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Gaps in Palliative Care Education among Neonatology Fellowship Trainees.

ABSTRACT: Background: To provide proper care for infants at risk for death, neonatologists need expertise in many areas of palliative care. Although neonatology training programs have implemented a wide variety of palliative care educational programs, the impact of these programs on trainees' skills and effective communication regarding end-of-life issues remains unclear. Objective: To determine whether neonatology fellowship programs are providing formal palliative care education and assess whether this education is effective at increasing fellows' self-reported comfort with these important skills. Methods: An anonymous survey was sent to program directors (PDs) and fellows of ACGME accredited neonatology fellowship programs in the United States. Using a 5-point Likert scale, participants were asked about the palliative care education they received, and their comfort level with several key aspects of palliative care. Results: Twenty-four (26%) PDs and 66 (33%) fellows completed the survey. Fourteen PDs (58%) reported including palliative care education in their formal fellowship curriculum, whereas only 20 (30%) responding fellows reported receiving palliative care education. Of the responding fellows, most (80%) reported being uncomfortable or only somewhat comfortable with all assessed areas of palliative care. Fellows who received formal education were more comfortable than those without it in leading goals of care conversations (p = 0.001), breaking bad news (p = 0.048), discussing change in code status (p = 0.029), and grief and bereavement (p = 0.031). Conclusions: Most fellows report being uncomfortable or only somewhat comfortable with essential areas of palliative care. Formal palliative care education improves fellows' self-reported comfort with important aspects of end-of-life care. To promote a well-rounded neonatology fellowship curriculum, inclusion of formal palliative care education is recommended.

SUBMITTER: Wraight CL

PROVIDER: S-EPMC8675219 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background: Whether graduating pulmonary and critical care medicine (PCCM) fellows feel adequately trained in interstitial lung disease (ILD) remains unknown. In addition, there are no published data describing the current approach to educating trainees about ILD. Objective: To characterize the present state of ILD training during fellowship and to determine graduating PCCM fellows' perceived abilities to diagnose and manage ILD. Methods: We surveyed PCCM fellowship program directors nationwide and compared their perceptions of graduating fellows' abilities to diagnose, provide initial management to, and offer longitudinal care to patients with ILD using a series of unpaired t tests. We also inquired about existing practices for educating fellows about ILD. We then surveyed graduating PCCM fellows from 19 different preselected programs to assess comfort level with ILD in comparison with other core clinical domains. Results: Program director respondents (n = 74, 40% response rate) rated graduating fellows' abilities to establish specific ILD diagnoses and to provide initial management similarly (4.3 ± 0.8 on five-point Likert scale), whereas the ability to provide longitudinal expert care was rated significantly lower (3.8 ± 0.9, P = 0.001). Most respondents (n = 52, 70.3%) reported having dedicated outpatient ILD specialists with whom fellows could rotate, but only half required this rotation. In addition, very few (n = 17, 23.0%) reported that a majority of patients with suspected or newly diagnosed ILD were scheduled in fellow clinics, many of whom received subsequent longitudinal care from dedicated ILD specialists. Among 71 third-year fellow respondents, confidence in managing ILD was rated poorly (3.2 ± 1.0 on a five-point Likert scale) in contrast to more common diseases like chronic obstructive pulmonary disease (4.4 ± 0.7, P < 0.001) and asthma (4.2 ± 0.8, P < 0.001). Conclusion: Trainee exposure to ILD in both clinical and educational settings varied across PCCM fellowships nationwide. Fellows nearing graduation were significantly less confident in their ability to manage ILD compared with other more common pulmonary diseases.

Project description:BackgroundPeople living in rural and remote locations are disadvantaged in accessing palliative care. This can be attributed to several factors including the role diversity and the low numbers of patients with specific conditions, as well as the difficulties rural health practitioners have in accessing opportunities for professional education. A program of multidisciplinary palliative care video conferences was presented to health practitioners across part of northern Australia in an effort to address this problem.MethodThe educational content of the video conferences was developed from participant responses to an educational needs assessment. Following cycles of four consecutive video conferences, 101 participants completed evaluative on-line surveys. The quantitative data were analysed using frequencies and analysis of variance tests with post-hoc analyses where appropriate, and an accessibility and remoteness index was used to classify their practice location.ResultsAll participants found the content useful regardless of their remoteness from the tertiary centre, their years of experience caring for palliative care patients or the number of patients cared for each year. However, change in confidence to provide palliative care as a result of attending the video conferences was significant across all disciplines, regardless of location. Doctors, medical students and allied health professionals indicated the greatest change in confidence.ConclusionsThe provision of professional education about palliative care issues via multidisciplinary video conferencing increased confidence among rural health practitioners, by meeting their identified need for topic and context specific education. This technology also enhanced the networking opportunities between practitioners, providing an avenue of ongoing professional support necessary for maintaining the health workforce in rural and remote areas. However, more attention should be directed to the diverse educational needs of allied health professionals.

Project description:Background: Demographic change and the medical imperative to accompany patients at all times and also in the case of illness leading to death require good basic knowledge of palliative care in large parts of the medical profession. Palliative care has been introduced into undergraduate medical education as a compulsory subject: "interdisciplinary subject 13 palliative care" (Q13). While course concepts for Q13 have already been positively evaluated, assessment of the consolidation and practical relevance of the knowledge taught is lacking. Methods: Assessment of the consolidation of the learning content from Q13 after the practical year (the "practical year" is the sixth and final year of undergraduate medical education in Germany) by means of a survey with a proven questionnaire and integrated qualitative free-text analysis of a cohort of medical students (n=176) who had already participated in an evaluation before and after Q13. Results: The response rate was 96% after Q13 and 45% after the practical year (PY). Teaching was predominantly perceived as more helpful than the PY (p<0.001). Compared to the status after Q13, students rated themselves as less competent after the PY in all areas surveyed, including drug-based pain therapy (p=0.0386). The certainty in informing patients about the incurability of the disease also decreased significantly after the PY (p=0.0117), although the preparation in Q13 was positively highlighted. Conclusion: The knowledge acquired in Q13 could not be anchored in the PY. On the contrary, after initial practical experiences, the students found it challenging to conduct conversations in cases of serious illness and to deal with their own uncertainty in the care of seriously ill patients. Structural factors regarding palliative care in the PY, as well as intrinsic motives of students, such as prior knowledge or motivation to learn, should be analyzed to identify ways to close the gap between theoretical and practical training in general palliative care. To generate samples that are sufficiently representative, future studies on teaching should be easily accessible to students and consider attractive forms of evaluation including electronic methods and social media.

Project description:Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable. We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepatology fellows enrolled in accredited fellowship programs during the 2020-2021 academic year. We assessed the frequency of PC provision and comfort with physical and psychological symptom management, psychosocial care, communication skills, advance care planning, and end-of-life care. A total of 45 of 56 (79%) of transplant hepatology fellows responded to the survey; 50% (n = 22) were female. Most trained at centers performing over 100 transplants per year (67%, n = 29) distributed evenly across geographic regions. Most fellows (69%, n = 31) had a PC or hospice care rotation during residency, and 42% (n = 19) of fellows received education in PC during transplant hepatology fellowship. Fellows reported feeling moderately to very comfortable with communication skills such as breaking bad news (93%, n = 41) and leading family meetings (75%, n = 33), but nearly one-third (30%, n = 13) reported feeling not very or not at all comfortable assessing and managing anxiety and depression (30%, n = 13) and spiritual distress (34%, n = 15). Nearly one-quarter (22%, n = 10) had never discussed or documented advance care plans during fellowship. Fellows wished to receive future instruction on the assessment and management of physical symptoms (68%, n = 30) and anxiety and depression (64%, n = 28). Conclusion: Our survey highlights gaps in PC experience and education during transplant hepatology fellowship, lack of comfort in managing psychological distress and advance care planning, and desire to improve skills, particularly in symptom management. Future studies should investigate how to enhance transplant hepatology competencies in these PC domains and whether this impacts clinical care, advance care planning, or patient experience.

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Gaps in Palliative Care Education among Neonatology Fellowship Trainees.

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