Table 1.

Items based on the ASCKS framework which were used to generate the 12-item observer communication skills rating scale.

	Item	Item description
Avoid assumptions and loaded words	Uses neutral language throughout	Does not use the terms ‘wrong’ or ‘normal/abnormal’ (unless using it to reassure)
Set up the scan	Asks about feelings about the pregnancy	Asks a question similar to, ‘How are you feeling about the pregnancy?’ prior to the scan.
	Prepares patient for the possibility of an internal scan	Informs patient prior to the first scan that an internal scan may be needed following the trans-abdominal scan, or establishes that an internal scan will not be needed.
	Explains silence	Informs patient prior to the scan that they will be silent for a while during the scan.
	Explains use of the monitor	Informs patient prior to the scan of how and when they will offer to share the screen/images with them.
Clear, honest information	Seeks permission to communicate findings using the monitor	After the scan has been conducted, the sonographer offers to show the monitor to the patient.
	Communicates findings using widely understood terms	When communicating the findings, the sonographer uses the word ‘miscarriage’ if indicated, or other suitable and widely understood term
Kindness	Expresses regret	When delivering the news, the sonographer uses the term ‘sorry’ and/or ‘unfortunately’ and/or ‘I'm afraid’
	Emotion naming	Names an emotion on one or more occasions (e.g., ‘surprise’; ‘anxiety’; ‘devastating’; ‘upsetting’; ‘tense’). This shouldn't be framed as an instruction, e.g., ‘Don't worry’, or future framed e.g., ‘If you're feeling worried about it’.
	Emotional experience naming	Names an emotional experience on one or more occasions, e.g., ‘uncomfortable’; ‘stressful’; ‘awful’; ‘hard’; ‘difficult’; ‘not nice’. This shouldn't refer to a physical experience, e.g., ‘that could be sore’, or to a choice, e.g., ‘if you're comfortable with that?’
	Wish statement	Uses a wish statement, e.g., ‘I wish I had different news for you’
	Use of ‘baby’	The term ‘baby’ is used as default, unless patient uses other term, e.g., ‘fetus’