Difficult Conversations in Fetal-Neonatal Neurology: National Survey of Educational Experiences and Needs of Child Neurology Residents.

BACKGROUND: Fetal-neonatal neurology (FNN) is a growing subspecialty within child neurology that often involves difficult conversations with families regarding new neurological diagnoses and prognoses. We assessed child neurology residents' educational experiences and needs regarding difficult conversations in FNN. METHODS: We performed a descriptive survey-based study of the educational experiences of child neurology residents in their neurology training. An anonymous RedCap survey was distributed by e-mail to program directors of all US child neurology programs for distribution to residents for optional, voluntary completion. RESULTS: Forty-seven child neurology residents in training programs in 12 states participated. Nearly all (92%) spent at least one week during the academic year providing consultations in the neonatal intensive care unit. About half participated in at least one fetal neurology consultation over the course of six months. A majority of respondents (87%) had been part of a difficult conversation in FNN, defined as delivering serious news or discussing neurological prognosis, and 68% led at least one difficult conversation over the course of six months. Respondents were more often comfortable delivering diagnoses and prognoses in neonatal neurology than in fetal neurology. A minority (32%) had communication training specific to FNN, and almost all (96%) were interested in improving their ability to conduct difficult conversations in FNN. CONCLUSIONS: Child neurology residents were variably exposed to FNN and often actively participated in difficult conversations with families. Most residents had not had communication training specific to FNN and were interested in improving their ability to conduct difficult conversations in FNN.

Duke Scholars

Author Monica Elizabeth Lemmon Pediatrics, Neurology