Multiple Mini Interview (MMI) Communication and Interpersonal Skills Syllabus

What is the BUILD framework for rapport, and what does each letter mean?

B - Build the relationship, U - Understand the patient, I - Inform the patient, L - Listen, D - Develop a plan together. A structure emphasising partnership and shared decision-making.

State a simple structured approach for any MMI communication/scenario station.

1. Read the prompt and identify the task and role, 2. Introduce yourself and build rapport, 3. Explore the other person's perspective (open questions, ICE), 4. Respond to emotions empathically, 5. Give information clearly / address the issue, 6. Agree a plan and summarise, 7. Safety-net and close.

What is shared decision-making, and how does it appear in MMI stations?

Shared decision-making is a collaborative process where the clinician and patient jointly make decisions, combining clinical evidence with the patient's values and preferences. In MMIs it appears as offering options, checking preferences, and agreeing a plan together rather than dictating.

How should you manage your own emotional reactions during a confrontational MMI station?

Stay calm and composed, control your tone and body language, avoid becoming defensive, pause before responding, acknowledge the other person's emotion, and focus on the issue not the person. Self-regulation models the calm you want the scenario to reach.

What are the key steps to de-escalate an angry actor in a role-play station?

1. Stay calm and lower your tone, 2. Acknowledge and name their anger, 3. Listen without interrupting, 4. Express empathy and apologise where appropriate, 5. Find out the underlying concern, 6. Offer to help/resolve, 7. Agree concrete next steps.

What is the difference between a 'full apology' and an 'expression of regret', and when is each appropriate?

A full apology accepts responsibility for a specific fault ('I'm sorry, we made a mistake'). An expression of regret acknowledges the person's experience without admitting blame ('I'm sorry you've had to wait so long'). Use regret when fault is unclear; a full apology when an error clearly occurred.

What are the components of an effective apology in a healthcare/MMI context?

1. A sincere statement of sorrow, 2. Acknowledgement of what went wrong and its impact, 3. Acceptance of responsibility where appropriate, 4. Explanation (without excuses), 5. A commitment to put it right or prevent recurrence.

What is the statutory basis for apologising after errors that 'duty of candour' establishes in the UK?

The professional and statutory duty of candour requires healthcare professionals to be open and honest when something goes wrong, to tell the patient promptly, apologise, explain what happened, and put things right. Apologising is not an admission of legal liability.

In an angry-actor scenario, why is it a mistake to immediately defend yourself or the institution?

Defending immediately invalidates the person's feelings, escalates the conflict, and signals you are not listening. The person needs to feel heard first; acknowledging their emotion and exploring the cause de-escalates far more effectively than justification.

What is the recommended first move when you enter an MMI 'actor' scenario room?

Read the door/prompt carefully to identify your role and the task, then enter, introduce yourself by name and role, and open with a warm, open question that invites the actor to share, while observing their emotional state to calibrate your approach.

How should you treat the actor in an MMI role-play, and what is a common candidate error?

Treat the actor as a real person with genuine feelings, engaging naturally and empathically. A common error is talking 'about' the situation to the examiner or breaking character; instead, stay immersed and direct your communication to the actor.

What is 'safety-netting', and how is it used to close an MMI station?

Safety-netting is telling the person what to do if things change or worsen, and what follow-up to expect ('If the pain gets worse or you develop a fever, come back or call this number'). It closes the loop, manages risk, and demonstrates responsible practice.

List common types of role-play scenario encountered in MMIs.

Breaking bad news, an angry/complaining patient or relative, a colleague who made an error, a friend in distress, persuading someone to change behaviour, explaining a procedure or diagnosis, handling a confidentiality dilemma, and consoling a grieving person.

In a 'colleague made an error' MMI scenario, what should you balance?

Patient safety and duty of candour against supporting and not humiliating your colleague. Address the error directly but tactfully, encourage the colleague to disclose it, escalate if patient safety requires it, and maintain a non-judgemental, supportive tone.

What is the recommended approach to a 'distressed friend' scenario (non-clinical role-play)?

Listen actively without judging, acknowledge and validate their feelings, avoid rushing to solutions, ask gently what they need, offer support and signpost help if needed, and respect their autonomy. The focus is empathic support, not fixing the problem.

What does the acronym BREAKS stand for as a bad-news framework?

B - Background (prepare, gather facts), R - Rapport, E - Explore what the patient knows, A - Announce (give a warning shot then the news), K - Kindling (respond to the emotional reaction), S - Summarise and plan.

What is the difference between hearing and listening?

Hearing is the passive physical perception of sound. Listening is the active, conscious process of interpreting, understanding, and responding to what is said. MMIs reward listening, not merely hearing.

Why are silences (pauses) valuable in communication stations, and how should you use them?

Silences give the person time to think, process emotion, and continue speaking. Used after a difficult disclosure or emotional moment, a deliberate pause shows respect and patience and avoids rushing the person, rather than rushing to fill the gap.

What is the 'BATHE' technique used for in brief psychosocial consultations?

B - Background ('What's going on?'), A - Affect ('How do you feel about it?'), T - Trouble ('What troubles you most?'), H - Handling ('How are you coping?'), E - Empathy (a supportive empathic statement). A quick structure for exploring the emotional context.

How should you handle a patient who disagrees with your advice or refuses a recommended action?

Respect their autonomy, explore their reasons and concerns without judgement, check their understanding, provide clear balanced information, correct misconceptions, and reach a shared plan. Avoid coercion; document and safety-net if they still decline.

What is 'validation' in communication, and give an example phrase.

Validation is communicating that a person's feelings are understandable and legitimate given their situation. Example: 'Anyone in your position would feel anxious about this — it makes complete sense.' It builds trust and de-escalates without necessarily agreeing on facts.

Why is summarising important at the end of a communication station, and what should a good summary include?

Summarising checks accuracy, demonstrates listening, and ensures both parties share the same understanding. A good summary recaps the main points, the agreed plan, who does what next, and invites the person to correct or add anything.

What is the difference between sympathy, empathy, and compassion?

Sympathy = feeling pity/sorrow for someone. Empathy = understanding and sharing their feelings from their perspective. Compassion = empathy plus the motivation and action to help relieve their suffering. Compassion adds the behavioural step to empathy.

How should you respond when an actor begins to cry in a station?

Pause and allow space, acknowledge the emotion ('I can see this is really upsetting'), offer tissues if available, sit at their level, use a gentle tone, and avoid rushing on. Respond to the emotion before returning to information or tasks.

What are key principles for giving clear instructions in an information-giving station (e.g. explaining medication)?

Use plain language, give one instruction at a time, be specific (dose, timing, duration), explain the reason, highlight warning signs, check understanding with teach-back, offer written information, and invite questions.

What does the acronym 'PEARLS' represent for empathic statements?

P - Partnership, E - Empathy, A - Acknowledgement, R - Respect, L - Legitimisation (validation), S - Support. A set of relationship-building statements that convey empathy and partnership to the patient.

What is reflective questioning, and how does it differ from leading questioning?

Reflective questioning feeds back the person's words to invite elaboration ('You said you felt abandoned — can you tell me more?'). Leading questioning steers them toward a desired answer ('You weren't really that upset, were you?'). Reflective is open and neutral; leading is biased and should be avoided.

What should you do if you do not know the answer to a question an actor asks in an MMI?

Be honest, avoid bluffing, acknowledge the limit of your knowledge, and say how you would find the answer or who you would ask ('That's a great question — I'm not certain, but I'd check with the senior team and come back to you'). Honesty maintains trust.

What is 'transference of structure' between gathering and giving information — i.e. how should an information-giving station flow?

First find out what the person already knows and wants to know (perception/invitation), then give tailored information in chunks, check understanding, respond to emotion, address their ICE, agree a plan, and summarise with safety-netting. The structure mirrors SPIKES/Calgary-Cambridge.

State three behaviours that demonstrate respect for autonomy in a communication station.

1. Giving balanced information so the person can make an informed choice, 2. Asking for and honouring their preferences, 3. Not pressuring or judging them, but supporting whatever informed decision they make (while safety-netting).

Summarise the ideal opening 30 seconds of any MMI communication station.

Greet warmly, introduce your name and role, confirm who you are speaking to, briefly establish the purpose, adopt open body language, and ask a calibrating open question while reading the person's emotional state — setting the tone of rapport, structure, and empathy for the whole station.