https://doi.org/10.4081/ecj.2026.14932
Comments on Interpersonal skills training for the emergency department – exploring a mentalizing approach
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Published: 1 April 2026
Dear Editor,
We read with great interest and appreciation the brief report by Patrick et al.,1 which discusses the implementation of “mentalizing skills” as a training intervention for Emergency Department (ED) staff. We believe this work addresses a highly relevant issue in Emergency Medicine, highlighting relational competencies that are often overlooked in traditional training pathways. These skills are essential for managing the clinically and emotionally intense interactions typical in the ED.
This article prompted us to consider how the concept of mentalization can provide a valuable framework for understanding deeper and less visible forms of moral distress in the context of Italian EDs. This understanding goes beyond simply addressing burnout and can be described as “moral erosion”.2,3 [...]
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1) Patrick J, Gallagher B, Hicks D, et al. Interpersonal skills training for the emergency department: exploring a mentalizing approach. Emerg Care J 2026;22:14344. DOI: https://doi.org/10.4081/ecj.2026.14344
2) Bell V, Murray E, Muñoz L, Krahé C. In harm's way: moral injury and the erosion of trust for emergency responders in the United Kingdom. Eur J Psychotraumatol 2025;16:2513107. DOI: https://doi.org/10.1080/20008066.2025.2513107
3) Morley G, Bradbury-Jones C, Ives J. Moral distress and moral injury: insights from healthcare ethics. J Clin Ethics 2019;30:107–118.
4) Coen D, Casagarnda I, Cavazza M, et al. Facing the Emergency Department crisis in Italy. Emerg Care J 2021;17:10331. DOI: https://doi.org/10.4081/ecj.2021.10331
5) Poggiali E, Barbieri G, Salvatore V, Salinaro F. The Emergency Rooms and Emergency Medicine should not be the answer to the weakness of the Italian National Health System. Emerg Care J 2021;17:10304. DOI: https://doi.org/10.4081/ecj.2021.10304
6) Giamello JD, Abram S, Bernardi S, Lauria G. The Emergency Department in the COVID-19 era: who are we missing? Eur J Emerg Med 2020;27:305-6. DOI: https://doi.org/10.1097/MEJ.0000000000000718
7) Freund Y. The challenge of emergency medicine facing the COVID-19 outbreak. Eur J Emerg Med 2020;27:155. DOI: https://doi.org/10.1097/MEJ.0000000000000699
CRediT authorship contribution
Paola Franceschini drafted the manuscript. Stefano Perlini critically revised the manuscript. All the authors approved the final version.
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