Primary Palliative Care for Pediatric Residents: A Curricular Framework and Pilot

Published:March 17, 2023DOI:



      Palliative care (PC) is high value, holistic care for a child and their family across the entire arc of an illness. All physicians should be competent in symptom management and providing goal-concordant care that acknowledges quality of life; however, there is insufficient education in pediatric residency to develop competence in basic or “Primary” Palliative Care (PC).


      We completed a needs assessment and developed a longitudinal, comprehensive, and integrated primary PC curriculum for pediatric residents with the goal of developing foundational primary PC skills regardless of eventual career trajectory. After one year of implementation, we assessed resident comfort with primary PC skills via retrospective pre-post survey.


      We found a statistically significant (p<0.05) increase in residents’ comfort with pain management, delivering serious news, and discussing goals of care. An increase in comfort with management of other symptoms was not statistically significant.

      Next Steps

      After one year of implementation, residents describe an increase in comfort with primary PC skills. Next steps include more rigorous evaluation and expansion to include more education in medical ethics. While the educational need is universal, resident needs are constantly evolving and each institution should tailor this curriculum to fit their specific trainee needs and institutional expertise.


      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


        • “Palliative Care.” World Health Organization
        World Health Organization, Aug. 2020: 5
        • Gans D.
        • Kominski G.F.
        • Roby D.H.
        • et al.
        Better outcomes, lower costs: palliative care program reduces stress, costs of care for children with life-threatening conditions.
        Policy Brief UCLA Cent Health Policy Res. 2012; PB2012-3: 1-8
        • Committee on Approaching Death
        Addressing Key End of Life Issues; Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.
        National Academies Press (US), Washington (DC)March 19, 2015
        Pediatric Palliative Care and Hospice Care Commitments, Guidelines, and Recommendations.
        Pediatrics. 2013; 132: 966-972
        • Schowalter J.E.
        Death and the pediatric house officer.
        J Pediatr. 1970; 76: 706-710
        • Kemper K.J.
        • Schwartz A.
        • Wilson P.M.
        • et al.
        Burnout in Pediatric Residents: Three Years of National Survey Data.
        Pediatrics. 2020; 145e20191030
        • Baker J.N.
        • Torkildson C.
        • Baillargeon J.G.
        • Olney C.A.
        • Kane J.R.
        National survey of pediatric residency program directors and residents regarding education in palliative medicine and end-of-life care.
        J Palliat Med. 2007; 10: 420-429
        • Kolarik R.C.
        • Walker G.
        • Arnold R.M.
        Pediatric resident education in palliative care: a needs assessment.
        Pediatrics. 2006; 117: 1949-1954
        • Michelson K.N.
        • Ryan A.D.
        • Jovanovic B.
        • Frader J.
        Pediatric residents' and fellows' perspectives on palliative care education.
        J Palliat Med. 2009; 12: 451-457
        • Friedrichsdorf S.J.
        • Remke S.
        • Hauser J.
        • Foster L.
        • Postier A.
        • Kolste A.
        • Wolfe J.
        Development of a Pediatric Palliative Care Curriculum and Dissemination Model: Education in Palliative and End-of-Life Care (EPEC) Pediatrics.
        J Pain Symptom Manage. 2019 Oct; 58 (Epub 2019 Jun 18): 707-720
        • Romanos-Sirakis E.
        • Demissie S.
        • Fornari A.
        Implementation of a Multi-Modal Palliative Care Curriculum for Pediatric Residents.
        Am J Hosp Palliat Care. 2021 Jan 28; 1049909121990826 (Epub ahead of print)
        • Wilson P.M.
        • Herbst L.A.
        • Gonzalez-Del-Rey J.
        Development and Implementation of an End-of-Life Curriculum for Pediatric Residents.
        Am J Hosp Palliat Care. 2018 Nov; 35 (Epub 2018 Jul 15): 1439-1445
        • Asuncion A.M.
        • Cagande C.
        • Schlagle S.
        • McCarty B.
        • Hunter K.
        • Milcarek B.
        • Staman G.
        • Da Silva S.
        • Fisher D.
        • Graessle W.
        A Curriculum to Improve Residents' End-of-Life Communication and Pain Management Skills During Pediatrics Intensive Care Rotation: Pilot Study.
        J Grad Med Educ. 2013 Sep; 5: 510-513
        • Bjork R.A.
        • Bjork E.L.
        Desirable difficulties in theory and practice.
        Journal of Applied research in Memory and Cognition. 2020; 9: 475-479
        • Firth J.
        • Rivers I.
        • Boyle J.
        A systematic review of interleaving as a concept learning strategy.
        Rev Educ. 2021; 9: 642-684
        • Kern D.
        • et al.
        Curriculum Development for.
        Medical Education: A Six Step Approach. The Johns Hopkins University Press, 1998
      1. ACGME Program Requirements for Graduate Medical Education in Pediatrics. June 12, 2022 . 〈〉

        • Trowbridge A.
        • Bamat T.
        • Griffis H.
        • McConathey E.
        • Feudtner C.
        • Walter J.K.
        Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital.
        Acad Pediatr. 2020; 20: 81-88
      2. Entrustable Professional Activies – EPA 6 for General Pediatrics. 2021 . 〈〉

      3. Vital Talk: Vital Talk; 2018 [cited 2022 08/15]. Available from: 〈〉.

        • Osborn R.
        • Bullis E.
        • Fenick A.M.
        • et al.
        X + Y scheduling in pediatric residency: continuity, handoffs, and trainee experience. Acad Pediatr. 2019 Jul; 19: 489-494
        • Geldhof G.J.
        • Warner D.A.
        • Finders J.K.
        • Thogmartin A.A.
        • Clark A.
        • Longway K.A.
        Revisiting the utility of retrospective pre-post designs: The need for mixed-method pilot data.
        Eval Program Plann. 2018; 70: 83-89