School of Clinical Medicine, University of Cambridge

Stage 1 OSCE

Station: Breaking Bad News

Candidate Instructions (these instructions will be provided to you one week prior to
the examination)

This is a 10 minute station + 2 minutes reading time

This station assesses your ability to break bad news to a patient.

You are: A surgical PRHO at Addenbrooke’s Hospital. You are seeing a patient who
requires a below knee amputation for ischaemia/insipient gangrene, due to atherosclerosis.
You have not seen this patient before.

Today you are seeing: Jo(e) Smith Age: 40 - 60

Scenario: The patient is middle aged and was a life long smoker until he/she gave up one
year ago. He/she is in bed on the ward. He/she has suffered intermittent claudication for 5
years. A below knee amputation is now essential because the patient has chronic rest pain
and has dusky cyanosis of the foot. Angiography has demonstrated that the femoral arteries
are adequate and good wound healing is anticipated.

Other Information: If no operation is performed the patient can expect - increasing pain,
onset of gangrene, spread of infection from local area of gangrene to septicaemia and
ultimately death.
• The operative mortality is 5%
• The operation will be followed by fitting of prosthesis
• Walking on prosthesis by 6 weeks
• Rehabilitation lasting 3 – 6 months

Task: You have been asked by the surgical registrar to see Jo(e) Smith:

 To break the bad news that a right below knee amputation is necessary
 Deal with any concerns the patient may have.

You are not expected to discover the rest of the essential background information nor
consent the patient for operation.

Time: You have 2 minutes to reacquaint yourself with the instructions and 10 minutes
for the interview