In October 2020, the USMLE increased the number of items assessing communication skills on the USMLE Step1. To some, that is a dream come true and to others, their worst nightmare. With a plethora of different and effective communication styles in the social world, it can be sometimes hard to tell what answer choice embodies the practice of medicine. However, it’s grossly important that these skills become a routine part of study habits not only for your USMLE exams but for your future career.
Here are a few tips we suggest for approaching USMLE questions that assess communication skills and ethics:
1. Don’t assume you are a conversational expert. It is okay to practice these types of questions in your q-banks so that you not only have a good understanding of how to speak to patients on exam day but also in your clinical practices.
2. Lead with empathy and compassion. Often, patients are scared, need reassurance, and expect further guidance. After hearing your patient’s concerns (or after reading the vignette), find an answer option (or respond) in a manner that affirms you understand how the patient is feeling. For example, you can note, “Thank you for sharing those details with me. I understand how scared/stressed/frustrated you feel.” From there you can guide the patient history to address their concerns and educate.
3. Remember to respect patient privacy. Brush up on times when it is acceptable to ask parents to leave the room or when to ask the elderly questions outside the presence of their caretakers. Additionally, understand appropriate times to ask spouses or significant others to exit.
4. For decision-making and consent scenarios understand the concepts of “power of attorney” and “living will.” It is important in every situation to assess the patient’s decision-making capacity before they give their consent.
5. Familiarize yourself with the definitions of these words: autonomy, beneficence, nonmaleficence, and justice. Be sure the response you are selecting follows each of these values.
6. Remember to follow HIPAA.
7. Understand when to utilize your hospital ethics team’s reporting system.
8. Direct patient’s who have complaints about other medical professionals to speaking directly with the professional in question.
9. Brush up on your knowledge of STD reporting and testing. Understand what STDs must be reported to partners and if testing of a minor needs to be reported to parents or guardians.
10. Utilize SPIKES when discussing bad news and long-term patient care.
11. Start with open-ended questions and patient understanding whenever possible.