We will develop a computer simulator to teach and evaluate communication skills within the domain of end-of-life care. Care for patients for whom the prognosis is limited focuses mainly on improving quality of life. This involves not only pain and symptom relief but also an broad consideration of the patient as a psychological, social, and spiritual person. The caregiver may need to break bad news to patients, assess patients for signs of psychological and social morbidity, assess patients' end-of-life care priorities, and communicate with patients and families about difficult issues. Many factors, including the patient's goals and cultural background, influence how the caregiver must communicate with the patient. The simulation software will create a high-fidelity learning environment in which the user can practice important clinical skills such as assessing a patient for signs of psychosocial morbidity, using communication methods that promote patient disclosure, breaking bad news to patients, and facilitating psychological adaptation. The simulator will track user performance and offer directed advice. It will provide a valuable teaching tool and will be a possible vehicle for certifying a level of clinical competence.