We provide a curriculum for teaching pediatric fellows in critical care, cardiology, hematology/oncology, and neonatology about palliative care, end-of-life care, high-stakes communication, and pain and symptom management. This involves three simulated scenarios with debriefing for each group of fellows and a videotaped palliative care lecture. The resource also includes questionnaires, developed and assessed for reliability and validity that can be used to measure the effectiveness of the curriculum. An external rater training guide is also included so that reviewers of the fellows' videos have criteria with which to measure the fellows' progress and performance. Groups were similar at baseline for demographics, subspecialty, PGY status, and prior palliative care, end-of-life, and patient death experiences Over three months, the intervention (simulation) group significantly improved in self-efficacy (16.4 vs 6.1, Δ 10.3, p = .003) and perceived adequacy of medical education (7.4 vs 0.4, Δ 7.1, p < .001), but not in knowledge (1.1 vs 1.8, Δ -0.7, p = .20). We hypothesized that fellows would peak at the end of day 1 but lose skills over time. However, we saw that skills learned in the intervention group persisted at three months. Compared to the control group, intervention group fellows more strongly agreed that the education was useful (p = .02), would be used in clinical practice (p = .04), and recommended the education (p = .004).
By the end of the curriculum, learners will be able to:
- Develop a strategy for communicating with families during difficult conversations (fellows will experiment with these phrases and techniques during the simulations).
- Demonstrate increased comfort during palliative care and end-of-life conversations.
- Identify deficits in knowledge about palliative care and end-of-life symptom management.
- Correctly answer knowledge questions about different aspects of palliative care and end-of-life symptom management.
None to report.
This work was conducted with support from a KL2 Mentored Career Development Award of the Stanford Clinical and Translational Science Award (CTSA) to Spectrum (NIH KL2 TR 001083), Lucile Packard Foundation for Children’s Health, Child Health Research Institute Innovations in Patient Care Grant, Stanford CTSA (UL1 TR001085), and the Rathmann Family Foundation Educators-4-CARE (E4C) Medical Education Fellowship in Patient-Centered Care awarded to Katharine Brock, principal investigator.
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