Navigating Communication Challenges in Clinical Practice: A New Approach to Team Education.

Background: Cultivating a healthy work environment and upholding patient safety are important priorities in health care. Challenges in workplace communication are common and affect staff well-being and patient outcomes. Previous interventions have focused on organizational issues and work-life balance.

Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention.

Background: Despite growing interest in engaging patients and families (P/F) in patient safety education, little is known about how P/F can best contribute. We assessed the feasibility and acceptability of a patient-teacher medical error disclosure and prevention training model.

Methods: We developed an educational intervention bringing together interprofessional clinicians with P/F from hospital advisory councils to discuss error disclosure and prevention.

Practicing End-of-Life Conversations: Physician Communication Training Program in Palliative Care.

A Physician Communication Training Program (PCTP) utilizing scripts based on actual family conferences with patients, families, and the health care team was developed at one medical center in the Northeast. The program was designed, adapted, and directed by a palliative care social worker. The primary goal of the program is to help residents and attending physicians build better communication skills in establishing goals of care and in end-of-life planning.

Radiology trainees' comfort with difficult conversations and attitudes about error disclosure: effect of a communication skills workshop.

Purpose: The aim of this study was to assess the effect of communication skills training on radiology trainees' (1) comfort with communicating directly with patients and family members about unexpected or difficult diagnoses ("bad news"), radiologic errors, and radiation risks and (2) attitudes about disclosing radiologic errors directly to patients and their families.

Methods: One hundred nine radiology trainees from 16 US programs were asked to complete questionnaires immediately before and after attending an institutional review board-exempted, full-day communication workshop. Questionnaires assessed (1) comfort communicating with patients and their families generally and about bad news, radiologic errors, and radiation risks specifically; (2) attitudes and behavioral intent regarding a hypothetical vignette involving a radiologic error; and (3) desire for additional communication training.

Relational learning and interprofessional practice: transforming health education for the 21st century.

Theories and traditions emphasizing the centrality of caring have guided the evolution of the healthcare professions. In contemporary practice, creating a therapeutic context in which healing can occur relies not just on the caring dispositions of individual clinicians, but also on the collective relational capacities of interprofessional healthcare teams. This article describes the intersection and complementarity of relational and interprofessional learning approaches to health education, provides exemplars of shared learning models and discusses the benefits and obstacles to integrating relational and interprofessional philosophies into real world practice.

Stepping out further from the shadows: disclosure of harmful radiologic errors to patients.

Direct radiologist-to-patient disclosure of harmful radiologic errors comports with our profession’s aspirations toward enhanced patient care, professionalism, and visibility; obstacles to disclosure may be mitigated with education and research and managed by radiology guidelines.

Uncovering and validating clinicians' experiential knowledge when facing difficult conversations: a cross-cultural perspective.

Objective: To explore clinicians' experiential knowledge when conducting difficult conversations; and to verify if experiential knowledge is culturally based.

Method: Data were collected in Italy and the United States during the Program to Enhance Relational and Communication Skills (PERCS) workshops. At the beginning of each workshop, during a whiteboard exercise, clinicians shared the strategies they had found helpful in difficult conversations.

Sturdy for common things: cultivating moral sensemaking on the front lines of practice.

This essay argues that the field of bioethics should concern itself especially with the process of making moral sense that unfolds among clinicians, patients and family members during common but high-stakes conversations occurring on the front lines of practice. The essay outlines the parameters of a bioethics grounded in the moral experience of patients, families and practitioners. It challenges ethicists, educators, and clinician leaders to commit themselves to advocating and developing creative approaches to learning that will cultivate the moral sensibilities of frontline clinicians in this critically important domain of practice.

Cross-cultural adaptation of an innovative approach to learning about difficult conversations in healthcare.

Background: The Program to Enhance Relational and Communication Skills (PERCS) was developed at a large hospital in the United States to enhance clinicians' preparedness to engage in difficult conversations.

Aim: To describe the implementation of PERCS in an Italian hospital and assess the program's efficacy.

Methods: The Italian PERCS program featured 4-h experiential workshops enrolling 10-15 interdisciplinary participants.

Learning that leads to action: impact and characteristics of a professional education approach to improve the care of critically ill children and their families.

Objective: To determine the impact of an innovative professional educational approach on clinicians' confidence and ability to make institutional improvements in pediatric palliative care.

Design: Evaluation to assess impact of educational intervention on participants and participant institutions.

Setting: Retreats lasting 2.

[Between science and suffering: difficult conversations in healthcare].

Introduction: This article describes the adaptation and implementation of the Program to Enhance Relational and Communication Skills (PERCS) in Italy. PERCS was originally developed at Children's Hospital Boston and aims to enhance clinicians' preparedness to engage in difficult conversations with patients/families.

Description: After a period of collaboration by the first author with the Children's Hospital Boston, PERCS was launched at San Paolo Hospital, Milan, in 2008.

Difficult conversations: improving communication skills and relational abilities in health care.

Background: Communication skills and relational abilities are essential core competencies that are associated with improved health outcomes, better patient adherence, fewer malpractice claims, and enhanced satisfaction with care. Yet, corresponding educational opportunities are sorely underrepresented and undervalued.

Objective: To evaluate the impact of an interdisciplinary experiential learning paradigm to improve communication skills and relational abilities of pediatric critical care practitioners.

Assumptions and blind spots in patient-centredness: action research between American and Italian health care professionals.

Objective: To examine how patient-centredness is understood and enacted in an American (US) and an Italian group of health care professionals.

Methods: An action research methodology was used. Two interprofessional groups of US (n = 4) and Italian (n = 5) health care professionals independently wrote a patient-centred dialogue between a doctor and a patient based on the same scenario.

Difficult conversations in health care: cultivating relational learning to address the hidden curriculum.

The authors describe the philosophy and pedagogical approach of an innovative educational program, grounded in principles of relational learning and designed to improve the preparedness of health care professionals for engaging in challenging conversations with patients and families. The Program to Enhance Relational and Communication Skills (PERCS) is a project of The Institute for Professionalism and Ethical Practice at Children's Hospital Boston, developed in collaboration with Education Development Center, Inc. The one-day workshop is interdisciplinary in its structure, includes practitioners with varying levels of professional experience, uses trained actors to portray patients and family members, and involves learners in improvised case scenarios.

Relational learning in pediatric palliative care: transformative education and the culture of medicine.

The discrepancy between what is taught in formal educational settings and what is learned by practitioners in the informal flow of everyday practice has been called the hidden curriculum. In this article, the authors apply a well-documented range of concerns about the hidden curriculum and the erosion of professionalism to the arena of pediatric palliative care education. The authors propose that educational initiatives must always be grounded in the charged existential space of relationships among children, families,and practitioners, because the learning that matters most occurs within these relationships.

Sudden traumatic death in children: "we did everything, but your child didn't survive".

When caring for children who become suddenly and catastrophically ill, clinicians must simultaneously attend to a complex and rapidly evolving medical situation, as well as to the equally challenging demands of establishing compassionate relationships with family members and communicating well with colleagues. An 18-month-old toddler was brought to the hospital with severe head injury after being struck by a car. Over a period of hours, her condition evolved from prognostic uncertainty to the diagnosis of brain death and considerations of organ donation.

The initiative for pediatric palliative care: an interdisciplinary educational approach for healthcare professionals.

There is growing empirical evidence that the U.S. healthcare system fails to meet the needs of children with life-threatening conditions and their families.