ABSTRACT
Guidelines issued by the Royal College of Physicians (RCP) for host centres when writing scenarios for station 4 (Communication skills and ethics) are as follows:
The scenario should relate to everyday clinical practice and must not be too obscure and complex. It should not rely on detailed medical knowledge of any one condition, investigation, current management or prognosis.
The scenario should clearly define the task involved and what is expected of the candidate, e.g. obtaining consent for a procedure or discussing proposed management following diagnosis.
The scenario should be such as to sustain a 14-minute discussion between the candidate and the surrogate/patient.
The scenario should not be so complex that the surrogate/ patient cannot play the role required.
The topic should, wherever possible, be a universal problem applicable to global medicine. It must not be such that the candidate needs detailed knowledge of UK law.
It is desirable that the scenario should have an ethical component as it is difficult for examiners to sustain a five-minute discussion based on a scenario entirely confined to communication skills.
Patient organisations oppose the description of patients by their diagnoses, believing that this stigmatises them, e.g. referring to 'epileptics', 'diabetics' and 'acromegalics' is unacceptable. Patients should be referred to as patients with epilepsy, diabetes, acromegaly, etc.
Abbreviations should be avoided wherever possible. Universally accepted abbreviations such as ECG and CXR are 28allowable, but abbreviations for investigations, e.g. PCR, or organisations, e.g. DVLA, etc., may differ between countries and are therefore not allowable.
Emotionally charged topics need not be avoided provided the surrogate is well trained and experienced in role-playing. However, topics that involve particularly sensitive issues, e.g. sexual history, are best avoided.
It is worth taking a little time to study these guidelines. In particular it should be noted that the case must be a common clinical scenario and not obscure and complex, and there should be a well-defined task for the candidate. While some appreciation of law is required, you are not expected to have the knowledge of a lawyer.