Breaking bad news: a clinical skill for postgraduate exams.

Breaking bad news is a challenging station in postgraduate exams. Candidates can struggle if they have not practised delivering sensitive information in a professional and empathetic way. Limited experience of using this clinical skill as a junior doctor often compounds candidates' uncertainty in exams. A clear structure is essential for examination success. The most commonly used is the SPIKES framework, the elements of which are Setting, Perception, Invitation, Knowledge, Emotions and Strategy. This is a stepwise approach that allows candidates to break bad news in a structured way. This is beneficial in clinical practice, but is also invaluable in postgraduate exams, which often have prescriptive marking schemes. This article highlights the key topics and pitfalls that candidates may encounter and suggests tips for success in exams.