Active Listening and Patient-Centred Communication

Effective communication is not about what the healthcare professional says — it is about what the patient hears, understands, and feels. Active listening is the foundation of patient-centred communication, and it is one of the most commonly tested skills in the UCAT Situational Judgement Test.

This lesson covers what active listening actually means in clinical practice, the core components of patient-centred communication, and how these skills translate into higher SJT scores.

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What Is Active Listening?

Active listening is a deliberate, structured approach to hearing and understanding another person. It goes far beyond simply not interrupting.

The Components of Active Listening

Component	Description	Clinical example
Attending	Giving your full physical and mental attention to the speaker	Putting down your pen, turning away from the computer screen, making eye contact
Following	Encouraging the speaker to continue without directing the conversation	Using minimal encouragers: "Go on," "I see," "Tell me more"
Reflecting	Paraphrasing or summarising what the speaker has said to confirm understanding	"So what you're saying is that the pain started about three weeks ago and it's been getting worse?"
Clarifying	Asking questions to resolve ambiguity or fill gaps	"When you say the pain is 'bad,' can you describe what it feels like? Is it sharp, dull, burning?"
Summarising	Pulling together the key points of what has been said	"Let me make sure I've understood everything. You've been having headaches for two weeks, they're worse in the morning, and paracetamol isn't helping. Is that right?"

What Active Listening Is NOT

Common misconception	Reality
Waiting for your turn to speak	Active listening means genuinely processing what is being said, not planning your response
Agreeing with everything the patient says	You can listen actively and still respectfully disagree or offer a different perspective
Letting the patient talk indefinitely	Active listening includes skilled redirection when the consultation needs to move forward
A passive activity	Active listening requires concentration, effort, and practice

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Patient-Centred Communication: The Framework

Patient-centred communication places the patient's needs, preferences, and values at the centre of every clinical interaction. It is the communication model that the NHS aspires to and that the SJT rewards.

The Six Functions of Patient-Centred Communication

Function	What it involves	SJT relevance
Fostering the relationship	Building trust and rapport through empathy and respect	Scenarios testing how you respond to a patient's emotional distress
Gathering information	Using open and closed questions effectively	Scenarios where you need to understand a patient's concerns before acting
Providing information	Explaining diagnoses, treatments, and procedures clearly	Scenarios testing whether you explain things in a way the patient can understand
Making decisions	Involving the patient in decisions about their care	Scenarios where a patient disagrees with a recommended treatment
Enabling self-management	Helping patients manage their own health	Scenarios involving patient education and health promotion
Responding to emotions	Acknowledging and addressing the patient's feelings	Almost every SJT scenario involving patient interaction

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The Calgary-Cambridge Guide

The Calgary-Cambridge guide is the most widely used consultation framework in UK medical schools. While you do not need to memorise it for the UCAT, understanding its principles will help you identify the most appropriate responses in SJT scenarios.

Key Stages of a Good Consultation

Stage	Key skills	What goes wrong if this is skipped
Initiating the session	Greeting the patient, introducing yourself, establishing the agenda	Patient feels rushed or unimportant
Gathering information	Open questions first ("Tell me about..."), then focused questions	Important concerns may be missed; patient feels interrogated
Providing structure	Signposting, summarising, managing time	Patient loses track of the conversation; consultation overruns
Building the relationship	Empathy, active listening, non-verbal communication	Patient does not trust the doctor; information is withheld
Explaining and planning	Checking understanding, shared decision-making	Patient leaves confused or with unrealistic expectations
Closing the session	Summarising, safety-netting, confirming the plan	Patient is unclear about next steps; important issues left unaddressed

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Open vs Closed Questions

One of the most common SJT themes involves choosing between open and closed questioning approaches.

When to Use Open Questions

Open questions allow the patient to express themselves in their own words. They typically begin with "What," "How," "Tell me about," or "Can you describe."

Situation	Example open question
Starting a consultation	"What brings you in today?"
Exploring a concern	"Can you tell me more about what's been worrying you?"
Understanding the patient's perspective	"How has this been affecting your daily life?"
Checking emotional state	"How are you feeling about all of this?"

When to Use Closed Questions

Closed questions seek specific information and typically have a limited set of possible answers.

Situation	Example closed question
Clarifying a symptom	"Is the pain constant or does it come and go?"
Checking understanding	"Do you understand why we're recommending this test?"
Confirming information	"So the pain started on Monday — is that right?"
Assessing urgency	"Are you having any chest pain or difficulty breathing right now?"

The SJT Rule of Thumb

In SJT scenarios, responses that use open questions first are generally rated as more appropriate than those that jump straight to closed questions. This is because open questions demonstrate respect for the patient's perspective and are more likely to uncover the patient's true concerns.

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ICE: Ideas, Concerns, and Expectations