What are communication skills in healthcare?

The specific things a clinician does with questions, explanations and silence so that information gets through, from the patient, to the patient and family, and across the care team. In practice they group into five: opening and listening, keeping the conversation open, staying in a hard conversation, explaining so it’s understood, and talking to the team.

What are the 5 C’s of communication in healthcare?

There’s no single agreed list. The versions that circulate under that name mix qualities of a message, like clear, concise and correct, with steps of an encounter, and they don’t match each other. They’re useful as reminders; for teaching and grading, a list of observable behaviors works better.

What communication skills do nurses need?

The same five as any clinician. Two come up on almost every shift: reporting changes to the team, often with a structure like SBAR, and checking that patients understood their instructions, for example with teach-back.

Can communication skills be taught?

Yes. The Cochrane review of communication training in cancer care included 17 randomized trials, and in the ones it could pool, trained clinicians used more open questions and showed more empathy. It also notes that communication skills don’t reliably improve with experience alone, so the practice has to be planned.

What is the teach-back method?

A way of checking understanding by asking patients to state in their own words what they need to know or do about their health, as AHRQ describes it. The point is to check the clinician’s explanation; if the patient can’t explain it back, the explanation gets redone.

An instructor talking with a student playing the patient in a skills lab while classmates look on

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Practical training

Communication skills in healthcare that programs can grade

By Beatriz Zambrano · Founder September 22, 2026 5 min read

In this article

A working definition

What the term actually covers

Communication skills in healthcare are the specific things a clinician does with questions, explanations and silence so that information gets through: from the patient, to the patient and family, and across the care team. Each of those moves can be observed, graded and practiced until it comes out on its own, which is what makes them teachable.

The popular shortcuts don’t help much with the teaching. Search for the 5 C’s or the 7 C’s of communication and you’ll find lists that don’t agree with each other: some describe a good message (clear, concise, correct), others the steps of an encounter. They work as reminders on a poster, and they’re hard to turn into a rubric.

One of the best-known frameworks in medical education, the Calgary–Cambridge guide, was reworked around that gap in 2003. Its authors describe learners caught between “two apparently conflicting models of the medical interview”: the communication course, which teaches the process, and the traditional medical history, which teaches the content. Their answer was to teach both as a single clinical method.

A clinician listening to a patient across the consultation desk

The five skills

Communication skills for nurses and everyone else on the unit

One card per skill, with what it covers and what it looks like when it works. They apply to every role on the unit, from nursing students to residents.

Five communication skills clinical work runs on

01Opening and listeningGetting the patient to say the part they were deciding whether to say.

Open questions, silence after difficult news, reflecting back what you heard and validating the feeling before moving on. These are the techniques students can name earliest, and naming them is the easy half.

02Keeping the conversation openCatching the well-meant replies that shut a patient down.

False reassurance, jumping to advice, changing the subject, the “why” question. None of them sounds rude, which is why they survive in practice, and spotting one afterward doesn’t stop the next one.

03Staying in a hard conversationThe patient who won’t talk, the family that answers first, anger and denial.

This is where a single technique runs out and the skill becomes deciding what to change: the question, the timing, the room or the person asking. Breaking bad news belongs here too, usually taught with the six steps of SPIKES.

04Explaining so it’s understoodPlain language, then a check with teach-back.

AHRQ describes teach-back as asking patients “to state in their own words what they need to know or do about their health.” Its toolkit adds the reminder that matters most in class: “you are checking how well you explained something, not testing the patient.”

05Talking to the teamHandoffs and escalation calls, with a structure that keeps them complete.

SBAR (situation, background, assessment, recommendation) is the framework AHRQ’s TeamSTEPPS curriculum uses to share a patient’s condition, and I-PASS is the one built for handoffs. Both turn a habit into a checklist someone can grade.

The first three have their own pieces on this blog, and each goes further than a card can: therapeutic communication techniques for opening and listening, non-therapeutic communication for the replies to unlearn, and therapeutic communication in nursing for the four situations where the right sentence stops working. Breaking bad news has its own piece too, on training hospital staff to break bad news. The sources for teach-back and SBAR are AHRQ’s teach-back tool and the TeamSTEPPS SBAR page.

Where it gets taught

How nursing and medical programs train them

Experience alone doesn’t take care of it. The Cochrane review of communication training for professionals in cancer care opens by noting that “research suggests communication skills do not reliably improve with experience.” It included 17 randomized trials with 1,240 clinicians, and in the ones it could pool, those who were trained used more open questions, showed more empathy and were less likely to answer an emotional moment with facts only. The review couldn’t tell how long the effect lasts, which is a good argument for spreading practice across the whole program.

On a program calendar, that translates into a few habits anyone can check:

Grade communication inside clinical tasks. A history-taking station gets scored for what was asked and for how it was asked, the integration Calgary–Cambridge argues for.
Give each skill more than one attempt, with feedback while the student still remembers what they said.
Write the rubric in behaviors, like “asked an open question before the first closed one,” which two graders can score the same way. The case for writing soft skills as observable behavior is in our piece on soft skills in clinical education.

One observable behavior to grade, skill by skill

Skill	An observable behavior to grade
Opening and listening	Opens with an open question and lets the patient finish before the first closed one
Keeping the conversation open	Responds to the concern the patient raised before offering any reassurance
Staying in a hard conversation	Changes something (the question, the timing or the setting) when the first approach stalls
Explaining so it’s understood	Closes with teach-back: the patient states the plan in their own words
Talking to the team	The handoff or escalation call includes every SBAR element

Where the attempts come from

More graded conversations per student

The limit, as usual, is attempts. A graded conversation needs a case, a patient who reacts and someone to score it, so each skill tends to get very few of them.

The team side

The skill with the clearest numbers

Of the five, talking to the team is the one with the hardest outcome data. The I-PASS study ran a resident handoff program across nine hospitals and 10,740 patient admissions: a standard mnemonic, communication training, faculty observation and a campaign to keep it going. Medical errors fell 23%, from 24.5 to 18.8 per 100 admissions, and preventable adverse events fell 30%.

Oral handoffs took 2.4 minutes per patient before the program and 2.5 minutes after.

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Frequently asked

Questions people ask about this.

What are communication skills in healthcare?

The specific things a clinician does with questions, explanations and silence so that information gets through, from the patient, to the patient and family, and across the care team. In practice they group into five: opening and listening, keeping the conversation open, staying in a hard conversation, explaining so it’s understood, and talking to the team.
What are the 5 C’s of communication in healthcare?

There’s no single agreed list. The versions that circulate under that name mix qualities of a message, like clear, concise and correct, with steps of an encounter, and they don’t match each other. They’re useful as reminders; for teaching and grading, a list of observable behaviors works better.
What communication skills do nurses need?

The same five as any clinician. Two come up on almost every shift: reporting changes to the team, often with a structure like SBAR, and checking that patients understood their instructions, for example with teach-back.
Can communication skills be taught?

Yes. The Cochrane review of communication training in cancer care included 17 randomized trials, and in the ones it could pool, trained clinicians used more open questions and showed more empathy. It also notes that communication skills don’t reliably improve with experience alone, so the practice has to be planned.
What is the teach-back method?

A way of checking understanding by asking patients to state in their own words what they need to know or do about their health, as AHRQ describes it. The point is to check the clinician’s explanation; if the patient can’t explain it back, the explanation gets redone.

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