Patient centered clinical communication has a positive influence on patients' satisfaction, health outcomes and economic costs. Although communication skills tend to decline with time unless regularly recalled, most medical schools still deliver clinical communication training only during pre-clinical years. Several barriers prevent communication skills training from occurring in clinical practice: students, junior doctors and clinical supervisors' attitudes; insufficient structured training, clinical supervisors' lack of effective communication and teaching skills; organizational constraints such as lack of time, competing priorities and weak hierarchy support. In order to optimize communication skills learning in practice, there is need to: 1) provide regular structured trainings and tailor them to trainees' needs; 2) extend communication skills to all fields of medicine; 3) improve trainers' clinical teaching and communication skills 3) modify the climate and structure of the working environment so that that use of both good teaching and communication skills in clinical practice becomes supported and rewarded.