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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.

The current study aimed to evaluate simulation-based medical education (SBME) training and its contribution to the learning process of students in a communication sciences and disorders (CSD) program. The training was integrated in different stages of the program, over 4 years, with different students. The content and complexity of each of the simulation activities targeted specific skills, tailored to the students' learning phase. Students completed a nine-item survey at the end of the first and second semesters of the second year, evaluating the simulation training program structure and students' self-efficacy relating to the building of relationships between care givers and patients. A total of 246 questionnaires were analyzed. Students reported significantly increased self-efficacy in a range of clinical skills and perceived the inclusion of simulated patients (SPs) into a clinical skills program as valuable. Our data suggest that scenarios that reflect real-life situations (environment, atmosphere, equipment, etc.) have the strongest impact on the students' ability to implement professional and communication skills. A strong positive correlation was found between the video-based debriefing and students' perception of the improvement in their professional and communication skills. These findings suggest that this is a feasible and powerful training approach that can be applied in the CSD curriculum.

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.

Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected.The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up.Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3.Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09).This preliminary study demonstrates the value of communication skills training in the intensive care environment.