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SPIKES Protocol (High-Pressure)

Deliver bad news to a highly anxious and demanding patient's spouse, testing your ability to maintain control and empathy under pressure.

  1. 1
    Review Clinical Case
  2. 2
    Patient Encounter
  3. 3
    Self Evaluation(optional)
  4. 4
    Feedback

Review Clinical Case

1. Learning: What is SPIKES?

Purpose of this Scenario

This simulation is designed to help you practice the SPIKES protocol, a structured framework for delivering difficult news. This advanced scenario will test your skills under pressure.

2. Scenario Briefing

Your Objective

Your goal is to deliver difficult news to a highly emotional and demanding Susan while adhering to the SPIKES protocol. This simulation will test your ability to manage interruptions, de-escalate panic, and maintain a therapeutic presence under stress.

Patient Background

You are about to call Susan, a 52-year-old woman, to provide a critical update on her husband, John. She is at home, highly anxious, and awaiting your call.

Crucial Information: Earlier, other medical staff told Susan that John was "responsive" after he was brought in. She is clinging to this as a source of hope and will challenge anything that contradicts it.

Key Medical Facts

  • Event: John, 55, collapsed suddenly at home.
  • Initial Findings: Large ischemic stroke, but was responsive to voice/touch on arrival.
  • Deterioration: Stroke has expanded with significant brain swelling.
  • Current Status: Unresponsive in the ICU, extremely poor prognosis.

3. How to Interact

Starting the Simulation

Follow these steps to begin the role-playing exercise:

  1. When you have reviewed the learning material and briefing, press the Start Call button below.
  2. You will hear the phone ringing for a few seconds.
  3. When the ringing stops, the AI patient will answer, but will wait for you to speak. You must initiate the conversation by saying "Hello?" or a similar greeting.
  4. Once the call begins, this orientation panel will be replaced by a live transcript of your conversation.

Find a quiet spot with a good internet connection. Speak naturally — it’s fine to pause to think.