The purpose of the study was to examine the relationship between resident communication skills competence and their ability to self-assess within that domain. Six research questions guided the study. The first research question sought to explore the varied levels with which residents demonstrated competence within the domain of communication skills as measured by Standardized Patient Parents (SPPs) using the Breaking bad news Assessment Schedule (BAS) instrument. The second research question examined how residents' self-assessments corresponded with Standardized Patient Parent assessment of their communication skills performance. The third research question asked how resident communication skill competence related to their ability to self-assess within the domain. The fourth question explored how resident gender related to their ability to self-assess their communication skills performance. The fifth question explored how the number of years of residency training experience related to residents' ability to self-assess their communication skills. The sixth research question explored the amount of significant variance in resident ability to self-assess their communication skills that could be explained by gender, year in training, ethnicity, and theoretical element of communication skills competence. The methodology implemented was a non-experimental, cross-sectional research design. A purposeful sample of Duke pediatric residents was used for this study. Each resident participated in a standardized patient parent (SPP) scenario in which they were asked to break bad news to a set (mother and father) of SPPs. Immediately subsequent to the scenario, the residents were asked to self-assess their performance using the Breaking Bad News Assessment Schedule (BAS) and both SPPs were asked to assess each resident's performance as well. Data analysis techniques included computation of means, standard deviations, frequencies, and percentages for the descriptive data. Chi Square tests, paired t-tests, and a multiple regression were also used to answer the six research questions. Findings indicated that resident communication skill competence varied considerably from very low on the scale used to very high. Resident self-assessed scores also varied considerably, though by a narrower margin. When looked at overall, resident self-assessed scores were shown not to correlate with SPP scores. Using tertiles, it was clearer that residents who were scored by the SPPs to have the least communication skills competence (bottom tertile) overestimated their performance, residents in the middle tertile were generally accurate in their self-assessments, and those in the top tertile underestimated their performance. Therefore, Kruger and Dunning's (1999) self-assessment framework was supported by the findings of this study. While residents in each tertile were shown to be somewhat inaccurate in their self-assessment, the greatest concern remains for those who overestimated, particularly those in the bottom tertile who overestimated to the greatest degree. Of the variables gender, level of residency training, ethnicity, and four theoretical elements to effectively breaking bad news, none were shown to have an impact on residents' ability to self-assess their communication skills. One theoretical element, "Breaking the News," was shown to explain 35% of the variance in residents' ability to self-assess. General recommendations from this study include streamlining enhanced communication skills training into the framework of the existing residency curriculum. This enhancement should be implemented for all residents regardless of gender, training level, or ethnicity to improve their communication skills. Based on the literature and the corroborating results of this study, this should, in turn, enhance the residents' ability to more effectively self-assess their communication skills. Research recommendations include efforts to determine the most effective and efficient means of streamlining communication skills training into the existing residency training curriculum. Furthermore, studies should be done for additional knowledge and skill domains to determine if Kruger and Dunning's self-assessment framework is generalizable to residency domains outside that of communication skills. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]