1. The Calgary-Cambridge model — your backbone for every OSCE station

Created by Kurtz and Silverman (Cambridge, 1996; updated 2013), the model breaks every consultation into 5 tasks: Initiating the session, Gathering information, Physical examination, Explanation and planning, and Closing the session, with two parallel threads — building the relationship and providing structure. It is the explicit reference for the MCC Communicator role.

1.1 Initiating the session (30-60 seconds)

• Greet, identify yourself by name and role, confirm patient identity.
• Open-ended question: "What brings you in today?" — avoid "What's the problem?" which can feel cold.
• Wait for the golden minute: 60 seconds of uninterrupted listening before redirecting.
• Use a screening question: "Is there anything else?" until the patient says no.

1.2 Gathering information — the FIFE framework

1.3 Explanation and planning (the "chunks and checks")

Deliver information in small chunks (1-2 sentences) then check: "Does that make sense so far?". Use plain language; never say "benign" or "idiopathic" without translating. Then offer a summary back from the patient: "Just to make sure I explained this well, can you tell me what you'll do when you get home?" — this is called the teach-back method and is on most NAC checklists.

2. SPIKES — breaking bad news in 5 minutes

According to Baile et al. (Oncologist, 2000): "SPIKES is a six-step protocol for delivering bad news that maximizes the patient's autonomy and minimizes the physician's distress." Reference cited by SOGC, CMA Code of Ethics, and Health Canada palliative care guidelines. Source: theoncologist.onlinelibrary.wiley.com (accessed 2026-05-27).

3. The 5 A's for smoking cessation (CAN-ADAPTT 2011)

1. Ask: "Do you smoke?"
2. Advise: "Quitting smoking is the single most important step you can take for your health."
3. Assess: readiness using transtheoretical stages (precontemplation → action).
4. Assist: nicotine replacement, varenicline (Champix), bupropion (Zyban), counselling.
5. Arrange: follow-up in 1-2 weeks.

Varenicline is contraindicated in severe psychiatric illness only with caution; NRT and bupropion remain options. Pregnant women should be offered behavioural counselling first; NRT is acceptable if behavioural therapy fails.

4. Counselling scenarios commonly tested

4.1 HIV+ disclosure to partner

In Canada, an HIV+ person has a legal duty to disclose before sex that poses a realistic possibility of transmission (R. v. Mabior, SCC 2012). Counsel: confidentiality of test, partner notification options (patient-led or public health-assisted), and the protective effect of antiretroviral therapy ("U=U" Undetectable = Untransmittable).

4.2 Contraception counselling (SOGC)

• Use a shared decision-making approach.
• Cover: efficacy (Pearl Index), STI protection, return to fertility, side effects.
• Long-acting reversible contraception (IUD, implant) is first-line for adolescents per SOGC.
• Discuss emergency contraception: levonorgestrel 1.5 mg within 72 h or ulipristal acetate within 120 h.

4.3 Vaccine hesitancy

Use the CASE approach: Corroborate, About me, Science, Explain/Advise. Validate feelings ("I understand you have concerns…"), share your background ("As a physician, I've reviewed the evidence…"), summarize science, recommend a clear action.

5. Handling difficult patient encounters

5.1 The angry patient

Use the BATHE technique: Background, Affect, Trouble, Handling, Empathy. Stay calm, sit at eye level, name the emotion ("You seem really frustrated"), apologize for the system delay if appropriate, and avoid defensive language.

5.2 The patient seeking opioids

Stay non-judgemental. Screen with Opioid Risk Tool (ORT), check provincial pharmacy network (Narcotics Monitoring System in Ontario). Offer addiction medicine referral, consider buprenorphine/naloxone induction. Never escalate doses without functional gains.

5.3 Cultural safety with Indigenous patients

Open with land acknowledgement if appropriate, invite the patient to share their preferred name and pronouns, ask if they wish family or an Elder present. Avoid hand-shaking until offered. Use Two-Eyed Seeing: integrate biomedical and traditional approaches.

6. Key takeaways

• Calgary-Cambridge structure is universal — apply it in every station.
• FIFE explores the patient's perspective in < 90 seconds.
• SPIKES = breaking bad news in 5 steps + Strategy.
• 5 A's for smoking cessation; CASE for vaccine hesitancy; BATHE for anger.
• Cultural safety = patient-defined, lifelong humility, Two-Eyed Seeing.

Further reading

• SPIKES protocol (Baile et al., Oncologist)
• CFPC — Patient-Centred Care framework
• Canadian Virtual Hospice — breaking bad news scripts
• Indigenous Health — cultural safety resources