Background: Decision making at the end of life can be complex and emotionally challenging
for healthcare providers, particularly in pediatrics. Unfortunately, few undergraduate and
graduate medical education curricula adequately address these issues. In this article, we describe the plan and progress to date of the design, implementation, and evaluation of an endof-
life curriculum for pediatric residents.
Needs assessment: Prior to the development of a formal end-of-life curriculum, a survey
was given to a single cohort of residents four times over the course of their training to assess
their attitudes toward end-of-life issues and their experience with the informal curriculum
in residency. Entering pediatric residents felt relatively uncomfortable dealing with death
and dying, but by the end of training, residents felt more comfortable dealing with these issues.
Residents were relatively ambivalent about the degree to which their education helped
them to deal with end-of-life issues.
Curriculum development and evaluation plan: A number of curricular interventions were
developed including a noon conference series, grand rounds presentations, a 3-hour seminar
on giving bad news, and written information for the housestaff manual. The curriculum was
implemented in the fall of 1999. The impact of the curriculum will be assessed using a single
interventional group with historical control study design. The evaluation instruments will
include the previously used survey and an objective written examination. The 3-hour seminar
will be assessed with a pre-test post-test crossover design using standardized patients.
Discussion: This rigorous, feasible, and cost-effective approach to curriculum development
is intended to serve as a model for end-of-life education in pediatric residencies.
