The communication skills of house officers in medical clinic were studied. Ten communication skills were identified as being central to the doctor-patient relationship. Twenty interns and residents were observed in 60 clinic visits. Skills well-demonstrated by the house officers related to listening, history taking, assessing patient compliance, examining the patient, and prescribing therapy. Underdeveloped skills were those that involved obtaining the patient's understanding of his illness, social history, and emotional response and the doctor's explanation of the illness. To enhance performance of these skills, changes are recommended in four areas of ambulatory teaching: liaison psychiatry, faculty development, medical precepting, and the relationship between faculty and house officers.