title: Training in difficult conversations: a national survey of pediatric hematology-oncology and pediatric critical care physicians.
abstract: BACKGROUND
  In pediatric oncology and critical care, physicians give difficult news, including discussions regarding palliative care and comfort measures, but there are minimal data regarding fellowship program preparation for this task.
  
  
  OBJECTIVE
  We surveyed graduates of pediatric hematology/oncology and critical care fellowships regarding communication training to describe teaching methods, assess which were helpful, and determine whether comfort level is related to training experiences.
  
  
  METHODS
  A 12-question Web survey was sent to physicians completing fellowship in the previous 5 years.
  
  
  RESULTS
  Of 345 fellows identified, 171 (50%) responded. Prior training included observing senior physicians (100%), being observed (78%), reading (56%), lectures (46%), role-play (20%), workshops (16%), simulation (13%), and videos (13%). Observing senior physicians was thought most helpful. More years since training (p < 0.0005) and frequent difficult conversations (p = 0.009) were predictors of current comfort. Only workshops were associated with feeling better prepared at the end of training (p = 0.019).
  
  
  CONCLUSIONS
  Training may help physicians feel prepared for difficult conversations, but ongoing experience was strongly associated with comfort level.
authors.affiliation: The Children's Hospital of Philadelphia, Pennsylvania 19104, USA. segall@email.chop.edu
authors.forename: Leslie
authors.initials: L
authors.lastname: Kersun
authors.forename: Lin
authors.initials: L
authors.lastname: Gyi
authors.forename: Wynne Ellen
authors.initials: WE
authors.lastname: Morrison
mesh_terms: D003142:Communication; D003422:Critical Care; D004501:Education, Medical; D005257:Fellowships and Scholarships; D005260:Female; D019538:Health Care Surveys; D006405:Hematology; D006801:Humans; D008297:Male; D008495:Medical Oncology; D010372:Pediatrics; D010820:Physicians; D013663:Teaching; D014342:Truth Disclosure