Background: Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Objective: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Design: Multimethod evaluation of an educational program. Setting/Context: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. Measures: As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. Results: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Conclusion: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.

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Purpose: Rates of sexually transmitted infections among adolescents remain high in the United States and Botswana. Mobile phone density rates in Botswana exceed those of the United States. Yet, in both countries, safer sex information continues to be delivered primarily via face-to-face curricula such as Becoming a Responsible Teen and Living as a Safe Teen . While social media shows promise as a medium for delivering risk-reduction information to youth, few studies have been conducted in either country to assess its effectiveness. This study examines adolescents in both countries, their mobile phone and social media usage, and their perceptions of safer sex interventions delivered via social media. Design and methods: Three focus groups were conducted with 28 adolescents 13–18 years of age who lived in the United States (n=14) and Botswana (n=14). Data analysis was ongoing, which informed the data collection process. After the first group, no additional revisions were made to the focus group protocol. An abridged method of analyzing the data was employed. Results: Adolescents in all groups discussed peer pressure and connectedness with mobile phones and social media and had general knowledge of STIs and HIV. The adolescents agreed that adaptation of risk reduction interventions for mobile phone and social media delivery was warranted, and they shared ideas for adaptation. Practice implications: Our findings provide a starting point for researchers interested in developing a social media intervention with global implications for sexual health promotion.

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