Annexe A: Communication and Relationship Management Skills

Scope and weight

Seven questions is the smallest clinical block, but communication also lives inside other platforms: consent in Platform 1, health promotion in Platform 2, handover in Platform 5. Candidates who prepare Annexe A well tend to find those other questions easier. The questions describe a conversation and ask what to say, ask or do next. There is rarely a calculation or a fact to recall; there is a human situation and a choice between responses.

What is tested

• Core skills. Active listening, open questions and empathy.
• Difficult conversations. Breaking bad news, responding to distress, end-of-life conversations with patients and families, and handling complaints.
• Cognitive and sensory needs. Communicating with people with dementia or delirium, learning disability (easy read, Makaton), sensory impairment or aphasia.
• Language and culture. Using interpreters, crossing language barriers, and cultural and religious sensitivity.
• Conflict. De-escalation of anger and aggression.
• Mental distress. Therapeutic communication with self-harm and suicidal ideation.
• Behaviour change and understanding. Motivational interviewing, teach-back, health literacy and giving information.
• Professional communication. Telephone, written and electronic standards, SBAR escalation, and giving and receiving feedback.

Local points to anchor your answers

• Use a professional interpreter. Do not rely on a family member, particularly a child, to interpret clinical information, because accuracy, confidentiality and the person's freedom to speak are at risk. Confirm local policy.
• Ask directly about suicide. Asking does not plant the idea. The therapeutic response is to listen without judgement, assess risk and follow the local pathway. Do not leave the person alone if the risk is immediate.
• Capacity-informed communication. Support the person to decide by adapting the way you communicate, as the Mental Capacity Act requires. Use pictures, easy read or time.
• Reasonable adjustments. The Equality Act 2010 requires adjustments for disabled people, including communication adjustments.
• De-escalation. Keep a safe distance, a calm tone and an exit route, and avoid confrontation. Restrictive options come last.
• SBAR. Use Situation, Background, Assessment, Recommendation when you escalate by phone or in handover.

Three typical traps

1. Reassuring too early. "Don't worry, everything will be fine" shuts down the conversation. The better response acknowledges the feeling and asks an open question.
2. Answering for the person. With a patient who has a communication difficulty, speaking to the relative instead of the patient is a distractor. Address the patient and adapt the method.
3. Avoiding the direct question. When a patient hints at self-harm or suicide, changing the subject or only referring on is weaker than asking, listening and assessing.

How the questions are framed

Annexe A stems are short scenes. A man has just been told he has cancer and sits in silence. A woman with dementia keeps asking to go home. A patient who speaks little English needs consent explained. A relative is shouting at the nurses' station. A young person with a learning disability is frightened of a blood test. The question asks for the next thing you say or do, or for the response that is least helpful.

What the exam asks about each group

• Listening and empathy. Pick the response that reflects the feeling, uses open questions and leaves room for the person to speak. Interrupting, fixing and reassuring too soon are distractors.
• Bad news and end of life. Give information in small pieces, in plain language, in a private setting, check understanding and offer support. Do not use euphemisms that confuse.
• Dementia and delirium. Stay calm, use short sentences, validate the feeling behind the words and avoid arguing about facts.
• Learning disability, sensory impairment and aphasia. Adapt the method with easy read, Makaton, pictures, written text, extra time or a quiet space, and speak to the person.
• Language and culture. Book an interpreter, check preferences and respect religious and cultural needs.
• Anger and aggression. De-escalate with space, tone and listening, and escalate for help when safety is at risk.
• Mental distress. Ask openly about suicidal thoughts and respond without judgement.
• Information and behaviour change. Use teach-back to confirm understanding and motivational interviewing to explore change.
• Professional communication. Keep written and electronic messages clear, factual and secure, and give and receive feedback constructively.

The right answer almost never closes the conversation. It opens it, adapts it or makes it safe.

A practical test for any option is to imagine saying it aloud to the person. If it sounds dismissive, rushed or like a script, it is probably a distractor. If it sounds like what a calm, respectful colleague would say, it is probably the answer.

How to revise it

1. Learn a few reliable phrases for each skill: an open question, a reflection, a teach-back request and an empathy statement.
2. Practise the order of a bad-news conversation: prepare, find out what the person knows, give a warning shot, share the news simply, respond to emotion, agree the next steps.
3. Make a needs table pairing each communication difficulty with the adjustment: dementia, aphasia, hearing loss, learning disability, language barrier.
4. Rehearse SBAR aloud with a made-up deteriorating patient.
5. Review options by asking: does this one respect the person, give clear information, and check understanding?

Pair with Platform 2 for behaviour change, Platform 1 for consent and capacity, and Platform 5 for handover.