PLAB 2 breaking bad news stations: a complete guide

Breaking bad news tests your humanity and your structure at the same time. Done well, it is calm, honest and led by the patient. The widely taught SPIKES framework gives you a scaffold so that, even under pressure, empathy and clarity come together.

The SPIKES framework

• Setting — ensure privacy, sit down, and give your full attention.
• Perception — find out what the patient already knows or suspects.
• Invitation — ask how much they want to know.
• Knowledge — give a warning shot, then the news clearly and simply.
• Emotions — pause, allow silence, and respond to feelings before facts.
• Strategy — agree clear next steps and check understanding.

The warning shot

A brief phrase that signals difficult news is coming — “I’m afraid the results are not what we hoped” — gives the patient a moment to prepare. Skipping it, and blurting out the diagnosis, is one of the most common ways to lose marks.

Use silence well

After delivering the news, stop talking. Let the patient react. Acknowledge the emotion in plain words before you move on. Filling the silence with more information is the instinct to resist.

Common pitfalls

• No warning shot — delivering the news abruptly.
• Burying the patient in information when they need a moment.
• Rushing to a plan before they are ready.
• False reassurance instead of honest, gentle support.

Rehearse breaking-bad-news stations with emotionally responsive AI patients on ZWIP, so the hardest moments — the warning shot, the silence, the tears — feel familiar before exam day. For more on the framework, see our guide to the SPIKES protocol.