Development and Evaluation of a Child Neurology Resident Curriculum for Communication Around Serious Illness
Child; article; human; quality of life; ethics; palliative therapy; physician; clinical article; disability; Only Child; communication skill; resident; human experiment; Neurology; training; neurology; curriculum; evaluation study; residency education
Background: Communication around serious illness is a core competency for all residencies. One-fifth of neurology residencies have no curriculum. Published curricula use didactics or role-play to assess confidence performing this skill without evaluation in clinical settings. The SPIKES mnemonic (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary) outlines 6 evidence-based steps for communication around serious illness. It is unknown whether child neurology residents can incorporate SPIKES into communication around serious illness in clinical settings. Objective(s): To develop and evaluate a curriculum on communication around serious illness using SPIKES for child neurology residents that shows long-term skill retention in clinical settings at a single institution. Method(s): In 2019, we created a pre-post survey and skills checklist based on SPIKES, with 20 total including 10 core skills. Faculty observed residents' (n = 7) communication with families and completed both preintervention and postintervention checklists for comparison. Residents underwent training in SPIKES during a 2-hour session using didactic and coached role-play. Result(s): All (n = 7) residents completed preintervention surveys, 4 of 6 completed postintervention. All (n = 6) participated in the training session. Following the training, 75% of residents reported improved confidence in use of SPIKES, though 50% were still unsure about appropriately responding to emotions. There was improvement in all SPIKES skills, with significant improvement in 6 of 20 skills up to 1 year following training. Conclusion(s): This is the first evaluation of the implementation of a communication around serious illness curriculum for child neurology residents. We identified improved comfort with SPIKES after training. Successful acquisition and utilization of this framework in our program suggests it could be incorporated into any residency program.Copyright © The Author(s) 2023.
Martin JA; Sampey F; Feldman A; Silveira L; Press CA; Messer R; Barry M; Kaul P
Journal of Child Neurology
2023
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/08830738231172539" target="_blank" rel="noreferrer noopener">10.1177/08830738231172539</a>
Core Curricular Priorities in the Care of Children With Medical Complexity: A North American Modified Delphi Study
children with medical complexity; complex care; curriculum development; pediatrics; postgraduate medical education; residency education
Background: Previous studies of pediatric residents have identified educational gaps in caring for children with medical complexity. Training opportunities in complex care vary across residency programs. Defining core curricular topics in complex care is a priority in medical education. Objective(s): To identify core topics to include in a standard complex care curriculum for pediatric residents. Method(s): An initial topic list was generated through literature review and proceedings of national meetings. Expert panelists were identified based on experience in complex care and residency education. A modified Delphi method was used to determine group consensus by asking participants to rate the importance of complex care curricular topics for pediatric residents. Consensus was defined as >70% of experts identifying a topic as essential. There was a predetermined maximum of 3 iterative, electronic survey rounds, with feedback provided to participants between each round. Result(s): Sixteen experts participated. Response rate was 100% for all rounds. Experts were from the United States (44%) and Canada (56%); most were affiliated with an academic medical center (96%) involved in both inpatient and outpatient care (69%). Eleven topics were identified as essential across 3 rounds: feeding difficulties, pain/irritability, transition, feeding tube management, difficult discussions, team management/care coordination, dysmotility, aspiration, safety/emergency planning, neuromuscular/skeletal issues, and advocacy. Essential topics were organized according to the International Classification of Functioning, Disability and Health. Conclusion(s): Eleven curricular priorities in complex care were identified across multiple domains of the International Classification of Functioning, Disability and Health framework, serving as a guide for standardized curriculum development for future pediatricians. Copyright © 2020 Academic Pediatric Association
Huth K; Newman L; Glader L
Academic Pediatrics
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.acap.2020.01.014" target="_blank" rel="noreferrer noopener">10.1016/j.acap.2020.01.014</a>
Evaluation of residents' level of comfort with palliative care concepts before and after
child; comfort; conference abstract; controlled study; hospice; human; life; nomenclature; nurse practitioner; palliative therapy; patient care; pediatric hospital; residency education; skill; tertiary health care; total quality management
Introduction The specialty of Pediatric Palliative care and Hospice is growing exponentially, however, residency training programs are often underprepared to meet the evolving educational needs of their trainees with regards to the field. While Pediatric Advance Care Teams (PACT) have been established at many children's hospitals, they are frequently in different stages of development. Residents are often at the forefront of patient care, and may find themselves in difficult end-of-life situations requiring skills not formally taught in their training. As PACT teams grow into their roles at various children's hospitals, residents will continue to be challenged by unfamiliar and unique situations, resulting in a need to educate residents in palliative care. Methods The objective of the quality improvement project was to evaluate residents' understanding of several concepts of palliative care, develop an educational intervention, and to reevaluate resident understanding following this intervention. Goal improvement was 40% over 2 months. 91 pediatric residents of a single program associated with a tertiary care pediatric hospital were invited to participate in the survey. The pretest survey addressed residents' level of comfort of 5 concepts in palliative care on a scale from 1 (least) to 10 (most). The pretest evaluated comfort describing palliative care terminology, comfort discussing concepts with family, and their ability to identify the roles for residents and PACT. After collection, a conference was prepared by the investigators in collaboration with the PACT team physician and nurse practitioner to ensure consistency within the institution. The conference was designed to address knowledge gaps revealed by the survey. Audio and visuals were recorded and made accessible online for all residents. Following the conference, a document was distributed to the residents, addressing the educational needs concerning palliative care, as well as scholarly links to numerous AAP resources on palliative care. A post intervention survey identical to the pretest was then administered. Results 55 residents responded to the pretest survey, with 16 responding post intervention. Pretest mean scores were calculated from the 5 questions, with an average score of 5.68 of a possible 10. Post test mean scores were averaged with result of 7.60 of a possible 10. Post test intervention mean scores showed an increase of 34% from baseline. Conclusion These results show that after intervention, there is a significant increase in residents' level of comfort regarding understanding of basic concepts of palliative care. With educational materials which concisely address the needs determined by initial evaluation, we were able to effectively engage the residents through both audio and visual means to achieve an appreciable and replicable intervention for educating residents in palliative care. Moving forward, we will focus on continuing educational and clinical opportunities for residents in collaboration with the growth of the PACT team.
Pohl C E
Pediatrics
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Communicating death and dying through simulation: A project with pediatric residents
acute disease; child; clergy; comfort; communication skill; conference abstract; conversation; curriculum; emergency treatment; human; Likert scale; pain; palliative therapy; residency education; resident; simulation; teaching; terminal care
Program Goals Pediatric residentscare for a wide spectrum of children with acute and chronic disease processes. They are often the first to communicate with families, yet receive little formal training in conveying difficult information. In 2014, during this author's chief resident academic year, many residents expressed feelings of frustration and inadequacy when caring for children at end-of-life, and also reported a lack of opportunities to process their patients' deaths. To address these needs, we partnered with an interdisciplinary team to create an end-of-life communications-based curriculum that was integrated into our existing resident simulation program. We aimed to provide communication opportunities for our residents in a safe, structured, and directly observed environment where they could practice communication skills and reflect on their experiences. We hypothesized that residents would value these simulations as part of their residency training, and would feel more comfortable communicating difficult news after practicing such skills. Evaluation The end-of-life simulation curriculum was developed by an interdisciplinary team of ICU and hospitalist physicians, pediatric palliative care professionals, child life specialists, and hospital chaplains. Over two years, all residents participated in simulations that focused on communicating with parents (standardized actors) in pediatric death and dying situations. Three pausing points were included during the simulation, offering residents the unique opportunity to discuss together how best to approach the next conversation with the standardized parent-actor. Following the simulations, the interdisciplinary team debriefed with the residents, allowing opportunity for reflection and addressing questions and concerns. After each simulation/debriefing cycle, educational resources were provided through an electronic teaching file, as well as opportunities to meet oneon- one with members of the interdisciplinary team for further processing. Pre-tests and post-tests were used to evaluate residents comfort with end-of-life communication and pediatric palliative care provision. A 5-point Likert scale was used to evaluate residents' level of comfort with a variety of skills/topics, including: discussing end-of-life care options with parents, limiting emergency treatment, managing pain/symptoms, pronouncing death, and coping with one's own responses to a child's death. Discussion Pediatric residents feel unprepared to communicate with families in end-of-life situations. Through this innovated simulation curriculum, we have been able to better understand the needs of our resident trainees and by providing exposure to these complex situations in a safe, empowering environment. Following our first year of data collection, we found that 92% of residents reported feeling more comfortable communicating with families in end-of-life situations after participating in a two hour simulation. The residents reported benefitting from these experiences; 100% of residents requested additional training in palliative care. We anticipate having second cycle data available for presentation in Fall, 2016 to further demonstrate the how this innovative simulation enhances pediatric resident education.
Greening H G; Havalad V; Kobler K
Pediatrics
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).