P2A093: Delivering Serious News in Pediatric Cardiology – a Pilot Program

Background: Pediatric cardiology fellows receive limited formal training on delivering serious news. Delivering serious news has been shown as a teachable skill in pediatric trainees with simulation-based communication as a primary educational intervention. While there have been publications showing the use of communication courses in multiple fields in pediatrics, there have been no studies in pediatric cardiology trainees. Pediatric cardiologists recognize the importance of good communication and desire further development of these skills. We hypothesize that a formal training course will improve pediatric cardiology trainee perceptions on skill and preparedness for delivering serious news.

Methods: A four-hour simulation course for pediatric cardiology trainees using an evidence-based structured method to teach delivering serious news (VitalTalk) was designed. Based on an internal needs assessment, three cases were developed to address common, challenging pediatric cardiology scenarios; fetal diagnosis of hypoplastic left heart syndrome, new diagnosis of hypertrophic cardiomyopathy in a teenager, and Fontan failure in a young adult. An initial training session was completed to familiarize the actors with the cases. The course then consisted of a didactic session with a case demonstration, followed by small group case-based simulations where simulated actors portrayed families. Trained faculty facilitators provided feedback to trainees on interactions with families. A standardized pre- and post-course survey was developed and administered to trainees to assess perception of skill and preparedness. Paired survey responses were compared using McNemar’s test.

Results: Six pediatric cardiology fellows participated in the course, including fellows from all training levels. Only 33% of participants had received formal training in delivering serious news and 17% in techniques of responding to emotion. All participants endorsed encountering barriers to delivering serious news. The proportion of participants who felt good or very good about their ability to deliver serious news and ability to deal with family’s emotions increased from 0% to 83%. The proportion of participants who felt well or very well prepared to provide serious news about a patient’s illness increased from 17% to 67%. However, given the small number of participants, these changes were not statistically significant. All participants felt that this course was valuable in improving communication skills and additional training in delivering serious news would be beneficial.

Conclusion: Pediatric cardiology fellows have little formal training in delivering serious news. A simulated communication course increased perception of skill and preparedness among trainees. By improving trainee preparedness, we hope that families will feel more satisfied with these discussions. We provide an evidence-based communication framework for delivering serious news in pediatric cardiology, including didactic content and cases. We look forward to sharing this content with other training programs nationally to help pilot similar educational courses.