1287: A Missed Conversation: Spirituality as a Persistent Gap in PCCM Communication Training

Introduction: There is no standardized curriculum for end-of life communication training in pediatric critical care medicine (PCCM) fellowship programs. This variability may contribute to inconsistent confidence/competence among trainees. The impact of communication training and clinical experiences during fellowship on perceived communication confidence at graduation remains unknown. This study aimed to: 1) describe graduating PCCM fellows’ self-perceived confidence/competence in delivering serious news, 2) characterize the types and formats of communication training received, and 3) evaluate the impact of clinical exposures and didactic training on communication confidence. Methods: We conducted a prospective cohort study of PCCM fellows from 44 institutions who completed validated surveys during their first-year bootcamp and again in their final year. Surveys assessed self-perceived confidence in serious illness communication, including delivering bad news, discussing goals of care, code status, addressing spiritual concerns, and supporting family emotions. Participants also reported the types and formats of communication training received. Descriptive statistics and paired comparisons assessed changes in confidence and associations with training and clinical exposures. Results: Fifty-three fellows completed both surveys. By fellowship completion, most felt well-trained in delivering bad news (94.3%), discussing goals of care (84.9%), code status (86.8%), and supporting family emotions (94.4%). Fewer felt confident addressing spiritual concerns (56.6%). Confidence improved significantly across all domains (p < 0.001), except in addressing spiritual concerns, where 58.8% reported no change. Confidence was not significantly associated with patient volume, number of patient deaths, or the type/format of communication training. Conclusions: Self-perceived communication confidence increases over the course of PCCM fellowship, independent of training modality or clinical exposure. However, confidence in addressing spiritual concerns lags behind, highlighting a key training gap. Future research should explore how confidence translates to performance and to identify educational strategies, particularly around spirituality, that enhance communication effectiveness with families of critically ill children.