Inclusion Criteria:  PATIENTS:  Appointment scheduled with a resident participant at one of eight primary care clinics in our health system had completed an appointment with a resident participant within 2 months of the resident completing their communication course 18 years of age or older proficient in English  RESIDENTS:  PGY2 and PGY3 Internal Medicine residents at Cleveland Clinic Scheduled to receive required educational curriculum on communication Scheduled to see patients at one of the eight primary care clinics in our health system  Exclusion Criteria:  PATIENTS:  No appointment scheduled with a resident participant at one of eight primary care clinics in our health system had not completed an appointment with a resident participant within 2 months of the resident completing their communication course Less than 18 years of age Not proficient in English  RESIDENTS:  Not PGY2 and PGY3 Internal Medicine residents at Cleveland Clinic Not scheduled to receive required educational curriculum on communication Not scheduled to see patients at one of the eight primary care clinics in our health system