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Background Simulation-based training improves residents’ skills for end-of-life (EOL) care. In the field, staff providers play a significant role in handling those situations and in shaping practice by role modeling. We initiated an educational intervention to train healthcare providers for improved communication skills at EOL using simulation of sensitive encounters with patients and families. Methods Hospital physicians and nurses (n = 1324) attended simulation-based workshops (n = 100) in a national project to improve EOL care. We analyzed perceptions emerging from group discussions following simulations, from questionnaires before and after each workshop, and from video-recorded simulations using a validated coding system. We used the simulation setting as a novel tool for action research. We used a participatory inquiry paradigm, with repetitive cycles of exploring barriers and challenges with participants in an iterative pattern of observation, discussion and reflection – including a description of our own responses and evolution of thought as well as system effects. Results The themes transpiring included lack of training, knowledge and time, technology overuse, uncertainty in decision-making, poor skills for communication and teamwork. Specific scenarios demonstrated lack of experience at eliciting preferences for EOL care and at handling conflicts or dilemmas. Content analysis of simulations showed predominance of cognitive utterances - by an order of magnitude more prevalent than emotional expressions. Providers talked more than actors did and episodes of silence were rare. Workshop participants acknowledged needs to improve listening skills, attention to affect and teamwork. They felt that the simulation-based workshop is likely to ameliorate future handling of EOL situations. We observed unanticipated consequences from our project manifested as a field study of preparedness to EOL in nursing homes, followed by a national survey on quality of care, leading to expansion of palliative care services and demand for EOL care education in various frameworks and professional areas. Conclusions Reflective simulation exercises show barriers and paths to improvement among staff providers. When facing EOL situations, physicians and nurses use cognitive language far more often than emotions related expressions, active listening, or presence in silence. Training a critical mass of staff providers may be valuable to induce a cultural shift in EOL care.

University of Iowa Legal Studies Research Paper, Number 15-22.

In this short piece we provide an interactive, annotated International Business Transactions (IBT) syllabus. The introduction and annotations seek to connect the current discourse on experiential legal education to andragogy — the study of adult learning.In 2013 we set out to re-develop a 3-credit IBT course. We applied various experiential pedagogical methodologies — developed initially to train Israeli air force pilots and later adapted to medical training and grounded in theoretical and empirical education research — to serve in a traditional IBT course. The goal was not only to develop legal skills such as negotiation, contract drafting, and client counseling but more importantly to impart knowledge including legal doctrine, legal theory, and policy considerations through the use of a series of structured, in-class experiences.The piece includes embedded documents as part of the interactive reading experience. It is therefore best viewed in Adobe.