Breaking bad news after early pregnancy loss — 12-minute structured oral station

Opening prompt — “Walk me through how you will tell this patient what the scan shows.”

Examiner is listening for: a plain death statement, response to emotion, parent-led choices.^[1][2]

Model response:^[1][2]

• “I would make sure the diagnosis is confirmed by two clinicians and find a private room. I would ask her whether she would like her partner present before I start the conversation.”
• “I would sit down, ask what she understands from the scan so far, and ask how much detail she would like me to explain now.”
• “I would give a warning shot and then say plainly: I am so sorry. The scan shows that this pregnancy has stopped developing and you are having a miscarriage. I would pause.”
• “I would acknowledge emotion. If she can, I would explain the options for managing the pregnancy and ask what she would like to do. I would offer written information and the name of the bereavement midwife before she leaves.”^[1][2]

Probe 1 — “She is silent and looks at the screen. What do you do now?”

• “I stop. I do not fill the silence with detail. I keep my eye level with hers, say I am so sorry, and ask whether she would like her partner brought in.”^[1]

Probe 2 — “She asks: did I do something wrong?”

• “I would say: most miscarriages happen because of how the pregnancy developed and not because of anything you did or did not do. I would offer to explain what is known from the scan, say that investigations are sometimes offered, and avoid speculation until review.”^[2]

Probe 3 — “She says she would like to manage this at home. What now?”

• Describe expectant, medical and surgical management with the choice framed by safety and the patient's preference.
• Give analgesia and written bleeding-and-pain advice, explain infection warning signs and the timing of further tests.
• Discuss contraception and the timing of a future pregnancy only when the patient raises it; do not push conception advice.^[2]

Probe 4 — “Three months later she attends at six weeks’ gestation. What changes?”

• Acknowledge the previous loss explicitly; ask how she feels about the pregnancy and what would help; ask about anxiety, sleep and support.
• Offer continuity with a known clinician, flexible visit frequency and an individualised surveillance plan; repeat screening for anxiety and depression.
• Do not promise reassurance. State: “I cannot promise the outcome, but we will agree a clear plan and a route back when anxiety rises.”^[3][4]

Probe 5 — “The midwife is in tears after the disclosure. How do you respond?”

• Thank her; do not pathologise her response; offer a brief voluntary peer check-in and identify anyone too distressed to continue.
• Offer supervision, reflective practice or employee assistance and ensure a learning-focused review. Do not force a group debrief.^[3]