RCEM OSCE( Difficult referral )

In the MRCEM OSCE exam, a difficult referral station is designed to assess how well you communicate clinical information and manage interpersonal challenges when referring a patient to another specialty or team.
Here are the key aspects to focus on:
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1. Clinical Communication 

• Present clearly: Use SBAR (Situation, Background, Assessment, Recommendation) or similar structure. 

• Be concise but complete: Include relevant history, exam findings, investigations, and what you’re requesting. 

• Demonstrate clinical reasoning: Show that your referral is appropriate and justified.
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2. Interpersonal Skills 

• Stay calm and professional: The receiving doctor may be dismissive, unhelpful, or even rude. Keep your tone polite and non-confrontational. 

• Acknowledge concerns: If they raise valid points, acknowledge and address them. 

• De-escalate conflict: Avoid arguments. Stay focused on patient care.
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3. Patient Advocacy 

• Focus on patient safety: If the other party refuses the referral but the patient is unstable or needs urgent input, escalate appropriately. • Stand your ground politely: Don’t back down if the referral is clearly needed, but don’t be aggressive.
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4. Escalation if Needed 

• Know when to escalate: If blocked and patient care is compromised, state that you would escalate to a senior (e.g. ED consultant or specialty registrar). 

• Stay within your level: Recognise your role and limitations.
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5. Professionalism 

• Be respectful: Even in the face of difficulty. 

• Avoid blaming: Keep the discussion clinical and patient-centred.

_{Khaled Khalifa}

_{Consultant Emergency Medicine}

_{Manchester University NHS Foundation Trust, UK}

_{Wythenshawe Hospital}