A five-year evaluation and redesign of the communication skills component of the Introduction to Clinical Medicine course was undertaken at the State University of New York Health Science Center at Syracuse College of Medicine. The objectives of the evaluation were to determine the effectiveness of the component in teaching communication skills, identify areas of the component in need of change, and monitor the effectiveness of previous changes. In the first three years, the evaluation focused on the students' perceptions of the importance of communication skills in their training as physicians. Based on the evaluations for those three years, the component was modified substantially. One of the changes was the introduction in years four and five of simulated patients for practicing interviewing skills. The evaluations in years four and five focused on the effectiveness of using the simulated patients and the students' perceptions of how well the course objectives were met.