Teaching Communication Skills Transferring Clinical Communication Skills From the Classroom to the Clinical Environment: Perceptions of a Group of Medical Students in the United Kingdom Jo Brown, MSc Abstract Purpose To better understand the transfer of classroom-learned clinical communication skills (CCS) to the clinical environment of the hospital ward, where they are practiced and refined by students. Method The author first briefly presents the literature on clinical communication, provides an overview of the debates around the notion of transfer, and presents a sociocultural model of developmental transfer applied to CCS learning. Second, she describes a focus group and nine individual interviews carried out with 17 fourth-year medical students at one medical school in the United Kingdom in 2008. The goal was to elicit their views of CCS teaching, learning, and transfer of CCS to the clinical workplace. Results The findings are presented under the four main themes of transition, where students experienced the transition from the medical school to the hospital ward as a mixture of positive and negative impacts on transferring their CCS skills; the clinical culture, where senior doctors had the greatest impact on student learning and emergent clinical practice; clinical communication as a vehicle for professionalism and being a “good” doctor; and, finally, transfer mechanisms, where simulated practice with actors and the clinical history template were powerful learning tools. Conclusions Findings indicate that more needs to be done to support, develop, and embed CCS into the professional practice of medical students in the clinical workplace. This may be achieved by greater collaboration of educators in the academic and clinical environments. Using the developmental transfer model applied to CCS learning may help foster this relationship. Acad Med. 2010; 85:1052–1059. I carried out this study to look at the issue of transferring clinical communication skills (CCS) from the classroom of the medical school—where they are in the main taught and learned—to the clinical environment of the hospital ward, one of the domains where they are practiced. I explored this notion of transfer in two ways: • Using the literature on clinical communication to investigate the relationship between the contexts of teaching, learning, and professional practice and their combined impact on CCS, using transfer theory as a foundation • Eliciting the perceptions of a group of medical students about how the CCS curriculum prepares them to transfer skills to professional practice in a clinical environment Background CCS are taught and learned as part of the core curricula of most medical schools in the United Kingdom. 1,2 CCS cover a wide range of skills but, at a basic level, concern themselves with the tasks of • eliciting a patient history, • explaining (e.g., giving information or describing a procedure, test, or risk), • exploring (e.g., trying to ascertain what the patient is thinking, feeling, or expecting), • discussing informed consent, • breaking news, • negotiating (e.g., working out a management or treatment plan), • passing on accurate information to colleagues (written or spoken), and • presenting a case history to colleagues. 3 Two decades ago, these core skills were rarely formally part of medical education in the United Kingdom. 4 Their importance was outlined by the General Medical Council in Tomorrow’s Doctors, 5,6 an important guide to curriculum content for all UK medical schools. Subsequently, CCS have been a growing part of the medical curriculum. Many studies have reported the importance of effective communication skills to improve patient health outcomes, 7 to foster patient adherence to treatment, 8 and to improve patient satisfaction with the medical encounter. 9,10 Aspegren and Lonberg-Madsen 11 reported that doctors who had not undertaken communication skills training were unable to demonstrate important basic communication skills, even after 10 years or more of postregistration clinical work. Willis and colleagues 12 reported that medical students who had not received CCS training believed these skills could not be learned and were intrinsic, but those who had received training developed a richer conceptualization of communication and felt this had helped them understand the needs of their patients. Ms. Brown is senior lecturer in clinical communication, Centre for Medical and Healthcare Education, St. George’s, University of London, London, United Kingdom. Correspondence should be addressed to Ms. Brown, Fourth Floor, Hunter Wing, Cranmer Terrace, London SW17 0RE, UK; telephone: (020) 8725-0681; fax: (020) 8725-0806; e-mail: jbrown@sgul.ac.uk. Academic Medicine, Vol. 85, No. 6 / June 2010 1052