In the room where it happens: do physicians need feedback on their real-world communication skills?

Evidence suggests that the quality of a doctor’s communication, including non-verbal interaction, data-gathering skills, levels of empathy, ability to summarise and clarify, information sharing and interactive patient educational strategies, is associated with positive patient health outcomes.1–4 In this issue, Amelung et al 5 contribute to this evidence using observational data combined with in-depth qualitative analysis to explore how misalignment and misunderstanding in the doctor–patient interaction can lead to negative ‘interim’ outcomes critical to patient safety. This accumulation of evidence provides even clearer targets for the education of physicians. Our medical education research group has called for the identification and definition of Educationally Sensitive Patient Outcomes (ESPOs)—those interim outcomes that can be maximised through education and training of physicians and that are critical to ultimate health outcomes.6 7 Having the skills to ensure that a patient is fully informed and activated to act in his or her own best interest is an ESPO—an outcome directly attributable to physician practices, at least in part, that we as educators can teach and measure. Amelung and colleagues found that a failure to achieve consensus at the end of the care visit often manifested as a ‘false’ sense of concordance between physician and patient, leading to lack of patient follow-through and/or dissatisfaction.5 This finding illustrates the critical importance of patient education, an essential aspect of the Calgary/Cambridge model8 that often gets short shrift in the broader communication literature. Teach-back is the simplest and most commonly used core skill in patient education. It is effective in creating dialogue that facilitates trust, shared understanding, accurate information gathering and most importantly patient activation—patients who are empowered to and engaged in actively managing their health.6 9 Our work, using standardised performance-based assessment of medical students and residents, has consistently shown that (1) patient education …