Pediatric Palliative Care Subcompetencies for Pediatric Critical Care Medicine Fellowship Trainees

Integration of pediatric palliative care (PPC) and pediatric critical care medicine (PCCM) is essential in providing high-quality patient care. To date, no standardized or recommended framework for educating PCCM fellowship trainees in palliative care exists. We aimed to develop PPC subcompetencies for PCCM fellows within the constructs of the established Accreditation Council for Graduate Medical Education (ACGME) six core competencies.

An eight-member multicenter panel consisting of joint PPC and PCCM clinicians with expertise in fellow education curricula design used a modified Delphi method to construct subcompetencies for PPC within the ACGME core competency domains (patient care, medical knowledge, interpersonal/communication skills, professionalism, problem-based learning, and system-based practice). The process for development involved the following steps: 1) literature search, 2) evaluation of the ACGME program requirements for PPC and PCCM, 3) consensus meetings and evaluation to generate core knowledge, skills, and experiences needed using rating scales to sequentially prioritize curriculum content, and 4) selection and approval by multicenter team. Complete agreement was necessary for subcompetency inclusion.

Following the multi-step review process, 20 subcompetencies mapped to the core competency domains were included. A majority of subcompetencies were within the medical knowledge domain. Subcompetencies were further mapped to suggested entrustable professional activities and to specific recommended training years for subcompetency completion.

We present the first recommended PPC subcompetencies for PCCM fellows. Utilization of subcompetencies for fellow trainees is necessary to build primary palliative skills and improve confidence in delivering palliative care medicine within the pediatric critical care setting. Future efforts are needed to determine best practices for teaching and measuring competence. Recommended subcompetencies have the potential to standardize national PPC curricula for PCCM fellowship programs.