How to break bad news
Other platforms explain it with text and video. In VMS you practice it on the patient.
Breaking bad news is a skill that can be learned. The SPIKES steps are the most used structure in medical education.
Step by step
Setting
Private room, seated, phone off, tissues ready, family present if the patient wants. [1]
Perception
Ask what they already know: "What have you been told so far?" [1]
Invitation
Ask how much they want to know: "Would you like me to go through the results in detail?" [1]
Knowledge
A warning shot ("I'm afraid I have bad news"), then the news in plain words, in small pieces, without jargon. [1]
Emotions
Pause. Name the emotion and respond with empathy: "I can see this is a shock." Silence is fine. [1]
Strategy and summary
When they are ready, agree on the next steps, summarize and check understanding. [1]
Support
Offer written information, a contact and a follow-up time. [1]
Common errors
- Giving the news in a hallway.
- Using medical terms.
- Talking to fill every silence.
Practice it in VMS
In VMS 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.
VMS cases that train this skill
Sources
Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.