Table 2.

Examples of breakout activities in palliative care education

Liberating structure	Rational for use	Steps
Impromptu networking   • Used for participant introductions	• Get people up and moving • Acquaint with others you don’t know • Keep them thinking about the week	• Everyone gets up and finds someone they don’t know • Pairs introduce one another • 2 questions: (1) What do you hope to get from this workshop? 20 What do you hope to contribute to this workshop? • 2 min per person—3 rounds
Conversation café   • To discuss opportunities and challenges of palliative care	• Engage everyone in making sense of profound challenges • Encourages everyone to express themselves • Distributes conversation	• Get into small groups • A talking object is passed from person to person • Round 1: Each person shares one strength and one challenge in their setting in regard to palliative care—1 min per person • Round 2: Reflections after listening to everyone—1 min per person • Round 3: Open conversation 15 min without object • Round 4: Take aways—1 min per person
Open space   • To develop a palliative care quality improvement project	• Participants control the agenda • Allows individuals to begin teaming with others in their area of interest • Allows leaders to emerge • Everyone who joins the group cares about the challenge at hand	• Map of room drawn and taped to wall • Blank sticky notes in middle of room • Participants invited to propose a topic to discuss with others—write it on a sticky note and stake a place in the room, e.g., curriculum development, pain management, pediatrics • Once 4–5 topics proposed, individuals can wander to a group • Lead must stay with group but others can wander in and out: Bee (pollenates and moves ideas) or butterfly (goes group to group for various interests)
Fishbowl   • To illustrate successes and challenges of establishing palliative care services	• Share knowledge gained from experience • Uses expertise of those who have established a palliative care program • Allows participants to ask questions and engage • Participants can jot down take aways for their palliative care plans	• 3–4 of us in the inner circle to talk about the good, bad, and ugly of establishing palliative care in the hospital and community • Converse and share stories without engaging outer circle for 10–15 min • Outer circle gets together in groups of 4 to list 3 questions—or could just have open questions • Inner circle answers questions and interacts with outer circle • Allow 1–2 empty seats for others to enter in and ask questions
Improv   • To demonstrate positive and negative communication skills	• Everyone included as players or observers • Only so much about communication can only be taught in a textbook—it has to be role modeled• Allows them to create their own context for the situation, and our team responds/communicates	• Volunteers recruited to be a patient and family member—they write the scenario, e.g., patient has high anxiety (but can’t be told she has cancer) but daughter trying to support • Play out the scene according to cultural context • Allow others to respond of what went well and what could have been different
Appreciative interviews   • To discuss successes and strategies for improved psychosocial care	• Discovers and builds on the root causes of success • Acknowledges each individual for their contribution to psychosocial care • Allows participants to share ideas that can be incorporated into the palliative care plans	• Get into pairs • One person interviews another: (1) Please tell a story about a time when you provided good psychosocial care. (2) What do you think made this good psychosocial care possible. 3 min • Switch—3 min • Get in groups of 4 • Interviewer tells partner’s story—3 min × 4 • Collect group insights—write on flip charts the patterns for success
Crowd sourcing   • For developing a Palliative Care Plan	• Rapidly generates a group’s most powerful actionable ideas • Everyone participates by writing down ideas • Ideas are anonymous • Participants vote on most resonating ideas	• Everyone gets an index card • Everyone is asked, “What big idea do you have to integrate palliative care into your setting?” or “What first step will you take to start palliative care in your setting?” • Cards are collected and shuffled • Cards are handed out • Participants wander and get into pairs to discuss what is on their card and rate from 1–5 (5 is high) • Couple exchanges cards and scores • Everyone exchanges cards • 5 rounds so each card has 10 scores • Last person adds the scores—discuss top 10 ideas • End by asking—“What caught your attention?”
1–2–4–ALL   • Used to discuss pain cases	• Distributes group participation • Allows for individual reflection, small group interaction, and then a larger exchange of ideas	• Participants get into their breakout groups • Each group is given a case study • Individuals reflect on the study for 5 min and write down thoughts • Groups of 2 share thoughts • Groups of 4—or could convene the whole group to share thoughts and come up with a plan • Plan is written on the flip chart • ALL—each group presents their case and plan to the larger group
Celebrity interviews   • To integrate spiritual Concepts into Palliative Care Services and engaging Islamic Spiritual Leaders as experts	• Explores big challenges with those knowledgeable in the area • Allows participant leaders to share experiences on integrating spirituality into care • Relies on their beliefs and customs • Stories emerge that bring concepts to life	• One person from each country chosen by leaders ahead of time; option: give them questions the night before • The three celebrities are seated in chairs at the front of the room • Interviewer introduces topic to be discussed and conducts the interviews: (1) What inspired you in this work? (2) How do you manage stress in your work? (3) What role does spirituality have in your work? (4) How do you integrate spirituality into your patient care? • Audience asks questions after the interviews
Wise crowds   • To discuss pain and symptom management challenges	• Taps into the wisdom of the group in rapid cycles • Allows for those facing symptom management challenges to get ideas from regional colleagues to solve the issue • One participant gets to be the client while others in the group are consultants—assumes expertise exists among the participants	• Request for a volunteer who is having a problem solving a symptom management issue: Describe a challenge you are having in providing good symptom management to your patients • The client shares the problem with the group while they only listen—2 min • Consultants ask questions—2 min • Client turns their back on the consultants while they discuss solutions—5 min • Client rejoins group to reflect on the suggested solutions

© Jeannine M. Brant; data from [18]