"Learning With the Patient": How Obstetrics and Gynecology Trainees Develop Patient Counseling and Informed Consent Skills.

Background Effective patient communication is a critical skill developed during medical education, but it lacks standardized teaching methods. There is little data on how trainees learn these skills, impeding the development of evidence-based educational initiatives. Social learning theory, particularly communities of practice, is a valuable lens to study how residents develop these competencies as they progress toward unsupervised practice. Objective The authors sought to understand obstetrics and gynecology (OB/GYN) residents' views of their learning about patient counseling and informed consent through the framework of social learning theory. Methods Using constructivist grounded theory, the authors conducted semistructured interviews with residents from all years of a postgraduate residency program in OB/GYN (n=13) at a single academic medical center from 2023 to 2024. Residents were prompted to reflect on specific influential experiences in patient counseling. Through constant comparison and iterative analysis, key themes and conceptual relationships were identified. Results Residents constructed their learning of counseling and informed consent during 3 simultaneously occurring and iterative phases: preparing, conversing, and evolving in practice. In the preparing phase, residents established fundamentals through experiential and didactic learning. The conversing phase described the growth that occurred when trainees counseled patients unsupervised, as they learned how to word and structure conversations and develop the physician-patient relationship, facilitating shared decision-making. Finally, trainees evolved in practice as autonomy increased and they understood nuances within their field more firmly, contributing to professional identity formation. Conclusions This study describes how trainees learn counseling and informed consent as they move toward unsupervised practice.