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

Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Practice implications: The use of our model can help to enhance communications skills training in clinical environments.