Introduction of a Pediatric Palliative Care Curriculum for Pediatric Residents

Abstract

The Pediatric Palliative Care Curriculum (PPCC) was introduced as a pilot study in response to the published need for increased pediatric education in end-of-life (EOL) care. The PPCC was designed to better train residents in EOL issues so they could become more comfortable and knowledgeable in caring for children and adolescents with life-threatening illnesses. The PPCC consisted of six hour-long sessions run by a clinical psychologist, a licensed social worker, and faculty with experience in EOL care. The curriculum repeated every 6 weeks for 1 year. Residents in the training program at Stanford University rotating through oncology, pulmonology, and pediatric intensive care unit (PICU) were invited to attend. Session topics included: (1) personal coping skills, (2) being a caring professional, (3) recognizing cultural and familial differences, (4) pain management, (5) practical issues, and (6) meeting a bereaved parent. Pretest and posttest surveys with five-point Likert scale questions were used to measure curricular impact. Statistically significant improvement was found in resident self-report of: feeling prepared to initiate do-not-resuscitate discussions (p </= 0.001), access to nonpharmacologic pain resources (p </= 0.005), exposure to role models who balance medical professionalism and expression of grief (p </= 0.005), ability to address dying patient anxiety (p </= 0.01), administer pain medications (p </= 0.01), initiate organ donation discussions (p </= 0.05), and discuss transition from curative to palliative care (p </= 0.05). Survey ratings for the following topics were unchanged: "expression of grief is unprofessional" and "residency stress prohibits the processing of and coping with grief." Pediatric residents who participated in this pilot study felt they learned important skills in pediatric EOL care and enhanced their confidence in their ability to care for dying patients and their families. Interventions like the PPCC may be useful at other institutions and aid in the transition to competency-based training.