Nonprocedural skills are an important element in house staff training. Unfortunately, most programs have devoted little effort to monitoring individual progress in this key attribute of the effective physician. We wholeheartedly support the recommendation of Tulsky et al1 that "communication about end-of-life treatment decisions be treated as a medical skill to be taught with the same rigor as other clinical procedures."
At Beth Israel Medical Center, New York, NY, we are demonstrating our commitment to this concept in a newly established educational experience. In July 1995, the Department of Medicine introduced a new requirement for the residency training program. To graduate, all residents must demonstrate proficiency in initiating a discussion about the health care proxy and advance directives with at least 3 patients. A mentoring program is in place to teach these skills. Mentors are drawn from a variety of disciplines and include physicians, patient representatives, social workers, and