Pediatric Residents' and Fellows' Perspectives on Palliative Care Education

Abstract

Background The American Academy of Pediatrics recommends that pediatricians become knowledgeable in and comfortable with providing palliative care. Objective The study goals included: determining the extent of training, knowledge, experience, comfort and competence in palliative care communication and symptom management of pediatric residents and fellows; obtaining residents’ and fellows’ views on key palliative care concepts; identifying topics and methods for palliative care education; and identifying differences in responses between residents and fellows. Design/Methods In academic year 2006–2007 pediatrics residents and fellows completed a survey on: training, experience, knowledge, competence, and comfort in delivering palliative care; palliative care practices; and suggestions for delivering palliative care education. Results Fifty-two (60%) and 44 (62%) residents and fellows respectively completed the survey. Residents and fellows described none to moderate levels of training, experience, knowledge, competence and comfort in palliative care. Most respondents said they would benefit from more formal palliative care training. Respondents identified discussing prognosis, delivering bad news, and pain control as the three most important areas of needed education. Learning about supporting families spiritually and emotional support for physicians were among the least important educational areas identified. Respondents recommended delivering education via observation, bedside teaching, and participation in multidisciplinary groups. Conclusions Efforts to improve education in pediatric palliative care are needed. A palliative care team could facilitate palliative care education through engaging trainees in “real-life” interactions. The role of physicians in providing spiritual support and the need for educating physicians in obtaining emotional support for themselves merit further investigation.

Reliability and Validity of the Pediatric Palliative Care Questionnaire for Measuring Self-Efficacy, Knowledge, and Adequacy of Prior Medical Education among Pediatric Fellows

“…Compared to other studies, these results are likely an accurate reflection of the comfort level of fellows and the palliative care education that has been provided-in terms of hours and type of education, and the number of patients who die who are cared for by pediatric residents and fellows. 4,[6][7][8][9][10] There are several limitations to this study. Selection bias could play a part in fellows that completed the survey, and hence we would exercise caution when citing these results to make generalizations about the state of palliative care education in pediatric residencies and fellowships.…”

“…Despite these recommendations, pediatricians and pediatric specialists lack training in palliative care and difficult conversations, [2][3][4][5] lack the skills required to care for these patients, 6 and in comparison to internal medicine trainees, care for fewer patients who die during their training. 4,7 Surveys of pediatric residents have found ''minimal training, experience, knowledge, competence, and comfort in virtually all areas of palliative care for children.''…”

“…4,7 Surveys of pediatric residents have found ''minimal training, experience, knowledge, competence, and comfort in virtually all areas of palliative care for children.'' While the majority of trainees and program directors feel that more palliative care education is desired and needed, most fellowship programs still lack formalized palliative care education.…”

A Resident’s View of Pediatric Palliative Care

“…Despite this, research shows that pediatric residents largely feel unprepared when faced with the palliative care needs of their patients. 3 The skills residents acquire through palliative medicine exposure include symptom management, complex care coordination, and addressing the core values of a patient and family. These principles are certainly applicable to the various situations that trainees and graduates eventually find themselves in.…”

Learning to Care at the End

“…need to become familiar and comfortable with the provision of palliative care to children." 3 With more than 50 000 children dying in the United States each year, and more than 500 000 facing life-threatening conditions, 4 every pediatrics resident will likely care for children who are severely or terminally ill. 4 However, most residents receive inadequate training in critical palliative care principles, such as assessing patients' and families' goals or introducing hospice as an alternative to curative therapy. 5,6 Program directors agree; less than 40% feel that graduating residents are competent in this field.…”