The SPIKES protocol for breaking bad news in PLAB 2

Breaking bad news tests both your humanity and your structure under pressure. The SPIKES protocol is a widely taught six-step framework that helps you deliver difficult information clearly while staying patient-centred — exactly what PLAB 2 examiners are looking for.

What does SPIKES stand for?

• S — Setting: prepare the environment, check privacy, and sit down.
• P — Perception: find out what the patient already knows or suspects.
• I — Invitation: ask how much they want to know before you tell them.
• K — Knowledge: give the information clearly, in small chunks, after a warning shot.
• E — Emotions: respond to feelings with empathy and pauses, not more facts.
• S — Strategy and summary: agree a clear plan and check understanding.

Why it works in the exam

SPIKES stops you from doing the two things that most often go wrong: blurting out the news without warning, and burying the patient in information when they need a moment to feel. The “warning shot” — a brief signal that difficult news is coming — and the deliberate pause for emotion are what separate a compassionate station from a clumsy one.

Putting it into practice

Use silence well. After delivering the news, stop talking and let the patient react. Acknowledge the emotion in plain words (“I can see this is a shock”) before moving on. Only once they are ready do you discuss what happens next.

No framework survives first contact without rehearsal. Practising breaking-bad-news stations with emotionally responsive AI patients on ZWIP lets you get comfortable with the hardest moments — the warning shot, the silence, the tears — before you meet them in Manchester.