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. 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. CONCLUSION: 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. PRACTICE IMPLICATIONS: Communication training programs can foster clinicians' sense of preparation by building upon their already-existing knowledge.