Merging the curriculum with the clinic: An intervention to foster deliberate practice of communication skills.

Abstract

While communication skills training is a core competency for residency education and relies on practice as a key element to achieve proficiency, most residency curricula focus mainly on lessons, rather than on learners' sustained and deliberate practice. We report on a program aimed to foster deliberate practice of communication skills in real world clinical environments. We introduced three discrete, evidence-based skills that could be immediately practiced with real patients in clinical settings, and a system to log and track practice of the skills. Nine residents participated, including two third-year, four second-year, and three first-year residents. We evaluated the program by performing open-ended, semi-structured interviews with all participating residents. Interview data were analyzed through an iterative series of close readings and discussions among authors, who then developed a codebook for final analysis and categorization of themes. Interviews revealed five themes that described a process of skill development that included barriers, but also positive evolution in residents' perceptions of the skills, once greater comfort and proficiency were achieved. Our data suggest that, for communication skills acquisition, sustained and deliberate practice in real-world clinical environments is a key element. The experiences of residents in our program outline a model of practice that builds upon previous educational theory and research, and provides a guide for future communication skills curricula. The use of our model can help to enhance communications skills training in clinical environments.