Self-assessment for competency and educational needs among pediatric resident on end-of-life care

Self-assessment for competency and educational needs among pediatric resident on end-of-life care

Phung B; Soliman A; Mohamed A

Psycho-oncology

2017

Education; Resident; Terminal Care; 8002-76-4 (opiate); 8008-60-4 (opiate); 53663-61-9 (opiate); Adjuvant; Aged; Child; Clinical Study; Comfort; Communication Skill; Delirium; Drug Withdrawal; Dyspnea; Feeding; Hospice; Human; Hydration; Opiate; Patient Referral; Symptom; Unclassified Drug; Very Elderly

Purpose: There is lack of standardized resident' curriculum or training for the rapidly emerging field of pediatric end of life care. Goal: To assess pediatric residents' perception of their clinical competence with end of life care and their education needs. To identify an opportunity for improving residents' education and training. Methods: End of life resident assessment survey published by D Weissman was used for evaluation. The survey is divided into 2 domains: clinical competency and education needs. Each domain is subdivided into communication skills and symptom management section. Results: Twenty pediatric residents returned the survey, 8 PGY1, 4 PGY2, and 8 PGY3. PGY1 reported the lowest average score (2.56 of 4), with improving score as we moved to PGY3 (3.1 of 4). Regarding competence with domain of communication skills, they reported significantly lower average score 58% compared to 69% for symptoms management (P < .5). The lowest percentage score among all residents was in discussing home hospice referral 52%, followed by the shift from curative to comfort care and withdrawal of support 54%, then DNR 55%. They felt more competent in giving bad news 72% and best in talking to children in age appropriate manner 91%. This was supported by the high percentage (83%) request of education in those areas. For the symptom management domain, the lowest percentage score among all residents was in management of terminal delirium (40%), followed by terminal dyspnea (48%), using adjuvant analgesics (68%) while they felt comfortable with using opioid analgesic (85%). The highest requested education was for the areas of managing delirium (82%) and dyspnea (81%), followed by hydration and feeding at end of life (68%). Conclusions: There is a major gap in the resident self-assessment in end of life communication skills and symptoms management. This present an improvement opportunity that can translate into better care for children at end of life.

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