Difficult conversations and conflict on the ABEM exam

ABEM’s scoring page describes three communication case types:

• Difficult Conversations: establish rapport, find out what the person knows, disclose, respond and react, provide closure.
• Managing Conflict: rapport, understand their position, explain yours, acknowledge the difference, find shared interests, propose a path forward.
• Patient-Centered Communications: rapport, respect the patient’s perspective, communicate clearly, share results, support shared decisions.

ABEM lists SPIKES and GRIEV_ING among its references (ABEM content). A simple version that maps to the scoring list:

1. Set up: introduce yourself, sit down, confirm who you are speaking with.
2. Ask: “What have you been told so far?”
3. Warn, then tell: a brief warning shot, then the news in plain words. For a death, say “died”.
4. Stop and respond: let silence happen. Name the emotion you see.
5. Close: next steps, who they can call, offer support services, ask what questions they have.

Conflict cases might involve a consultant, a family member or a colleague who disagrees with your plan. ABEM’s references include Getting to Yes and work on conflict in serious illness. In practice: hear their position fully, restate it, then state yours with the reason, and find the goal you share (usually the patient’s safety). End with a concrete plan both sides can accept, including who does what next.

Use plain language, check understanding with teach-back, and offer real options when there are any. If the patient chooses something you would not, make sure they understand the risks, document, and leave the door open to come back.

See how these fit with the other case types in our scoring guide and prep plan.