The communication station is a 10-minute role-play with a trained actor, run online over the Qpercom interview platform, and it is worth 50 of the 234 marks available at the 2027 ST3 Trauma & Orthopaedics interview. Five domains are scored at 10 marks each — and one of them is Technical Knowledge, which is why candidates who treat this as the "soft skills" station consistently underperform in it. Here is exactly what is marked, the frameworks the scenarios are built around, and the phrases that score against the ones that sink you.
What format does the 2027 communication station take?
You join a video station with a trained actor playing a patient, relative or colleague, observed by consultant interviewers who score you live. You get a short written brief, then 10 minutes of role-play. The 2027 interview has four scored stations — Commitment to Specialty, Clinical Judgement, Prioritisation and Communication — each worth 50 marks, sitting on top of the 34 marks carried forward from the validated self-assessment, for a total of 234. The full 2027 scoring matrix and self-assessment tables are on our self-assessment page.
The 2027 applicant handbook has not yet been published; in the 2026 cycle, interviews ran online via Qpercom over four days in late March, and the appointability threshold was 146/232. Expect similar for 2027, but verify against the handbook when it lands.
Which five domains are marked — and what does each reward?
| Domain | Marks | What the examiners are scoring |
|---|---|---|
| Technical Knowledge | 10 | The clinical content of what you say is correct: real risks with honest figures, the right pathway, the right operation. Fluent empathy wrapped around wrong facts scores poorly. |
| Judgement under Pressure | 10 | You stay structured when the actor cries, goes silent or gets angry. You know when to pause, when to apologise, and when to escalate to your consultant. |
| Situational Awareness | 10 | You read what the scenario is really testing — a candour disclosure dressed up as an angry-relative station, a safeguarding cue dropped mid-conversation — and you manage the 10 minutes so the conversation actually finishes. |
| Communication — Information Gathering | 10 | Open questions first. You establish what the person already knows, what they're worried about and what they want from the conversation before you give anything. |
| Communication — Information Giving | 10 | Warning shot, plain English, small chunks, check understanding, summarise, safety-net. No jargon, no monologue. |
Why is communication worth far more than 50 marks?
The two named communication domains are not confined to this station. Information Giving is also scored in Commitment to Specialty and in the Clinical station; Information Gathering is also scored in the Clinical and Prioritisation stations. Add it up and 60 of the 234 marks across the whole interview sit in the two communication domains alone — before counting Judgement under Pressure and Situational Awareness, which the communication station also tests. Practising this station is the highest-leverage preparation you can do, because the same behaviours are marked four times over.
Which frameworks should you actually use?
SPIKES for breaking bad news
SPIKES (Baile et al., 2000) remains the framework examiners recognise instantly: Setting, Perception, Invitation, Knowledge, Empathy, Strategy and summary. The two steps candidates skip under pressure are Perception ("What have you been told so far?") and Invitation ("How much detail would you like today?") — and those are precisely the steps that score Information Gathering. Deliver the news itself after a warning shot, in one plain sentence, then stop and let silence do its work.
Duty of candour when something has gone wrong
If the scenario involves an error — a missed injury, a delayed scan, wrong-site marking caught late — the examiners want to see the statutory duty of candour, not a vague apology. Under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, once a notifiable safety incident is identified the patient must be told in person, given a true account of all the facts known at that point, offered an apology, told what investigation will follow, and sent a written follow-up. The GMC's professional duty mirrors this for individual doctors: be open, put matters right where possible, and say sorry. Say the word "sorry" out loud in the station — an apology is an expression of regret, not an admission of liability — and name the next steps: senior involvement, Datix/incident reporting, and a written account to follow.
Consent conversations
For consent scenarios, the standard is material risk to this patient: what matters to a self-employed roofer differs from what matters to a concert pianist. Ask what they do and what they're worried about before listing risks, quote honest figures for the common and the serious complications, and always present the alternatives — including doing nothing.
What scenarios come up?
- Consent — classically a neck of femur fracture patient or their family, consenting for hemiarthroplasty or fixation, including capacity questions.
- Breaking bad news — an unexpected finding on imaging, such as a lytic lesion suspicious for metastatic bone disease.
- Duty of candour — disclosing a missed diagnosis or delay, for example a delayed scan in suspected cauda equina syndrome.
- The angry patient or relative — usually with a legitimate grievance underneath: cancelled surgery, repeated fasting, nobody has spoken to them for two days.
- Colleague conversations — negotiating theatre list order with another registrar, or raising concerns about a struggling or unsafe colleague.
Notice that every one of these still needs orthopaedic content — risks of hemiarthroplasty, the significance of a lytic lesion, the time-critical nature of cauda equina. That is the Technical Knowledge domain doing its work.
Which phrases score — and which sink you?
| Scores | Sinks |
|---|---|
| "Before I go on, can I check what you've been told so far?" | Launching into a monologue of information the person didn't ask for. |
| "I'm afraid the scan has shown something serious." (warning shot, then pause) | "There's nothing to worry about." (false reassurance) |
| "Something has gone wrong in your care, and I want to explain exactly what we know. I am sorry this happened." | "These things happen." / "It wasn't my fault — I wasn't on that shift." (minimising, deflecting) |
| "What matters most to you when you think about this operation?" | "The risks are infection, bleeding, DVT, PE, dislocation, leg-length discrepancy…" (an unweighted jargon list) |
| "That was a lot of information — can I check what you'll take away from today?" | "You'll be absolutely fine." (guaranteeing an outcome) |
| "This needs my consultant involved — I'll arrange for them to speak to you today, and here's what I can tell you now." | "The night team missed it." (blaming named colleagues) |
The pattern is consistent: gather before you give, apologise without deflecting, be honest about uncertainty, and escalate out loud. Saying "I don't know, but I will find out and come back to you today" scores Judgement under Pressure; bluffing loses it.
How should you practise?
Rehearse out loud, on camera, against the clock — 10 minutes is shorter than it sounds, and Situational Awareness marks go to candidates who close the conversation properly rather than being cut off mid-sentence. Recruit a colleague or partner as the actor and give them permission to cry, interrupt and push back. Work through each scenario family until the frameworks are automatic, then vary the clinical content underneath. The orthointerview.com question bank includes interactive communication scenarios with model answers and domain-by-domain mark schemes if you want structured material to drill against — see pricing.
Finally, remember the marks are anchored to the five domains, not to how the conversation "felt". After every practice run, score yourself /10 against each domain. The candidates who score highly are not the smoothest talkers — they are the ones who visibly hit all five columns of the mark sheet inside 10 minutes.