Examiners do not mark style; they mark behaviours. Frameworks give you a reliable order so that nothing is forgotten under pressure.
The consultation: Calgary–Cambridge in five steps
- Initiate: greet, introduce yourself and your role, confirm the patient’s name, explain what you will do and gain consent. “Hello, I’m Dr Rahman, one of the doctors here. Can I confirm your full name? I’d like to ask about the pain and then talk through what we should do. Is that all right?”
- Gather information: open question first (“Tell me what’s been happening”), listen without interrupting, then focus. Ask about ideas, concerns and expectations (ICE): “What do you think might be causing this? Is anything worrying you? What were you hoping we could do today?”
- Examine (when asked): explain, wash your hands, ask permission, expose appropriately, ask about pain, and say what you are doing.
- Explain and plan: give information in small pieces, in plain words; check understanding (“Can you tell me what you’ll do next?”); agree the plan together.
- Close: summarise, safety-net (what to watch for and when to seek help), arrange follow-up and ask “Is there anything else?”
Breaking bad news: SPIKES
| Step | What to do |
|---|---|
| Setting | Private place, sit down, switch off the phone, ask who they want with them |
| Perception | “What have you been told so far? What’s your understanding?” |
| Invitation | “Would you like me to go through the results in detail?” |
| Knowledge | Give a warning shot (“I’m afraid it’s not good news”), then short, clear sentences; avoid jargon and euphemism |
| Emotions | Pause, acknowledge feelings, offer tissues and time, respond with empathy before more information |
| Strategy and summary | Outline what happens next, who will support them, and arrange a follow-up |
Safety-netting, in one sentence
“If the pain gets worse, you start vomiting, or you feel faint, call 999 or go to A&E straight away; otherwise we’ll see you again on Thursday.” A good safety-net names the symptoms, the action and the time.
Common mistakes
- Starting with questions before introducing yourself or gaining consent.
- Interrupting within the first twenty seconds.
- Jargon (“hypertension”, “benign”) without explanation.
- Offering false reassurance (“I’m sure it’s nothing”).
- Finishing without a summary or safety-net.
General education, reviewed 24 October 2026. Guidance changes: confirm with the official sources. Not medical, legal or immigration advice.