title: Uncovering and validating clinicians' experiential knowledge when facing difficult conversations: a cross-cultural perspective.
abstract: OBJECTIVE
  To explore clinicians' experiential knowledge when conducting difficult conversations; and to verify if experiential knowledge is culturally based.
  
  
  METHODS
  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. The strategies were analyzed in each country through content analysis. Upon completion of this primary analysis, the themes identified within each country were synthesized into second-order themes by means of aggregated concept analysis.
  
  
  RESULTS
  We conducted 14 Italian and 12 American PERCS-workshops enrolling a total of 304 clinicians. The suggestions that were similar across both countries were related to: organizational aspects and setting preparation; communication and relational skillfulness; clinician mindfulness; interpersonal qualities and sensibilities; and teamwork and care coordination. Additionally, US participants identified attention to cultural differences as a helpful strategy.
  
  
  CONCLUSIONS
  Clinicians can access relational strategies, tied to their experience, that are typically unrecognized in medical education. The whiteboard exercise is an effective teaching tool to uncover and validate already-existing relational knowledge.
  
  
  CONCLUSIONS
  Communication training programs can foster clinicians' sense of preparation by building upon their already-existing knowledge.
authors.affiliation: Department of Medicine, Surgery and Dentistry, University of Milan, Milan, Italy. giulia.lamiani@unimi.it
authors.forename: Giulia
authors.initials: G
authors.lastname: Lamiani
authors.forename: Serena
authors.initials: S
authors.lastname: Barello
authors.forename: David M
authors.initials: DM
authors.lastname: Browning
authors.forename: Elena
authors.initials: E
authors.lastname: Vegni
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Meyer
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D003431:Cross-Cultural Comparison; D004502:Education, Medical, Continuing; D005260:Female; D006282:Health Personnel; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018794:Problem-Based Learning; D011369:Professional-Patient Relations; D015397:Program Evaluation; D036301:Qualitative Research; D015203:Reproducibility of Results; D014342:Truth Disclosure; D014481:United States