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Two of the underlying challenges facing anyone developing a healthcare communication skills training program for clinicians are legitimacy and credibility. A polarity exists in medicine between the positions that quality medicine is about technique and biomedical understanding, on the one hand, and that quality medicine is a humanistic endeavor in which emotional intelligence and communication and relationship skills are important, on the other. Although these two positions are not mutually exclusive, they are often posed as if they were, as though we had to choose between having an airline pilot who knew how to take off or one who knew how to land. During training, physicians primarily receive feedback on medical knowledge, decision making, and procedural skills. Suddenly holding them accountable for communication and interpersonal skills can feel like changing the rules halfway through the game.

A different version of these challenges comes from clinicians who believe that they are excellent communicators who do not need communication skills training. They may have strong interpersonal skills and great charisma and have warm relationships with their patients. They may have been practicing medicine for over a decade. Who are we to tell them how to do their jobs? How safe is it for them to consider that there is room for improvement in how they communicate with patients?

Resistance is to be expected. Be prepared for skepticism and pushback, and make a genuine effort to respond to resistance empathically from a perspective of curiosity and understanding. After all, skepticism is a prized quality in scientists, whom we expect to question and challenge ideas as a way of testing their validity. We show our colleagues respect by empathizing with the stress caused by both the changing measures of what represents high-quality healthcare and by the perception that their skills are being questioned. We show respect by welcoming their skepticism that communication skills can be taught effectively. A key to the success of our program was our expectation that very few clinicians would want to take our communication skills course and that many of those attending the course would reject what we were trying to teach. We will discuss later in this chapter why we made the choices we made and detail our various attempts to respond to this challenging environment.

How We Structured Our Course

Our basic framework for the course was to present a brief didactic on one of three phases of the medical interview followed by a brief demonstration of the skills for that phase and a longer period for skills practice. The didactic was given to provide a cognitive framework so that we could set up participants to succeed during the skills practice. For the first two phases, participants played both the patient and the clinician, whereas for the third phase, we originally employed standardized patients. At the end of the course, we spent 90 minutes practicing the skills ...

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