P3.I171: Impact of Palliative care educational curriculum on Neonatal-Perinatal Fellows' comfort level and communication skills

Background: Neonatal-perinatal Medicine (NPM) is a pediatric specialty in which patients have a higher risk of death and morbidity compared to rest of the pediatric population. Palliative care (PC) plays vital role in Neonatal Perinatal Medicine (NPM). Despite this, most NPM fellowship programs in the United States do not have standardized curriculum. As a result, fellows have decreased exposure to palliative care training and there is an increased need to improve skills and comfort with difficult conversations.

Methods: In order to implement PC education in NPM training, we designed a structured PC curriculum focusing on NPM fellows at a single center which incorporated 4 Didactic lectures, and 11 simulation cases over 2-years. To assess comfort level of fellows, pre and post-curriculum self-assessed comfort (SAC) surveys were completed. A yearly simulation-based Communication skills assessment Tests (CSAT) were conducted. An evaluation were completed by self, mock patient, and two faculty using a novel 13-question scoring tool. Each question was score from 0-2 with maximum cumulative score of 26

Results: 11 fellows completed the training. 19 SAC surveys and 54 CSAT evaluations were completed. SAC score improved by 21% (pre=24.55, post=31.13, p=0.012) pre and post-curriculum. In the survey, fellows claimed increased instances of active participation in communication with families specifically for code status discussion (0.82 vs 1.14, p=0.02) and for Hospice care conversations (0.45 vs 0.75, p= 0.04). CSAT scores between fellows improved with increasing level of training. (PGY4=19.37, PGY 5=19.12, PGY 6=22.19, p=0.05) and cumulative CSAT score improved by 16% (18.85 vs 22.72, p=0.01) between first attempt and second attempt. No significant difference was noticed in the CSAT scores based on the type of evaluator scoring the test.

Conclusion: Palliative care training is a vital education necessary for Neonatal-Perinatal fellows. Incorporation of a standardized curriculum can improve the comfort level and skills of NPM fellows to have difficult conversations with families.