Teaching Communication Skills in Surgery: The Competency We Keep Undervaluing

The evidence that communication quality in clinical encounters directly affects patient outcomes is substantial and growing. Patients who receive clear, comprehensible explanations of their diagnosis and treatment options have better adherence to rehabilitation programmes, experience less decisional conflict, report higher satisfaction with care, and — in orthopaedic surgery specifically — have better patient-reported outcomes after procedures like joint replacement and rotator cuff repair. These are not subjective measures of patient experience. They are objective markers of clinical effectiveness.

What surgical communication training currently looks like — and what it should

Communication training in surgical curricula is inconsistently embedded and variably delivered. At its best, it involves structured practice with simulated patients, video-recorded consultations reviewed with trained communication coaches, and systematic use of validated frameworks like the Calgary-Cambridge model. At its worst — which is more common — it consists of attending a one-day course early in training and thereafter learning communication "by osmosis" from senior colleagues, whose own communication habits may or may not be exemplary.

The consent consultation is perhaps the most important communication event in surgery, and it is one of the most poorly trained. Informed consent requires that a patient genuinely understands the proposed procedure, the realistic probability of benefit, the significant risks and how they would affect their life, the alternatives including non-operative management, and what the recovery process involves. Delivering that content clearly, in accessible language, while remaining alert to the patient's emotional state and readiness to process information, is a complex skill that requires deliberate practice — not simply the experience of having done it many times with variable feedback.

Breaking bad news: a surgical skill that is rarely taught

The conversation in which a surgeon explains an unexpected intraoperative finding, a post-operative complication, or an outcome that did not match the patient's expectation is one of the most demanding clinical communications that exists. It requires honesty, compassion, psychological safety, and the technical communication skill to deliver difficult information in a way that is accurate, comprehensible, and preserves the therapeutic relationship. These capabilities can be taught with simulation — and should be, systematically, in every surgical training programme.