The goal of this study is to determine whether mastery learning in communication skills can improve skills in a simulated environment and have translational improvements in outcomes. The main questions it aims to answer are: 1. Does mastery learning improve skills in the simulation laboratory? 2. Does mastery learning improve clinical skills as seen by milestone performance? and 3 Does mastery learning improve burnout levels? The study is a multi-institutional randomized controlled trial of anesthesiology residents from five different residency programs. Participants will be randomized to mastery training in communication skills and standard of care, which is vicarious learning. Researchers will compare these two groups to see if mastery learning improves skills and translational outcomes.

Inclusion Criteria:

• Anesthesiology residents rotating at Ann and Robert H. Lurie Children's Hospital of Chicago

Exclusion Criteria:

• Participant refusal
• Study participants who have already undergone the mastery learning in difficult conversations course.

de-identified study data will be available upon request when study is completed and published