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We read with great interest the article by Willis et al 1 on challenges that students face during difficult conversations in clinical scenarios. As medical students from Imperial College, London, we can relate to many issues raised in the article but have also identified some factors which could improve the significance of the results. The authors identify 3 areas of difficulties for conversations with patients; however, they do not provide a likely explanation for differences between year groups. It is possible that because students later in their training have had more opportunities to practice, they report "communication skills needs" as less of an issue, with evidence suggesting that sufficient preparation improves student confidence. 2 However, the data suggest that despite training, students still have difficulty in this area, and therefore, reviewing the curriculum may explain the trends. Reflecting on our experiences, we realize that it is through both practice and observations of difficult discussions had by senior doctors that communication skills are developed. Because students progress through medical school, they develop a more evolved role and naturally their struggles change alongside this. The faculty, however, have a responsibility to address these concerns to ensure that students feel confident and competent in consultations.

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