Planning for the Evaluation of a Pediatric End-of-Life Curriculum

Abstract

Decision making at the end of life can be complex and emotionally challenging for healthcare providers, particularly in pediatrics. Unfortunately, few undergraduate and graduate medical education curricula adequately address these issues. In this article, we describe the plan and progress to date of the design, implementation, and evaluation of an end-of- life curriculum for pediatric residents. Prior to the development of a formal end-of-life curriculum, a survey was given to a single cohort of residents four times over the course of their training to assess their attitudes toward end-of-life issues and their experience with the informal curriculum in residency. Entering pediatric residents felt relatively uncomfortable dealing with death and dying, but by the end of training, residents felt more comfortable dealing with these issues. Residents were relatively ambivalent about the degree to which their education helped them to deal with end-of-life issues. A number of curricular interventions were developed including a noon conference series, grand rounds presentations, a 3-hour seminar on giving bad news, and written information for the housestaff manual. The curriculum was implemented in the fall of 1999. The impact of the curriculum will be assessed using a single interventional group with historical control study design. The evaluation instruments will include the previously used survey and an objective written examination. The 3-hour seminar will be assessed with a pre-test post-test crossover design using standardized patients. This rigorous, feasible, and cost-effective approach to curriculum development is intended to serve as a model for end-of-life education in pediatric residencies.