Improving training in palliative care for pediatric fellows e a simulation-based multi-institution trial

Abstract

Objectives * Describe different methods of palliative care education, including simulation-based education and didactic education. * Delineate differences between pediatric fellow self-assessment data and external reviewer data of fellow performance. * Describe how a simulation-based curriculum can lead to changes in palliative care consultation at an institution. Original Research Background. Although palliative care (PC) skills can be learned “on the job,” pediatric trainees have few opportunities and often receive no formal PC education. Research Objectives. (1) To assess whether simulation- based or didactic education is a more effective method for teaching PC communication. (2) To assess competence over time. (3) To determine if PC consultation rates would increase after simulation-based education. Methods. (1) 35 pediatric fellows from cardiology, critical care, oncology and neonatology at two institutions enrolled 17 in the intervention group (IG) and 18 in the control group (CG). IG fellows participated in a 2- day intervention over three months consisting of three simulation scenarios with debriefing and a videotaped PC lecture. CG fellows received written PC education designed to be similar in content and time. Assessments were measured at baseline, post-intervention and at three months; mean differences for each outcomemeasure were assessed. (2) External reviewers rated IG encounters on nine communication competencies. Changes over time were assessed. (3) PC consultations from the IG institution’s four departments were compared in the six months pre- and post-intervention, normalized to inpatient admissions and hospital days. Results. Over three months, IG fellows significantly improved in self-efficacy (p=0.003) and perceived adequacy of medical education (p<0.001), but not knowledge (p=0.20) when compared to CG fellows. External reviewers noted improvement in three competencies (relationship building (p=0.04), opening discussion (p=0.01), gathering information (p=0.01)). There was a 65% increase in PC consultation rate, but no difference when normalized to inpatient admissions or hospital days (OR 1.5, 95% CI 0.9-2.5 for both). IG fellows more strongly agreed that they would use (p=0.04) and recommended (p=0.004).the education. Conclusion. Our simulation-based curriculum is an effective method for teaching PC communication to pediatric fellows compared with a didactic education model. Implications for Research, Policy or Practice. Such curriculum can be adapted for other pediatric trainees, and should be incorporated into fellowship training.