Pediatric palliative care training in fellowship: A national survey of adult palliative medicine fellowship directors and pediatric rotation directors

Abstract

Objectives * Outline the current state of education and clinical training of adult hospice and palliative medicine (HPM) fellows in pediatric palliative care (PPC). * Compare responses between adult HPM fellowship and pediatric rotation directors regarding the future of PPC education and training. Original Research Background. With only seven pediatric palliative care (PPC) programs in the country, there is a lack of PPC physicians. Large numbers of pediatric patients are cared for by palliative physicians trained in adult fellowships. Adult HPM fellowships require pediatric training, but little is known about what is taught and what educators’ thoughts are about this training. Research Objective. To describe adult HPM fellows’ clinical and educational exposure to PPC. Methods. An electronic survey was sent to adult HPM fellowship directors and their respective pediatric rotation directors. The survey elicited information about PPC learning objectives, didactics, and fellows’ PPC clinical experience. Finally, directors’ attitudes about the current and future state of PPC training was surveyed. Data was de-identified, and descriptive statistics, Chi-square, and sample t tests were analyzed. Results. 41 of 98 adult HPM fellowship directors and 36 of 80 pediatric rotation directors responded (response rates 42% and 45%, respectively). Most programs indicated their fellows spend time observing PPC teams manage symptom and communication issues rather than independently managing patients with supervision. For example, only 9 of 36 programs allowed adult fellows to independently convert opioids with supervision. Fellowship and pediatric rotation directors felt somewhat (46%) or very (17%) uncomfortable with adult HPM fellows practicing PPC. Fellowship and pediatric rotation directors disagreed about whether they would be likely to develop a pediatric track within their programs (p=0.04). Conclusion. Most adult HPM fellows are observing PPC teams rather than learning to independently manage patients. Both groups of respondents indicated discomfort with adult HPM fellows practicing PPC. Implications for Research, Policy or Practice. This study highlights that pediatrics rotations need restructuring or elimination from adult HPM fellowships, and questions whether training efforts should be redirected towards pediatricians and pediatric subspecialists to fill the void of PPC physicians rather than development of pediatric tracks.