grandchildren, which prompted her to call you out and derail the meeting.
Try instead: “I can hear how worried you are about them. After losing their mother, this is a lot for all of you. Let's talk about how to handle that conversation before we go further.”
What went well: You deeply explored her real worry (grandchildren) after initially rushing it, then offered a concrete family meeting.
Real scorecard output from one of our test runs. In test runs the practice answers are written by a test script, not by a customer.
What good looks like
What a strong answer does here
- Ask what she already knows before you say anything about the results.
- Give a warning shot, then say the word cancer in plain language, not jargon.
- Stay quiet after the news and let her react.
- Name her emotion, find her real worry about her grandchildren, and end with one clear next step.
Scored on:
- Data gathering
- Communication
- Empathy & ICE
- Clinical reasoning & safety-netting
Common mistakes
Weak lines, and what to say instead
Weak: “I have your results here. It is cancer.”
Better: “I am afraid the results show cancer. I am so sorry. Take a moment, and I will stay right here with you.”
No warning shot and no pause after the news.
Weak: “It is a malignant neoplasm. We will discuss management options.”
Better: “The biopsy shows cancer. We have a team that will go through every option with you.”
Jargon hides the meaning and sounds cold.
Weak: “Try not to worry. We will sort out the treatment plan.”
Better: “I can see this is a shock. What is going through your mind right now?”
Rushing past emotion instead of naming it and pausing.
Weak: “We can talk about the plan next week.”
Better: “Before we plan, what worries you most about telling your grandchildren?”
Misses her real worry and gives no clear next step.
Breaking Bad News (SPIKES): start talking in a few seconds. Your own side stays yours to fill in.
Try it free, no signupMake this useful for your next conversation
Your clinical skills exam practice plan
- Gather relevant information
- Explain and check understanding
- Address concerns and communication safety
Start with a free worksheet, then test your own response with a voice or text roleplay. Your first complete coaching report is free once across all areas. Create a free account to save your goal, actual words, and downloadable notes.
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FAQ
Questions about Breaking Bad News
What is the SPIKES protocol?
SPIKES (Baile et al., 2000) has six steps: Setting, Perception (what she already knows), Invitation (how much she wants to know), Knowledge (a warning shot, then plain words), Emotions (respond with empathy), and Strategy and summary. In this station you can practice all six with Margaret. Try it free →
What does the AI patient do?
Margaret Ellison speaks first. She is anxious and may say she is sure it is nothing. She reacts to what you say, and at the bell she says whether her main concern was addressed. You can type instead of talking at any time. Try it free →
Is this real medical advice?
No. This is training practice, not medical advice. It is for medical, PA and nursing students, residency programs and communication-skills courses. You practice the conversation with an AI patient, and the feedback is about your communication, not about any real patient's care. Try it free →
What is a warning shot when breaking bad news?
A short sentence that prepares the patient just before the news, such as “I’m afraid the results are not what we hoped.” It gives them a second to brace. Then say the diagnosis plainly, for example “The biopsy shows cancer,” and pause instead of rushing on. Try it free →
Sources: Baile WF et al., SPIKES: a six-step protocol for delivering bad news, The Oncologist 2000.
Training practice, not medical advice.
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