The candidate card
Setting
Palliative outpatient clinic
Candidate
In this original independent practice scenario, you are a doctor meeting Mr Sergio Lacsamana, aged 48, before a consultation with his wife, whose investigations have confirmed advanced pancreatic cancer. His wife has authorised discussion of her results with him, has decision-making capacity, and knows that a serious pancreatic illness is being investigated, but her preferred amount of information has not yet been established. Mr Lacsamana asks you to hide the cancer diagnosis; the proposed next step is to speak with his wife about what she understands, how much she wants to know and whom she wants involved, then offer a supported conversation at her preferred pace. Relevant general principles are that a spouse's request alone does not justify withholding information needed for a capable patient's decisions, distress does not itself establish incapacity, and a patient's wish to limit detail should be explored while ensuring valid informed decisions; fuller assessment and care planning can continue after this focused conversation.
Task (interlocutor: relative)
- Find out why Mr Lacsamana wants the diagnosis withheld and what his wife has said about receiving information
- Acknowledge his protective intention and explore the consequences he fears
- Explain his wife's role in choosing information and making decisions, without agreeing to deception or forcing unwanted detail
- Agree how to approach his wife about her preferences and offer a supported discussion if she wants him involved
In the test you get 3 minutes to read the card and plan, then about 5 minutes to talk. This card is original, written for this site; the interlocutor's card is not shown.
Prepare this card, then say it out loud.
Plan your opening and the tasks below. Keep these notes when you move to the AI role-play.
In this original independent practice scenario, you are a doctor meeting Mr Sergio Lacsamana, aged 48, before a consultation with his wife, whose investigations have confirmed advanced pancreatic cancer. His wife has authorised discussion of her results with him, has decision-making capacity, and knows that a serious pancreatic illness is being investigated, but her preferred amount of information has not yet been established. Mr Lacsamana asks you to hide the cancer diagnosis; the proposed next step is to speak with his wife about what she understands, how much she wants to know and whom she wants involved, then offer a supported conversation at her preferred pace. Relevant general principles are that a spouse's request alone does not justify withholding information needed for a capable patient's decisions, distress does not itself establish incapacity, and a patient's wish to limit detail should be explored while ensuring valid informed decisions; fuller assessment and care planning can continue after this focused conversation.
Getting your plan ready…
Preparation is free without an account. AI conversation and marking need sign-in; your first role-play is free. Notes are saved on this device when available. This checklist is your plan, not a score.
How to approach this card
- Invite him to explain what he fears would happen if his wife heard the diagnosis, and ask what she has actually said about receiving information. His likely concern may be distress, but do not assume hopelessness, cultural beliefs or a particular reaction.
- Acknowledge his protective intention before explaining your responsibility to his wife. This order recognises the relationship without accepting concealment; avoid blame or a lecture about rights that closes down discussion of the consequences he fears.
- Separate permission to discuss her results with him from authority to decide what she is told. She has decision-making capacity, and his request alone cannot justify withholding information needed for her decisions; distress itself would not establish incapacity. [Medical Board code](https://www.medicalboard.gov.au/Codes%20Guidelines-Policies/Code-of-conduct.aspx).
- Propose asking his wife what she understands, how much detail she wants and whom she wants involved before sharing further information. Avoid both a promise to conceal cancer and an announcement that she must immediately hear every detail regardless of her wishes.
- Close with agreement on approaching her about those preferences and offering support at her chosen pace, including him if she wants. If time is short, prioritise this next conversation over wider cancer counselling; do not invent a prognosis or let his agreement substitute for hers.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- This is a difficult conversation to be having about your wife.
- We can pause if you need a moment.
- Is there something you have found hard to put into words?
- Have I understood what feels most difficult for you?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| pancreatic cancer | Cancer in the pancreas. |
| decision-making capacity | Being able to understand information and make decisions about your care. |
| informed decisions | Choices made with an understanding of the information needed to decide. |
How this card is marked
Two assessors mark the recording on nine criteria: intelligibility, fluency, appropriateness of language and resources of grammar and expression (each 0–6), then relationship building, understanding and incorporating the patient's perspective, providing structure, information gathering and information giving (each 0–3). See the AI Speaking practice guide for what each criterion looks for.
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Questions about this role-play
What if he asks me to promise secrecy before he explains further?
Do not make a promise that would commit you to misleading his wife. Explain that you can listen carefully without deciding in advance what she will be told. Invite him to continue, and avoid turning the discussion into a bargain in which support depends on agreeing to secrecy.
What if he asks me to describe the cancer as only a serious pancreatic illness?
Do not adopt a description intended to leave her with a misleading understanding. Explain that you need to respond honestly to her questions. Keep language simple and sensitive, without using vague wording as a substitute for information she wants or needs for decisions.
What if Mr Lacsamana becomes too upset to continue?
Pause and ask whether he would like a moment before continuing. Do not interpret silence as agreement or press him to commit to speaking for his wife. Once he is ready, summarise the unresolved question and check whether he feels able to continue this conversation.
Sources
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