I'll take a run at the last one as they are near and dear to my heart, Exploration Skill Challenges.
I've used them aplenty in my two 4e games and, although others may disagree, I think the system's tools are beautifully built to convey the emotion and desperation of such play. Here are the component parts that I've used to good effect. I would recommend others organize their GMing technique around these tools and principles.
1. The Disease.
You can name it whatever you'd like or leave it unnamed (its likely that the players will only be exposed to its dastardly effects, not its tag). Regardless, it needs to attack surges, defenses, forbid benefits from an Extended Rest and it needs to be tenaciously persistent. I typically use Level + 5 versus Fort rather than the standard Level + 3. If you want to make it more virulent, you can step up the DCs by one (trade Easy for Moderate and Moderate for Hard). Anyway, as below:
Exposure: On each accrued failure, all party members are attacked.
Attack: Level + 5 vs Fortitude.
Special: On any successful attack, the target's stage of the disease increases by one.
Stage 0: The target recovers from the disease.
Stage 1: While affected by stage 1, the target loses 2 healing surges.
Stage 2: While affected by stage 2, the target loses a healing surge and takes a -2 penalty to AC, Fortitude, and Reflex.
Stage 3: While affected by stage 3, the target takes a -2 penalty to AC, Fortitude, and Reflex and cannot gain the benefits of an Extended Rest.
Check: At the end of each Extended Rest, the target makes an Endurance check if it is at stage 1 or 2. Stage 3 is removed by successful completion of the Exploration Skill Challenge or by the Cure Disease Ritual.
Lower than Easy DC: The stage of the disease increases by one.
Easy DC: No Change
Moderate DC: The stage of the disease decreases by one.
Special: The level of the disease equals the target’s level.
2. Expedition Role.
Just like establishing Marching Order in a dungeon is important so you know who will deal with what danger/complication, it is equally important to establish Expedition Roles in Exploration Skill Challenges. This will provide the players with agency and focus to determine how they specifically wish to be challenged when the GM derives complications/adversity as the fiction/challenge evolves. I find Dungeon World does a great job at breaking out the roles of an expedition in its Perilous Journey section (and the rules that interact with it). However, most D&D groups, due to their size, will require one more role. The roles I use are as follows:
- Trailblazer: Expedition leader, administrator, morale manager, organizer, final decision-maker.
- Scout: Reconnoiter, out-runner/rider, observer, seeker, surveyor.
- Quartermaster: Provisioner, supply manager, camp manager.
- Traveler: These folks are along for the ride but can sub in for another role as required.
3. Generating Thematic Complications.
Again, Dungeon World's advice on "Making Moves" is a good way for GMs to organize their thoughts and be prepared for what may come as the fiction emerges.
Dungeon World RPG Chapter 13: GM Moves, p 163 and 164
Moves
- Use a monster, danger, or location move
- Reveal an unwelcome truth
- Show sings of an approaching threat
- Deal damage
- Use up their resources
- Turn their move back on them
- Separate them
- Give an opportunity that fits a class' abilities
- Show a downside to their class, race, <tools/build/powers/equipment>
- Offer an opportunity, with or without cost
- Put someone in a spot
- Tell them the requirements or consequences and ask <a focused question>
Lots of great stuff there. One thing to remember is that "Use up their resources" and "Deal damage" basically means the same thing in a 4e Skill Challenge; tax the group 1 or more surges. Healing Surges are a wonderful open descriptor tool for Exploration Challenges. They can be anything from spoiled rations/lost provisions or supplies to the desperate morale hit of getting turned around, cresting a ridge to see an impassable gorge, getting terribly lost to an actual exposure event (starvation, frostbite, et al). Tax the PCs, the whole group, and do it with vigor.
Hazard attacks, encounters with hit and run predator packs, turning weather, stumbling upon a dangerous lair, geologic events, dangerous encounters with primitive natives, brutal accidents for an NPC they are escorting (eg a horrible fall that causes a broken leg), ominous weather conditions on the horizon or a terrible event that blows up from nowhere, environmental exposure (hypothermia, starvation), perhaps they are exposed to a 2nd concurrent disease (a true disease such as malaria or abyssal plague).
There are all manner of Exploration Trope-centric ways to complicate your players lives. Keep in mind their roles, consider source material (eg Heart of Darkness, Touching the Void, Alive, The Way Back) or famous expeditions, especially those who were unsuccessful (such as the Greely Expedition to the Arctic).
And don't forget Group Checks (typically Athletics, Endurance, Perception, Stealth) with half or more of the group passing being a success!