O0435 Oct.5: 2:31pm - Delivering Difficult News during PICU Bootcamp: A Novel and Effective Implementation of the Resilience Curriculum

Background: Delivering difficult news to patients and families is an essential but challenging component of clinical practice. Pediatric critical care medicine (PCCM) fellows do not report being comfortable giving difficult news to patients and families.

Objective: We sought to implement and evaluate a national program for training first year PCCM fellows to deliver difficult news.

Methods: The American Academy of Pediatrics Resilience Curriculum (Part B) was used to teach PCCM fellows the SPIKES (Set-up, Perception, Invitation, Knowledge, Empathy, and Summary) framework with didactics, faculty role modeling, and role play with faculty mentoring. This curriculum was incorporated into all three Pediatric Intensive Care Unit (PICU) Regional Bootcamps for first year fellows, a multi-day simulation preparatory course at the start of fellowship. Pre- and post-test surveys assessed self-efficacy in delivering difficult information and were analyzed using the Student's t-test.

Results: 130 PCCM fellows from across the country participated in the curriculum during the three PICU Regional Bootcamps. 108 fellows completed the survey, which was scored on 5-point Likert scale. The participants reported improved self-efficacy in the domains of knowledge, confidence, and comfort. Their knowledge increased from a mean of 3.5/5 to 4.1, confidence rose from 3.3 to 3.9, and comfort improved from 3.2 to 3.8 (Figure 1, all P<0.001). The fellows also reported increases in the skill categories of displaying empathy, conversation skills, and managing emotions, with the largest gain in managing emotions from a mean of 2.9 to 3.7 (Figure 2, all P<0.001).

Conclusions: Pediatric critical care medicine fellows participating in the AAP Resilience Curriculum demonstrated significant improvements in their self-efficacy to deliver difficult news to patients and families. A “Bootcamp”-style venue was ideal for implementation of this curriculum, given the ratio of faculty to fellows and the trainee expectation for suspended disbelief and challenging scenarios.