Teaching Communication Skills: Remembering What It Is Like To Be a Novice

If catheterization is the cardiologist's procedure, and endoscopy is the gastroenterologist's procedure, communication is the palliative care physician's procedure. We pride ourselves on our ability to have difficult conversation and are asked by other clinicians to talk about topics that make them uncomfortable.

The fact that we are skilled communicators, however, does not mean that we are skilled teachers of communication. In fact, in some ways our expertise in communication may make it more difficult for us to help less skilled learners learn what we already know. The educational literature points out that experts see the world quite differently than novices; they notice information that novices do not; they reason differently than novices as their knowledge is deeper and more contextual; and they are able to adapt to changing circumstances with little attentional effort. ¹ Experts, forgetting what novices have to learn, may be impatient teachers who do not understand why novices do not “just get it.”

Jackson and Back aim to rectify this problem by providing us with a toolkit of steps and options for teaching communication skills to less advanced learners. (In the interest of full disclosure, Dr. Back is one of my closest research colleagues and the best teacher I know.) They point out the importance of preparation and a safe environment to allow the learner to experiment with new ways of communicating and to be open to seeing new connections. They rightly place a great deal of emphasis on emotion, a core concept both in teaching and in communication skills.

Following Jackson and Back's advice will help you become a better teacher. The most important point in their paper, however, does not deal with process, but content. Their emphasis on the developmental trajectory of learning communication skills is critical. That is, when teaching you need to ask yourself “Where is this learner stuck and what would help the learner move forward in his or her trajectory from novice to expert?”

Unfortunately, we do not have much data on the developmental learning process of communication. ² It is thus up to us as teachers to try to remember how we learned communication skills and how our previous learners have progressed from novice to expert. When you were trying to learn to give bad news, what did you focus on first? What came next? Where are the places that you got stuck? How can you structure the teaching so that the learner can acquire new skills that will help his or her progress through the stuck point? Reflecting on these questions will improve your teaching.