Table 1. New Teaching Paradigm for Communication Skills.

Characteristic	Old Paradigm	New Paradigm
Role of teacher	Expert	Coach
Teaching approach	“Watch the expert in action”	“Let me set you up for a successful encounter”
Learning aids	Teacher lists desirable communication behaviors	Teacher builds strategy with learner on basis of what oncologist needs to accomplish with this particular patient in this visit
Work of teaching	Teacher has primary communication responsibility, and explains his or her thinking to learner afterward	Before encounter, teacher engages learner in goal setting and problem solving Learner has some primary communication responsibility After encounter, teacher debriefs learner
Outcome of feedback	Learner thinks, “ I should have said…”	Learner thinks, “Next time, I am going to…”
What teacher knows	“This is the right way to do it”	Novices are different from experts, and learner is moving along developmental path
Evaluation of learner	Summative judgment about learner's competence (or incompetence)	Formative judgment about learner's professional development