7 Using an adapted Shadowbox technique to teach healthcare staff how to manage a patient with end-of-life care needs- A blueprint for educators

Introduction Shadowbox technique was first described for use in training emergency and combat personnel. This educational technique allows a participant to observe a specific semi-scripted encounter being managed by an expert. Importantly, the expert is unscripted and acts naturally and spontaneously. The learner then reflects on how they might have managed the encounter before contrasting this with how the expert managed the situation, leading to practice change. This has been adapted for clinical education previously for infectious disease history taking and teaching nursing students (Mutch, 2022; Harder, 2020). In our context, we sought to empower junior clinical staff to advocate for patients with palliative care needs, following incident reports and anecdotal evidence. Methods A multi-professional group formed who created, wrote and edited scenarios based on three key areas: 1: Advocating for a dying patient amongst staff 2: Developing a shared understanding of what a patient and relatives understand 3: Communicating the use of anticipatory medicines in a healthcare team. We adapted the Shadowbox technique to have a voice-over at the conclusion of the videos explaining why the actions of the observed expert were best practice. Three short videos were created for use our trust's induction, in ad-hoc teaching and were embedded on the trust education website. Results We adapted the approach to allow greater flexibility in their use by incorporating a short explanation as to why the expert managed the situation they did. This allows the learner to consider how they may have acted prior to an explanation, allowing versatility in delivery while maintaining the underlying educational theory where learners challenge their existing practice by observing how an expert manages the same scenario. Conclusion The adapted shadowbox technique is a novel educational tool which has great utility for the unmet needs in palliative education due to time constraints on educators and professional groups, allowing flexibility in delivery while maintaining the underlying theoretical principles.