Commentary by Megan Doherty, MD, FRCPC, Fellowship in Palliative Medicine, Children’s Hospital of Eastern Ontario and Roger Neilson House, Palliative Care Team, Pediatric Program Director, Two Worlds Cancer Collaboration Foundation
Feature Article: Weaver, M. S., & Wichman, C. (2018). Implementation of a Competency-Based, Interdisciplinary Pediatric Palliative Care Curriculum Using Content and Format Preferred by Pediatric Residents. Children (Basel), 5(12).
Other Articles Referenced: Moody, K., McHugh, M., Baker, R., Cohen, H., Pinto, P., Deutsch, S., Santizo, R. O., Schechter, M., Fausto, J., & Joo, P. (2017). Providing Pediatric Palliative Care Education Using Problem-Based Learning. Journal of Palliative Medicine.
It is excellent to find this article which provides a clear description how to implement a competency-focused palliative care curriculum for pediatric residents.
In this article, the authors describe how they developed and implemented a palliative care education curriculum for pediatric residents. The curriculum was developing through a participatory approach to which involved residents in the development of the monthly sessions, through prioritization and strategizing around key palliative care competencies. This led to the development of a series of monthly 1 hour “Pal Care Power Hour” sessions which incorporated case examples, teaching and group discussion. This suggests a simple format which many pediatric palliative care teams could incorporate into their teaching activities. The authors provide a description of the topics covered in the Pal Care Power Hours sessions (Appendix A) which can serve a useful guide to possible topics to be incorporated into similar training programs for pediatric residency programs in Canada.
Many pediatric palliative care programs are located at tertiary Children’s Hospitals where pediatric residents are trained, but programs may not be able to accommodate all residents for a clinical rotation, due to limitations in the size of their clinical service. The described format of monthly teaching session offers a relatively simple way to provide training on palliative care for all pediatric residents. This format may have the additional benefits of complementing existing clinical exposure for residents and raising awareness among other clinical staff.
Recently, competency-based medical education (CBME) has become an important consideration among medical educators in Canada, with the planned transition to this model of education for all post-graduate training programs in the next 5 years. Thus there is a growing interest among educators about how the competency-based model can be incorporated into training in the field of palliative medicine. This article illustrates several practical ways of incorporating palliative medicine competencies into pediatric residency training.
The authors choose to highlight Social Cognitive Theory, which can guide the development of educational initiatives where behavioural changes are desired, in this case emphasizing increasing resident competency in palliative medicine, not simply knowledge acquisition.
In the article, the authors describe how Social Cognitive Theory suggests that for competency to develop, residents must intend “to incorporate palliative care principles into patient care”. To assess the effect of the training program on this, residents completed pre- and post-surveys, which included questions about attitudes towards their own skill in palliative care, including confidence and self-efficacy. These attitudes increased significantly on the post-palliative care curriculum survey.
Another component of Social Cognitive Theory, which the authors describe, is Situation – the perceptions of residents that there are opportunities to “integrate palliative care into patient care”. In the same survey, residents were asked to rate their perceptions of the medical community in supporting their efforts to apply palliative care principles and offering opportunities to integrate palliative care. Residents were also asked to rate their perceptions of the environment receptivity to palliative care (Figure 2). Their ratings of these supports also improved on post-surveys, when compare to the pre-curriculum survey.
The development of the “Pal Care Power Hour” with real life case discussions is an example competency-based medical education. The use of real case discussions was highly rated by the residents who participated in this program, highlighting the value of developing training which encourages application of palliative care principles in patient care. This article complements another recent study by Moody et al, which describes the effects of a pediatric palliative care problem-based learning (PBL) module on knowledge, attitudes and self-assessed competency for medical students. Clearly efforts to incorporate competency-based palliative care training into medical education are needed at both the under-graduate and post-graduate level and these recent publications are early steps in developing the evidence base in this area.