Perspective: To what end communication? Developing a conceptual framework for communication in medical education.

A growing discourse about broadening the educational experience of physicians in medical education focuses on professional formation and the wider social context within which health care is delivered. This shift suggests a complex reconfiguration of medical education. Where does one begin this task? First, medical education reform must be grounded in a clarification of the conceptual terrain where proposed changes in pedagogy and practice are occurring. More specifically, some clarity is needed regarding the basic or key competencies that students are expected to acquire through educational processes. Accordingly, the author argues that having a clear and comprehensive conceptual understanding of the educational aims defining this reform is a necessary starting point. Although descriptions of competencies (such as those required by CanMeds and the Accreditation Council for Graduate Medical Education) focus on lists of skills, greater detail is needed regarding our understanding of the values and rationale underlying such skills if they are to be applied in educationally effective ways. The author shows the extent to which and ways in which our understanding of these basic concepts will influence the direction of reforms. He examines various conceptions of the role of communication in medicine and indicates various educational benefits and shortcomings in these approaches. He concludes by identifying one concept of communication, termed "communication as a medical-epistemic competency, " that can include and incorporate many facets of communication in the medical context while also responding to broader societal changes being addressed through post-Flexner developments in educational reform.