In our previous article, we reviewed the history of Patient Centered Care and how the Picker Principles provided a foundation for empowering patients and improving healthcare outcomes around the world. We highlighted that patient autonomy is a cornerstone of this approach, yet it is also one of the most challenging areas to effectively navigate. In this article we propose tangible approaches to continuing medical education (CME) that can equip providers with the tools and skills to deliver effective patient-centered care while respecting time constraints in today’s busy healthcare environment.

To move from theory to practice, CME must shift away from traditional, passive learning and toward a new model of skills development. A core principle of this model is “active learning”- an approach that incorporates interactivity, practice and contextual relevance to improve retention and recall in challenging situations. The first and most critical step is to immerse physicians in situations that simulate the challenges they face every day:

1. Incorporate Real-World Scenarios: Use case studies and interactive training sessions that present mock patient scenarios. These cases should reflect diverse patient populations, complex medical conditions, and challenging communication scenarios [1, 2]. By engaging in interactive sessions, healthcare providers can practice navigating difficult conversations and challenging situations. Like learning to hit a tennis ball, practicing in a simulated environment will improve delivery and hone skills so that when pressed for time, the reflex response is effective and patient-centered [3].



2. Engage in Role-playing Exercises: Similarly, role-playing exercises work to reinforce new behavioural paradigms. By creating a simulated environment mirroring real-life patient encounters, these mock situations enable doctors to practice communication skills safely and gain confidence handling different scenarios, including sensitive conversations, addressing patient anger, or explaining complex diagnoses [4]. The biggest criticism of role-playing exercises is that they lack real-world authenticity, but these challenges can be addressed by better analysis of real patient-physician interactions, improved training of patient-actors, and potentially by integrating AI-simulated patients in the future [5, 6]. Role-playing should focus on the following key communication areas:
• Patient-Centered Communication and Shared Decision Making (SDM): These exercises should emphasize techniques for engaging patients, identifying shared values, clearly presenting more than one treatment option, discussing potential risks and benefits, verifying the patient’s understanding, and actively asking for the patient’s preferences to help them make informed choices that align with their values and preferences [7]. When patients feel like they are a part of the decision, patient satisfaction and treatment compliance improve substantially [8, 9]. Physicians’ use of SDM is an area that needs significant improvement. A meta-analysis in 2015 found that few primary care physicians were actively engaging in SDM, and a re-analysis in 2025 found that number has not shifted substantially [10].
• Active Listening Skills: Developing active listening skills is crucial for understanding patient preferences. CME courses should teach practitioners how to hear and understand patients’ concerns beyond words, including interpreting tone and body language.
• Empathy Skills: Empathy is key to respecting patient preferences. CME programs should include exercises and techniques to enhance practitioners’ empathy, helping them better understand and respond to patients’ emotional needs. Some would argue you can’t teach empathy, but engaging in activities like “the voice of the patient” (Australia has a non-profit organization dedicated to this), incorporating patient feedback, and using focus groups that allow practitioners to hear real patient stories in training can provide practitioners with different perspectives that open the door to understanding someone else’s context [11]. As part of that process, involving patients in CME program development as educators and consultants can provide valuable feedback to healthcare providers and add a lived experiences context to educational materials [12].
• Jargon-Free Communication: Design programs that help doctors learn to communicate effectively without the use of confusing medical jargon. Some examples might be:
• Diagnosis Explanation Scenario: Doctors practice explaining common diagnoses like hypertension or diabetes without using medical terms. They could be given a list of jargon words to avoid and asked to rephrase their explanation using everyday language.
• Treatment Plan Discussion: Simulate a scenario where doctors need to explain a complex treatment plan, such as a chemotherapy regimen, using simple terms and analogies that patients can easily grasp.

Once again, the training should not just be passive reading or reviewing of slides; it must involve principles of “active learning”, including novelty, interactive participation, rehearsal, and self-evaluation to reinforce concepts and the ability to deliver effectively under pressure [13].

3. Include Telemedicine Training: The COVID-19 pandemic spurred the rapid rise in telemedicine, and by 2021, 40% of Canadian healthcare visits were virtual [14]. With the surge in telehealth use and increasingly integrated applications, CME programs should include specific training on effective communication in virtual settings. This includes mastering nonverbal cues during video calls, utilizing patient portals for efficient information exchange and addressing technical issues with poise and clarity [14].
4. Leverage Technology: Utilizing remote video conferencing technologies can create accessible learning experiences that respect and maximize the limited time practitioners have for ongoing training. Beyond protecting valuable learning time by reducing travel, video conferencing provides opportunities to engage with specialists and patient groups that would not otherwise have been possible. As it becomes more accessible, incorporating AI simulations and VR can create additional opportunities for enhanced learning in a safe and judgment-free environment.
5. Focus on Cultural Competence and Implicit Bias: To respect patient preferences and deliver truly personalized care, practitioners need strong cultural competence – the ability to respect and understand cultural differences and the personal experiences that can impact a patient’s willingness to undergo treatment, or even simply discuss their symptoms. Eliminating implicit biases goes hand-in-hand with cultural competence training. Implicit biases are unconscious behaviours and judgments that can impede delivering on patient-centered care.

   Cultural competence training should include modules that enhance cultural sensitivity and awareness for groups that have traditionally reported significant difficulties in navigating healthcare, including lived experiences from women and individuals from marginalized communities [15-17]. Additionally, implicit biases around appearance, weight, sexual orientation, and gender identity have been found to affect practitioner attitudes and responses to patients [18, 19]. This training should focus on helping practitioners both identify and address their own implicit biases, as ingrained tendencies can impede delivery of optimal care, particularly in high-stakes situations. Because biases are often deeply ingrained, this form of training should be repeated on a regular basis, as one-time delivery of bias training has been found to be ineffective in shifting attitudes and behaviours [20, 21].



6. Emphasize Interprofessional Education: Interprofessional education (IPE) brings together professionals from different healthcare disciplines, enabling participants to learn from each other, network and establish future working relationships. IPE fosters interdisciplinary understanding and enhances collaboration skills in healthcare teams, breaking down traditional silos and promoting a more comprehensive approach to patient care [22]. In challenging areas such as chronic diseases and mental health, where diagnosis and treatment are often complex, building interdisciplinary relationships and establishing collaborative care systems through IPE can significantly improve patient outcomes [23, 24].

Better patient-centered care through CME

By building more effective CME programs, we can bridge the gap between medical expertise and effective patient communication to improve patient outcomes. Training for patient-centered care isn’t about learning new medical facts or how to treat a condition; it must focus on developing, practicing and honing a vital set of soft skills that empower physicians to connect with patients on a human level, even when they face busy schedules and demanding workloads. Indeed, physicians report that one of their biggest impediments to engaging in shared decision making is time constraints. Yet, studies found that consultation durations did not increase when shared decision making was implemented after proper training interventions [10]. This demonstrates that well-designed, targeted training can give physicians the tools to overcome perceived barriers like time constraints and build stronger patient connections.

As we continue to evolve our approach to healthcare education, patient-centered care must be prioritized in every aspect. Honoring the ongoing work of the Picker Institute and the principles they established, we need to keep the patient at the center of everything we do.

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