Commentary: communication skills: how simulation training supplements experiential and humanist learning.

The Viewpoint article in this issue by Drs. Michael Hanna and Joseph Fins, "Power and Communication: Why Simulation Training Ought to Be Complemented by Experiential and Humanist Learning," is provocative on several levels. This Commentary focuses on three interrelated questions that emerge from the article's consideration of power dynamics in encounters with simulated patients: (1) To what extent do medical students "perform" (i.e., put on an act) in the context of teaching and assessment that involves simulated patients?; (2) How might medical educators increase the likelihood that students will apply to subsequent practice the core skills and strategies learned in their communication skills training?; and (3) How can different learning modalities complement one another in communication skills training? The Commentary articulates important differences in the application of simulated patients (i.e., teaching versus assessment), elaborates on the issue of power and authority, and then addresses each question noted above. In the process, it outlines some of the avenues through which interpersonal and communication skills are learned--or unlearned--in medical education.