Authors: Dr Bevan Roodenburg, Dr Steve Philpot
Peer reviewer: A/Prof Chris Nickson
The Communication viva is distinct from all the other vivas that take place in the Second Part examination for Fellowship of the College of Intensive Care Medicine (CICM) of Australia and New Zealand.
The viva station involves an observed simulated communication encounter with an actor.
Here is a brief guide based on useful tips for performing well in this viva station.
What types of conversations should you expect?
Typical conversations used in the communication viva include:
- Breaking catastrophic news
- Breaking bad news
- Open disclosure (remember the exam is international, so knowledge of specific legislation is not being tested)
- Negotiating complex family emotions
- Shared decision making
What should you do outside of the room during the reading time?
Use this two minutes wisely:
- Carefully read and ensure you understand the question stem.
- Change gears to your family discussions mode (see below)
- Consider the purpose of the meeting.
What should you do during the observed communication station?
You will have a 10 minute communication interaction with an actor, that is observed by CICM examiners in the room.
To perform well in this station you should:
- Change down a gear – the comms viva is scored highest when the candidate speaks slowly, allows lots of pauses, avoids jargon etc. This is the exact opposite of every other viva where you are trying to score points as quickly as possible and communicate knowledge. When you see the stem and recognise that it is the comms viva, deliberately slow yourself down and “change gears”
- Change back up a gear at the end! – You need to do the opposite at the end of the comms viva! There will typically be a rest station after comms viva; take a few minutes to reflect on the conversation (it’s often quite heavy), and then put it behind you and consciously speed back up into “viva” mode. Perhaps think about a technical topic and run through something in your head to help you move on from the comms station.
- Realise you don’t need to “finish” the scenario – you will score more if you are halfway through a well conducted conversation than if you finish the conversation in a rushed way. For example, if the scenario is about requesting organ donation, you are not expected to get an “answer” in 10 minutes… that would rarely happen in real life.
- Realise it’s about communication, not “medical knowledge” – You don’t score marks for knowledge in this station, it is purely marked on communication. For example, if you are asked to explain brain death testing to a family member, there will be no marks allocated for knowing what the clinical tests are, only for how you choose to explain what the testing looks like. Don’t try to demonstrate knowledge of the topic.
- Focus on how you make the actor’s “character” feel – the actor is invited to comment before the examiners mark. They will be asked to reflect on how the candidate made them feel and if there were any frustrations on their part; this is then taken into consideration by the examiners. Pay attention to the family member and try to meet their needs, acknowledge their experience, establish rapport.
- Not treat the viva as a “tickbox exercise” – Although there is a marking guide for examiners, it is not a “tickbox” exercise in the comms station as other vivas are. You don’t score 1 mark for using silence, 1 mark for using signposting etc. etc. It is more general in the way the marking key is written, based on information transfer, response to emotions etc.
- Immerse yourself as if it is an actual family communication – Above everything else, “buy in” to the simulation aspect and just imagine you are in an actual family conversation. For those who are good communicators, that is all they need to do to pass the station! Don’t get so caught up in trying to “game” the viva that you don’t act as you normally would. To prepare for this viva, practice as much as possible at work and try to pick up skills for conducting these conversations.
How can you lose marks in the communication station?
Losing marks is easy to do: imagine how hard it is for examiners to mark you well if you don’t introduce yourself, if you don’t realise how hard this is, or how sad the family member might be. Of course, introductions could include questioning family about who else might be in the family/supports not present. It might feel like acting to you, but just engage in the simulated conversation and show compassion and caring.
What should you do when the communication station ends?
Leave when the bell rings at 10 mins and take a rest and change gears. There is typically a rest station immediately following the comms viva.
Think forward and change mode back to efficient, accurate, direct verbal and body language.
Disclaimer: This is blogpost does not represent formal advice from CICM – just a collection of tips from clinicians involved in teaching communication skills and helping trainees prepare for the communication viva.