Oteri Roberta, Borghi Lidia, Leone Daniela, Vegni Elena, Lamiani Giulia
UOC Psicologia Clinica, ASST Santi Paolo e Carlo, Milano.
Psicologia Clinica, Dipartimento di Scienze della Salute, Università di Milano.
Recenti Prog Med. 2020 Mar;111(3):142-148. doi: 10.1701/3315.32855.
Communicating unexpected and bad news is a stressful yet unavoidable aspect of clinical practice. However, there is a lack of educational models to train clinicians for difficult conversations. This study aims to: describe the main characteristics of the Program to Enhance Relational and Communication Skills (PERCS); present PERCS efficacy at 10 years since its inception in Italy; and illustrate a specific PERCS on organ donation as an example. PERCS is an educational model based on principles of experiential learning, developed at Children's Hospital Boston. PERCS has been offered as a continuing medical education program in an academic hospital in Milan. PERCS workshops last 5 hours and enroll a maximum of 13-15 interdisciplinary participants across levels of experience. The workshops are geared around the simulation and debriefing of difficult conversations. Before and after the workshops, participants rated their perceived preparation, communication and relational skills, confidence, and anxiety on 5-point Likert scales. Pre-post data were analyzed with paired sample t-tests. Between 2008 and 2018, 52 workshops have been offered, involving a total of 602 participants. Participants reported better preparation, confidence, communication and relational skills, and lower anxiety (for all dimensions, p<0.001) after the workshops. The strengths of the PERCS model includes: the integration between teaching specific skills and promoting relational attitudes, the learner-centered method, and its efficacy. Major challenges relate to the assessment of actual behavioral change of participants and long-lasting effect of the program at follow-ups.
传达意外和坏消息是临床实践中一个压力重重但又不可避免的方面。然而，目前缺乏用于培训临床医生进行艰难对话的教育模式。本研究旨在：描述增强关系与沟通技能项目（PERCS）的主要特征；介绍PERCS自意大利启动10年来的成效；并举例说明一个关于器官捐赠的具体PERCS。PERCS是一种基于体验式学习原则的教育模式，由波士顿儿童医院开发。PERCS已在米兰的一家学术医院作为继续医学教育项目提供。PERCS工作坊持续5小时，最多招收13 - 15名不同经验水平的跨学科参与者。工作坊围绕艰难对话的模拟和汇报展开。在工作坊前后，参与者通过5点李克特量表对他们感知到的准备情况、沟通与关系技能、信心和焦虑程度进行评分。前后数据采用配对样本t检验进行分析。在2008年至2018年期间，共举办了52场工作坊，共有602名参与者。参与者报告称，工作坊结束后，他们在准备情况、信心、沟通与关系技能方面有所提升，焦虑程度降低（所有维度，p<0.001）。PERCS模式的优点包括：将特定技能教学与促进关系态度相结合、以学习者为中心的方法及其成效。主要挑战涉及对参与者实际行为变化的评估以及该项目在随访中的长期效果。
