Case Story	Session 1	Learning Objectives	Session 2	Learning Objectives
78-year-old man with a history of dementia, COPD, chronic kidney disease, peripheral vascular and coronary artery disease with recurrent admissions due to COPD exacerbations and aspiration pneumonia was admitted to the hospital a week ago for sepsis due to pneumonia, initially requiring BIPAP support and complicated by acute kidney injury that resolved. He is now transitioned to nasal canula for oxygen support. Despite supportive cares, he remains intermittently arousable. Extensive workup has not revealed any specific cause of the altered mental status. A speech evaluation showed aspiration. He remains tube feed dependent. You are taking over the service today. The limiting factors for his discharge are ongoing artificial nutrition and general goals of care with his daughter with whom he lives.	Instructions to the Learner: Discuss goals of care with the daughter regarding artificial nutrition and the patient’s advanced dementia with this presumed new baseline. Challenges: Strong emotions of daughter remain a hurdle (Cynical, angry and indignant).	Address the emotions of the daughter before the conversation can progress. Emotional cues are potential empathetic opportunities.	Instructions to the Learner: Discuss prognosis and make recommendations regarding the plan of care. Challenges:1 Daughter remains resistant, feeling that she is “giving up” on her father.	Explore patient’s values (via healthcare proxy) before making any recommendations. Recognize the daughter’s emotions throughout the encounter and respond with empathy.

¹ It may improve readability if there is a break in line between "instructions to the learner" and "challenges" in session 1 and 2 subheadings