Pediatric End-of-Life Care Skills Workshop: A novel, deliberate practice approach

Published:November 18, 2022DOI:



      Pediatric end of life (EOL) care skills are a high acuity, low occurrence skill set required by pediatric clinicians. Gaps in education and competence for this specialized care can lead to suboptimal patient care and clinician distress when caring for dying patients and their families.


      A half-day workshop using a deliberate practice approach was designed by an inter-professional workgroup including bereaved parent consultants. Pediatric fellows (neonatal-perinatal medicine, critical care, hematology oncology, blood and marrow transplant) and advanced practice providers learned and practiced EOL skills in a safe simulation environment with instruction from interprofessional facilitators and standardized patients. Participant perceived competence (self-efficacy) was measured before, immediately-post, and 3 months post workshop.


      There were 28 first-time (of 34 total) participants in 4 pilot workshops. Participants reported significantly increased self-efficacy post-workshop for 6 of 9 ratings, which was sustained 3 months afterwards. Most (92%, n=22 of 24 respondents) reported incorporating the workshop training into clinical practice at 3-month follow-up.


      With early success of the pilot workshops, future iterative work includes expanding workshops to earlier, interprofessional learners and collecting validity evidence for a competency-based performance checklist tool. A project website ( was developed for local and collaborative efforts.

      Pediatric End of Life Care Skills Workgroup. Accessed November 30, 2021,


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Pediatric End of Life Care Skills Workgroup. Accessed November 30, 2021,

        • Connor SR
        • Downing J
        • Marston J.
        Estimating the Global Need for Palliative Care for Children: A Cross-sectional Analysis.
        J Pain Symptom Manage. Feb 2017; 53 (J Pain Symptom Manage): 171-177
      2. CDC Wonder. Centers for Disease Control and Prevention. Accessed April 2021,

      3. Institute of Medicine Committee on P, End-of-Life Care for C, Their F. In: Field MJ, Behrman RE, eds. When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. National Academies Press (US)

      4. Copyright 2003 by the National Academy of Sciences.
        All rights reserved. 2003;
        • Singh AL
        • Klick JC
        • McCracken CE
        • Hebbar KB.
        Evaluating Hospice and Palliative Medicine Education in Pediatric Training Programs.
        Am J Hosp Palliat Care. Aug 2017; 34: 603-610
      5. Henner N, Boss RD. Neonatologist training in communication and palliative care. Semin Perinatol. Mar 2017;41(2):106-110. doi:10.1053/j.semperi.2016.11.003

        • Odeniyi F
        • Nathanson PG
        • Schall TE
        • Walter JK.
        Communication Challenges of Oncologists and Intensivists Caring for Pediatric Oncology Patients: A Qualitative Study.
        J Pain Symptom Manage. Dec 2017; 54: 909-915
        • Hollingsworth CE
        • Wesley C
        • Huckridge J
        • Finn GM
        • Griksaitis MJ.
        Impact of child death on paediatric trainees.
        Arch Dis Child. Jan 2018; 103: 14-18
        • Wilson PM
        • Herbst LA
        • Gonzalez-Del-Rey J.
        Development and Implementation of an End-of-Life Curriculum for Pediatric Residents.
        Am J Hosp Palliat Care. Nov 2018; 35: 1439-1445
      6. Josey K, Smith ML, Kayani AS, et al. Hospitals with more-active participation in conducting standardized in-situ mock codes have improved survival after in-hospital cardiopulmonary arrest. Resuscitation. Dec 2018;133:47-52. doi:10.1016/j.resuscitation.2018.09.020

      7. Randall D, Garbutt D, Barnard M. Using simulation as a learning experience in clinical teams to learn about palliative and end-of-life care: A literature review. Death Stud. Mar 2018;42(3):172-183. doi:10.1080/07481187.2017.1334006

        • Brock KE
        • Cohen HJ
        • Sourkes BM
        • Good JJ
        • Halamek LP.
        Training Pediatric Fellows in Palliative Care: A Pilot Comparison of Simulation Training and Didactic Education.
        J Palliat Med. Oct 2017; 20: 1074-1084
        • Wolfe AD
        • Denniston SF
        • Baker J
        • Catrine K
        • Hoover-Regan M.
        Bad News Deserves Better Communication: A Customizable Curriculum for Teaching Learners to Share Life-Altering Information in Pediatrics.
        MedEdPORTAL. Aug 12 2016; 12: 10438
        • Flint H
        • Meyer M
        • Hossain M
        • Klein M.
        Discussing Serious News.
        Am J Hosp Palliat Care. Apr 2017; 34 (Am J Hosp Palliat Care): 254-257
      8. Snaman J, Kaye EC, Cunningham MJ, et al. Going straight to the source: A pilot study of bereaved parent-facilitated communication training for pediatric subspecialty fellows. Pediatric Blood & Cancer. 2017-01-01 2017;64(1):156-162. doi:10.1002/pbc.26089

      9. Foundation CK. The Cameron Kravitt Foundation. Accessed April 29, 2022.

        • Ericsson KA.
        Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice.
        Acad Med. 2015; 90: 1471-1486
        • Kern D.
        Overview: A Six-Step Approach to Curriculum Development.
        Johns Hopkins University Press, 2015
        • Snaman JM
        • Torres C
        • Duffy B
        • Levine DR
        • Gibson DV
        • Baker JN.
        Parental Perspectives of Communication at the End of Life at a Pediatric Oncology Institution.
        J Palliat Med. Mar 2016; 19: 326-332
        • Meyer EC
        • Ritholz MD
        • Burns JP
        • Truog RD.
        Improving the quality of end-of-life care in the pediatric intensive care unit: parents' priorities and recommendations.
        Pediatrics. Mar 2006; 117: 649-657
      10. Entrustable Professional Activities for Subspecialties, American Board of Pediatrics. Accessed March 23, 2021.

      11. Workshops in End-of-Life Training for Health Professionals in Children's Hospitals. Accessed June 10, 2021,

      12. Pediatric-Hospice and Palliative Medicine Competencies, Version 2.0. Accreditation Council for Graduate Medical Education; 2014. Accessed September 15, 2017.

        • Bajaj K
        • Meguerdichian M
        • Thoma B
        • Huang S
        • Eppich W
        • Cheng A.
        The PEARLS Healthcare Debriefing Tool.
        Acad Med. Feb 2018; 93: 336
        • Fund ZPCM.
        Regents of the University of Minnesota.
        Accessed April. 2022; 29
        • Benjamini Y
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        Journal of the Royal statistical society: series B (Methodological). 1995; 57: 289-300