MMI Role Play Station: Breaking Bad News Guide

MMI Role Play Station: Breaking Bad News Guide

In a UK MMI role play, play yourself unless the brief gives you another role. The station tests empathy, one of Imperial's five published interview criteria. Cut the clinicians' bad-news protocol to four steps: listen, acknowledge, tell and check, offer a next step.

The best-known bad-news protocol has six steps and was written for oncologists. A 17-year-old who performs all six steps on an actor playing an upset neighbour sounds rehearsed, and Manchester, for one, says rehearsed answers impress less. This page shows the short version, four constructed scenarios, and one marked transcript.

The school pages quoted below were checked on 7 November 2026. The Medical Schools Council and GMC sites returned HTTP 403 to our fetcher that day, so nothing from them is quoted. Your invitation email will say whether your circuit includes a role play.

What a role-play station is and who scores it

What the schools say:

• Newcastle (2027 entry policy): "In MMIs, these categories will be assessed with role play and interview questions. Each applicant will be scored on their performance at each MMI station by an individual selector." (Newcastle MBBS Admissions Policy)
• Manchester draws its interviewers from university and clinical staff and adds: "we also draw on the expertise of patient/lay representatives, current medical students and simulated patients." (Manchester interviews)
• Imperial lists "empathy" among its MMI criteria, alongside NHS Constitution values, motivation, work experience, and leadership and teamwork. (Imperial Medicine)

What none of these pages says is who plays the role at each school or whether the actor marks you. Assume either the actor or an observer in the room is scoring, and treat both as the audience.

Our view: play the role the brief gives you, as yourself. If the brief says you are a friend, a volunteer or a student, do not slip into a doctor's voice. The basis: Manchester says "Do not feel the need to be excessively formal unless required by the interview station scenario." The countercase: some briefs do put you in a professional role, such as a pharmacy assistant or a junior colleague. Then keep the role's limits: say what that person could and could not do.

The bad-news protocol, cut down for applicants

That protocol is SPIKES, published in 2000 under the title "SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer" (Baile et al., The Oncologist). Its abstract names four objectives: "gathering information from the patient, transmitting the medical information, providing support to the patient, and eliciting the patient's collaboration in developing a strategy or treatment plan for the future."

Those four objectives are what an applicant can actually do. Our four-step version:

1. Listen first. Ask what they already know or what they expected. Then stop talking.
2. Acknowledge. Name the feeling you see: "You look worried." Wait.
3. Tell plainly, then check. One or two sentences of news, no jargon. Then ask: "Does that make sense?" or "What questions do you have?"
4. Offer a next step. Something you can actually do, and say what you cannot do.

Never, in any role play:

• Diagnose or guess at medical facts you do not have.
• Promise an outcome: "It'll definitely be fine."
• Blame someone not in the room.

The NHS Constitution's "Respect and dignity" value puts step 4 in one line: "We are honest and open about our point of view and what we can and cannot do." (NHS Constitution for England, updated 17 August 2023)

Four role-play scenarios to practise

All four briefs are constructed by us for practice. They are not stations any school has said it uses.

The missing cat

You were minding your neighbour's cat for the weekend. On Saturday it got out and has not come back. Your neighbour has just arrived home. The hard part: you caused it. Apologise once, plainly, and move to what you have done and what you will do.

The cancelled visit

You volunteer at a care home. A resident's daughter has driven an hour to visit, but visits are cancelled today because of a sickness outbreak. The hard part: it is not your decision, and she is angry. Acknowledge the drive, explain the reason, offer what you can (a phone call with her mother, a message to the manager).

The volunteer's mistake

A fellow volunteer handed a patient the wrong meal menu, one with foods the patient is meant to avoid. The patient has not eaten yet. You are talking to the volunteer. The hard part: speaking up without humiliating them. Name what happened, why it matters, and that the nurse needs to know now.

The refused advice

Your grandfather has been told by his physiotherapist to use a walking frame. He refuses: he says it makes him look old. The hard part: he has the right to choose. Listen for the reason, respect it, and look for a step he will accept. The NHS says "If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected." (NHS consent to treatment)

A transcript marked line by line

Constructed example, written by us, not a real applicant or a real station. Brief (constructed): "You were looking after your neighbour Mrs Hale's cat, Pepper, this weekend. Pepper slipped out on Saturday morning and has not come back. Mrs Hale has just knocked on your door."

Applicant: Hi Mrs Hale, come in. Would you like to sit down? (Sets the scene. Offers a seat before the news.)

Actor: Is everything all right? Where's Pepper?

Applicant: I'm sorry, I have some bad news about Pepper. (Warns before telling.) On Saturday morning she got out when I opened the back door. I've been looking for her since and I haven't found her yet. (Tells plainly, in two sentences. No excuses.)

Actor: You lost her? She's never been outside on her own.

Applicant: (Pauses.) That must be frightening. (Acknowledges. Silence after.)

Actor: I trusted you.

Applicant: You did, and I let you down. I'm sorry. (Owns it once. Does not repeat the apology five times.) Can I tell you what I've done so far? (Asks permission before moving on.)

Actor: Go on.

Applicant: I've walked the streets around here twice a day, put her photo on the local group, and called the two vet surgeries nearby. Is there anywhere she might go that I don't know about? (Gathers information: the actor knows things you do not.)

Actor: She likes the garages behind number twelve.

Applicant: Then that's the first place I'll look. Would you like to come with me now, or would you rather I go and phone you? (Next step, offered as a choice.) Is there anything else you'd like me to do? (Checks.)

The applicant's lines, without our notes, are 133 words. A real station would run longer and continue with the actor's next reaction. The steps it shows: a warning shot, plain news, silence after the feeling, one apology, a question that uses the other person's knowledge, and a choice of next step.

What the applicant never says: "I'm sure she'll come back." That is a promise nobody in the room can keep.

Common mistakes in role-play stations

The only one of these a school page names directly is over-rehearsal: Manchester says "Have a series of pointers in your mind, but remember not to over-rehearse. Our interview style at Manchester is conversational, and we're not looking for a monologue." The rest are our judgement:

• Talking over the actor. If they start to speak, stop mid-sentence.
• Fixing too fast. A solution in the first minute tells the actor you have not heard them.
• False reassurance. "Don't worry" dismisses the worry.
• Apologising on a loop. Once, sincerely, then act.
• Leaving the role to explain your technique to the examiner. Stay in it until the bell.
• Filling silence. Count to three after you name a feeling.

Practise each of the four scenarios aloud with a timer at your school's station length, recorded. Then mark yourself on one question: did the other person get to say what they felt before you offered a fix? The UK MMI station question bank has the other station types, and how MMI stations are scored covers marking.

Questions about MMI role play

Do I have to act like a doctor in a role-play station?

No, unless the brief says so. Play the role you are given, as yourself.

What if the actor cries or gets angry?

Stop, acknowledge it, and wait. The emotion is part of the brief; your response to it is what the station is for.

Can I apologise if it was not my fault?

Yes, for how they feel ("I'm sorry this has happened"), without taking blame you do not own. If it was your fault, say so once.

Is the UK role play different from a US one?

The behaviours are the same. The UK pages tie them to NHS Constitution values and, at Imperial, a named empathy criterion. For US actor stations, see MMI role-play stations with actor examples.

Review the writing you send next

If you reapply, the caring and volunteering moments you practised with here belong in your next UCAS medicine personal statement. Get a free Quick Review of your UCAS medicine personal statement: GradPilot's UCAS medicine rubric checks whether you show readiness for medicine through actions and reflection rather than labels such as "empathetic".

More: the medical ethics interview questions guide, the UCAS medicine personal statement guide for 2027, and the medical school essays hub.

Sources

Retrieved 7 November 2026, except where noted.

• Newcastle University, MBBS Admissions Policy 2027 Entry (PDF): role play in MMIs, one selector per station.
• University of Manchester, Medicine interviews (2026/7 cycle): simulated patients, stressful elements, formality, over-rehearsal.
• Imperial College London, Medicine MBBS/BSc (2027 entry page): MMI criteria including empathy.
• Department of Health and Social Care, The NHS Constitution for England (updated 17 August 2023): Respect and dignity value.
• NHS, Consent to treatment (page last reviewed 8 December 2022): adults with capacity may refuse.
• Baile WF and others, SPIKES: a six-step protocol for delivering bad news, The Oncologist, 2000 (abstract retrieved through NCBI's E-utilities service): the protocol's four objectives.
• Not retrieved: Medical Schools Council and GMC pages (HTTP 403 on 7 November 2026).