Does Learner Communication Behavior Change Based on Context? Observations of Surgical Residents Across Clinical Rotations.

Objective: As surgical residency programs begin developing communication skills-specific training curricula, it is important to understand those skills required of surgeons in the many settings in which they work. It is also useful to observe the skills that residents already demonstrate, as well as those skills that need further development. This study evaluated surgical residents' communication behaviors across different services to understand how the clinical learning environment influences their approach to surgeon-patient interactions.

Design And Setting: Our communication coaching program used standardized observation and coding to evaluate residents' communication on pediatric surgery, community general surgery, and trauma/acute care surgery services.

Participants: Twenty-four senior residents were observed interacting with patients and families on morning rounds in each of 3 settings.

Results: A total of 373 patient-resident interactions were observed. Behaviors like introducing the team, showing courtesy and respect, and sharing next steps were consistent across settings. However, different patterns emerged when evaluating 15 skills: effective communication behaviors occurred at the highest rates in pediatrics, followed by community surgery, and lowest in trauma. Most communication behaviors varied significantly between settings, underscoring the need to understand effective communication in each context to support learner development accordingly.

Conclusions: Communication skills varied significantly among the same surgical residents across different settings. The findings highlight the importance of supporting learners in adapting fundamental aspects of effective communication in various clinical environments. Modern surgical training can benefit from increased focus on communication skills across learning environments, using 1:1 communication coaching that emphasizes existing strengths, and tailoring communication skills to particular settings.