The counselling and explanation station
- OSCE station
An OSCE station where you explain a diagnosis, test or treatment, or help a patient change a habit, in plain words and checking understanding.
What it is
Counselling stations come in two families. In explanation stations the task is to explain a new diagnosis (asthma, type 2 diabetes), a test or procedure, or a treatment such as an inhaler or a new medicine. In behaviour-change stations the task is to talk about smoking, alcohol or another substance with a patient who is often ambivalent. Both use a standardised patient trained with a script, hidden concerns and cues, who frequently contributes to the score. Examiners mark the content (accurate, relevant, pitched at the patient's level) and the process. A good process starts by agreeing the aim of the conversation and finding out what the patient already knows, believes, fears and expects; then signposts, gives information in small chunks in plain words and checks after each one; demonstrates and observes when a device is involved; and ends with teach-back, a plan the patient agrees to, a safety net, written information and follow-up. For behaviour change, motivational interviewing works better than advice or warnings: open questions, affirmations, reflective listening and summaries help the patient voice their own reasons for change; the clinician explores ambivalence and readiness, respects autonomy and avoids confrontation, labels and moralising. Non-judgmental, person-first language («a person who uses alcohol» rather than «an alcoholic») is part of what is assessed.
What is assessed
- Rapport and a shared agenda for the conversation.
- Exploring the patient's starting point: knowledge, beliefs, worries and hopes.
- Accurate, relevant content at the patient's level, without false reassurance.
- Structure: signposting, chunk-and-check and summaries.
- Shared decision-making: options, benefits and risks, and respect for the patient's choice.
- Non-judgmental, person-first language, especially about alcohol, tobacco and other substances.
- A close with a plan, written information, a safety net and follow-up.
How to do it (and why)
- Introduce yourself and agree the aim: «I have been asked to explain your inhaler; is that what you would like today?» — a shared agenda.
- Ask what they know and fear: «What have you heard about diabetes?» — you build on their ideas and answer the real concern.
- Signpost: «First what asthma is, then the treatment, then what to do if it gets worse» — structure helps recall.
- Explain in small chunks, in plain words, and pause to check — overload and jargon are where patients lose the thread.
- For a device, demonstrate, let the patient try and correct the technique — watching catches errors that words miss.
- For a habit, ask permission and reflect ambivalence: «Part of you enjoys it and part of you worries» — change talk must come from them.
- Ask about readiness and agree one small, concrete next step — a goal the patient chooses is more likely to happen.
- Use teach-back: «To be sure I explained it well, could you tell me how you will use it?» — it tests the explanation.
- Close with a safety net, written information and follow-up — the patient knows when to come back and who to call.
Mistakes that cost marks
- Launching into a lecture without asking what the patient knows or wants to know.
- Jargon, abbreviations and long monologues with no pauses.
- Asking «Do you understand?» instead of teach-back; most patients simply say yes.
- Confronting, labelling or moralising («You have to stop drinking»): it raises resistance and loses empathy marks.
- Missing a cue the standardised patient is scripted to give, such as a worried look or «my father died of that».
- Wrong or invented facts, or false reassurance («Nothing will go wrong»).
- Ending without a plan, a safety net or follow-up.
Self-check list
- Did I agree the aim of the conversation at the start?
- Did I ask what the patient knows, fears and expects?
- Did I signpost and explain in small chunks, without jargon?
- Did I notice and respond to the patient's cues and emotions?
- For a habit change, did I use open questions and reflections instead of lecturing?
- Did I check understanding with teach-back?
- Did I agree a plan the patient accepts and respect their choice?
- Did I give a safety net, written information and follow-up?
Test yourself
Think of the answer, then tap the question to see it.
Why is «Do you understand?» a weak way to check understanding in a counselling station?
Most patients say yes out of politeness or embarrassment. Teach-back, asking them to explain or show it in their own words, tests your explanation and reveals the gaps to correct.
A standardised patient says: «I know I should quit smoking, but it is the only thing that calms me.» What is a good response?
Reflect the ambivalence without arguing: «Smoking helps you with stress, and at the same time it worries you.» Then ask what a change would mean for them.
Which four core skills of motivational interviewing does the mnemonic OARS stand for?
Open questions, Affirmations, Reflective listening and Summaries. They help the patient voice their own reasons for change instead of being lectured.
What should you always do before giving information in an explanation station?
Find out what the patient already knows, believes, fears and expects, so the explanation starts at their level and answers their actual concern.
Elsewhere in DurgiPedia
- The medical interview: rapport, open questions and listening
- Interviewing in special situations: interpreters and breaking bad news
- Patient education and teach-back
- Therapeutic communication: techniques and barriers
- Respect for autonomy
Connections
In Pharmacology3
Educational content; it does not replace supervised hands-on training, your institution's protocols or a prescriber's order. A procedure is learnt with a teacher and done only once you are trained to do it.
Sources: Patient Communication In Substance Use Disorders (StatPearls (NCBI Bookshelf), 2023); Set Up and Execution of an Effective Standardized Patient Program in Medical Simulation (StatPearls (NCBI Bookshelf), 2023).
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Representative model, for educational purposes only.