[The experience of the Program to Enhance Relational and Communication Skills 10 years after its inception in Italy.]

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.