Provided it is used continuously, an approach that combines self-directed learning with observation and discussion of resident-patient consultations seems an effective method for transformative learning of communication skills.

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ContextCompetency-based education is a resurgent paradigm in professional medical education. However, more specific knowledge is needed about the learning process of such competencies, since they consist of complex skills. We chose to focus on the competency of skilled communication and want to further explore its learning process, since it is regarded as a main competency in medical education.ObjectiveThis study aims to explore in more detail the learning process that residents in general practice go through during workplace-based learning in order to become skilled communicators.MethodsA qualitative study was conducted in which twelve GP residents were observed during their regular consultations, and were interviewed in-depth afterwards.ResultsAnalysis of the data resulted in the construction of five phases and two overall conditions to describe the development towards becoming a skilled communicator: Confrontation with (un)desired behaviour or clinical outcomes was the first phase. Becoming conscious of one’s own behaviour and changing the underlying frame of reference formed the second phase. The third phase consisted of the search for alternative behaviour. In the fourth phase, personalization of the alternative behaviour had to occur, this was perceived as difficult and required much time. Finally, the fifth phase concerned full internalization of the new behaviour, which by then had become an integrated part of the residents’ clinical repertoire. Safety and cognitive & emotional space were labelled as overall conditions influencing this learning process.ConclusionsKnowledge and awareness of these five phases can be used to adjust medical working and learning environments in such a way that development of skilled medical communication can come to full fruition and its benefits are more fully reaped.

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Leary's Rose can be used in simulated and authentic work-based educational settings. To train the communication skills of nurses to be the patients' advocates, for example Leary's Rose was used in role plays in which nurses have to negotiate in the patients' interest with the doctor while they have to maintain partnership relationship and avoid opposition with the doctor.