(1109) Difficult Conversation Training for Pediatric Subspecialty Fellows

Introduction: Pediatric fellows often face challenging conversations with families, including delivering bad news, yet literature on pediatric fellowship curricula for these skills, particularly end-of-life (EOL) care, is limited. Communication education is crucial, and simulation training is a valuable tool. We hypothesize that a common simulation curriculum on difficult conversations and EOL care would benefit all fellows but may not fully meet the needs of pediatric critical care medicine (PCCM) fellows. Our goal was to gather feedback from fellows after the first institutional simulation session on these topics.

Methods: We integrated a simulation session into the common core curriculum for all pediatric subspecialty fellows at our institution, focusing on enhancing skills in difficult conversations. Fellows received reading materials outlining tools for disclosing difficult news two weeks prior. The session included a brief didactic on techniques, followed by simulations of disclosing bad news and goals of care conversations with standardized patients, ending with a debrief. A survey was sent to assess satisfaction and gather feedback for ongoing curriculum development.

Results: With a 53% response rate, feedback was evenly distributed across specialties. Most fellows (88%) had prior training in delivering bad news/EOL conversations, mainly through medical school (56%) and residency (31%), typically via lectures or simulation. Simulation-based training was preferred. Despite 95% of fellows recognizing its importance, only 25% of fellowship programs offer such curricula. Barriers include lack of structured programs and discomfort with EOL topics. Half of the general attendees found it helpful and preferred specialty-specific scenarios, while all PCCM fellows found the sessions beneficial and requested additional specialty-specific scenarios.

Conclusions: This survey indicates a need for a dedicated EOL/difficult conversations curriculum for pediatric fellows, with simulation-based training preferred. While incorporating such training in the common core curriculum is beneficial, it may not address all specialty specific needs, especially for PCCM fellows who may require more specialized training due to the nature of their field. Further research is needed to optimize EOL/difficult conversation training.