Table 2.

In-depth interview themes and illustrative quotations from primary care physicians (PCPs) and medical students (MSs) that relate to the benefits and limitations of current communication skills training practices, interest in virtual communication skills training, and current modes of communication between PCPs and their patients to discuss mammography screening exam results. Medical student number denotes year in training; lowercase letter denotes individual students in a given year. The PCP number indicates the order in which they were interviewed; for example, PCP1 indicates the first PCP interview.

Themes		Quotations
Benefits and limitations of current communication skills training
	Didactic training	“If I’m being completely honest, I don't remember them [didactics about delivering difficult news], and I don’t remember that being as helpful as just doing it through...practicing in real life.” [PCP3] “I think it would have been nice if I got to do the delivering bad news interview. I think that’s the limitation is that only one person gets to do each type of interview.” [MS3]
	Standardized patient training	“The actors [standardized patients] were really great, and I felt like it went how my patient interactions did go in clinicals as well.” [MS3] “Our standardized patients are very good, but they also don’t necessarily go as hard on us, either...They just kind of follow the scripts. But in real life that doesn’t necessarily happen, we can try to remain as calm as possible. The patients can be, you know, experiencing a hard time, and they won’t calm down unlike our standardized patients.” [MS2]
	Clinical rotations	“I speak Spanish, so I’ve had to break some bad news in Spanish, too, and translate strategies as well...It’s just a little bit different, like cultural communication...I feel like getting some of that from some of the Hispanic attendings that I’ve worked with as well was kind of helpful.” [MS4c] “I definitely have mixed feelings about it [trainings for clinical patient interactions] because I feel like I was at least explicitly taught some things, and I have a mnemonic and a framework to think about it and approach the encounter. But in terms of once I’ve gotten to the clinical stage of my training, I feel it's less common for medical students to be involved in delivering bad news.” [MS4a]
Interest in virtual training		“[I did] a virtual reality...trauma case with the SIM lab...it was actually very cool experience...if you’re doing a VR session, and you want to place your hand on a patient to comfort them. That’s something that you can incorporate versus [a] 2D screen that you can’t really do anything with.” [MS2]
PCP communication with patients		“[Patients] can self-schedule. So, without seeing me, it’ll come up...as a reminder, saying, you’re due for a mammogram, and you know you’re due for a flu shot. You’re due for a mammogram.” [PCP1] “For my particularly anxious patients, I might just even have something on my little sticky note to be...to call them again just so that they’re aware, because a lot of times...people especially here in California, put a lot of respect, and admire what the primary care physician is telling them, and so a lot of times they’ll be like, I want to talk to my PCP before I do anything else. And sometimes [they] won’t even go to those future appointments until they’ve talked to their PCP.” [PCP5]