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Talking with the patient

How to break bad news

Other platforms explain it with text and video. In Making Synapses you practice it on the patient.

MD / DOPANursing (NCLEX)
Practice it in VR with Blocky

Breaking bad news is a skill that can be learned. The SPIKES steps are the most used structure in medical education.

Step by step

  1. Setting

    Private room, seated, phone off, tissues ready, family present if the patient wants. [1]

  2. Perception

    Ask what they already know: "What have you been told so far?" [1]

  3. Invitation

    Ask how much they want to know: "Would you like me to go through the results in detail?" [1]

  4. Knowledge

    A warning shot ("I'm afraid I have bad news"), then the news in plain words, in small pieces, without jargon. [1]

  5. Emotions

    Pause. Name the emotion and respond with empathy: "I can see this is a shock." Silence is fine. [1]

  6. Strategy and summary

    When they are ready, agree on the next steps, summarize and check understanding. [1]

  7. Support

    Offer written information, a contact and a follow-up time. [1]

Common errors

Practice it in Making Synapses

In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.

Making Synapses cases that train this skill

515 Making Synapses cases train this skill: open the case library

Sources

  1. AAMC Core Entrustable Professional Activities (Core EPAs)
  2. NCCPA PANCE Content Blueprint

Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.