Breaking bad news at the 12-week scan — communication station

Communication station: breaking the news of a missed miscarriage at the 12-week scan. Tests structured bad-news delivery (warning shot, plain words, silence), language discipline (avoiding 'products of conception' and 'at least'), offering genuine choice about management, screening for mental health risk, the partner as a patient, and a documented follow-up plan. Includes assessor key and marking domains.

Prompt

A 31-year-old woman attends for her routine 12-week dating scan with her partner. The sonographer finds no fetal heartbeat and confirms a missed miscarriage at around 10 weeks gestation. She refers the couple through to the early pregnancy unit. You are the registrar who will break the news, conduct the conversation, offer choice about management, and plan follow-up. The couple conceived after 18 months of trying.

Station brief

Format. Communication station, approximately 12 minutes. You are the registrar who has just received the referral from the sonographer. The couple is in a private room. The assessor plays the woman; a colleague or the assessor may play the partner. ^[1]

Candidate instruction. Break the news of the missed miscarriage, conduct the conversation, offer genuine choice about management, screen for mental health risk, attend to the partner, and arrange follow-up. Verbalise each step of your communication deliberately — the assessor is marking how you behave as much as what you know. ^[1]^[6]

References6Show

[1]Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet, 2021.PMID 33915094
[2]Farren J, Jalmbrant M, Ameye L, et al. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ Open, 2016.PMID 27807081
[3]Kong GW, Chung TK, Lok IH. The impact of supportive counselling on women's psychological wellbeing after miscarriage--a randomised controlled trial. BJOG, 2014.PMID 24912398
[4]Somerville S, Dedman K, Hagan R, et al. The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch Womens Ment Health, 2014.PMID 24699796
[5]Coomarasamy A, Devall AJ, Brosens JJ, et al. Sporadic miscarriage: evidence to provide effective care. Lancet, 2021.PMID 33915095
[6]Farren J, Mitchell-Jones N, Verbakel JY, et al. The psychological impact of early pregnancy loss. Hum Reprod Update, 2018.PMID 30204882

Breaking bad news at the 12-week scan — communication station

Station brief

References6Show

[1]Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet, 2021.PMID 33915094
[2]Farren J, Jalmbrant M, Ameye L, et al. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ Open, 2016.PMID 27807081
[3]Kong GW, Chung TK, Lok IH. The impact of supportive counselling on women's psychological wellbeing after miscarriage--a randomised controlled trial. BJOG, 2014.PMID 24912398
[4]Somerville S, Dedman K, Hagan R, et al. The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch Womens Ment Health, 2014.PMID 24699796
[5]Coomarasamy A, Devall AJ, Brosens JJ, et al. Sporadic miscarriage: evidence to provide effective care. Lancet, 2021.PMID 33915095
[6]Farren J, Mitchell-Jones N, Verbakel JY, et al. The psychological impact of early pregnancy loss. Hum Reprod Update, 2018.PMID 30204882