Introduction

1. Learning That Leads to Action:Impact and Characteristics of a Professional Education Approach to Improve the Care of Critically Ill Children and Their Families Solomon MZ, Browning DM, Dokken DL, Merriman MP, Rushton CH. Learning that leads to action: impact and characteristics of a professional education approach to improve the care of critically ill children and their families. Arch Pediatr Adolesc Med. 2010;164(4):315-322.

2. Introduction • Clinicians who work with critically ill children confront difficult decisions, wrenching emotions, and tragic outcomes, often without adequate preparation or support. • The Initiative for Pediatric Palliative Care developed a comprehensive curriculum and conducted retreats for interdisciplinary teams across the United States and Canada. • The pedagogical approach involved relational learning across boundaries. • The study’s aim was to determine the impact of this approach to professional education on clinicians’ confidence to act as change agents and their ability to make institutional improvements in pediatric palliative care.

3. Methods Study Design • Immediate postretreat (intervention) evaluation via questionnaire of participants’ perceptions of pedagogy. • Longer-term survey and interview follow-up (1-2 years after retreat) to ascertain institutional improvements participants initiated and sustained after returning to their home institutions. Sample • Physicians, nurses, psychosocial staff, and bereaved parents from 20 health care institutions involved in 7 retreats between March 2006 and March 2007 in California, Maryland, North Carolina, Tennessee, Texas, West Virginia, and Wisconsin. Data Collection • Evaluation questionnaires completed by 657 of 782 retreat participants; response rate, 84%. • Online survey completed by 72 of 101 team leaders; response rate, 71%. • Follow-up telephone interviews with 21 of 26 team leaders; response rate, 81%.

4. Methods Data Analysis • Retreat evaluations and online survey analyzed using SPSS software (SPSS Inc, Chicago, Illinois). • Coded themes developed by 2 researchers (M.P.M. and a research assistant) for open-ended questions. • Telephone interviews with team leaders were analyzed to characterize the types of institutional achievements and the relationship between the pedagogy at the retreats and those achievements. Limitations • Study reports on institutional improvements that focus on process outcomes; we did not collect data on patient or family outcomes. • Scalability of this learning method is uncertain because the method requires trained facilitators who understand the “ground rules” used in the small-group seminars and are comfortable with relational learning across boundaries, the main pedagogical approach.

5. ResultsEvaluation of Learning Features by Discipline:Analysis of 657 Questionnaires Collected Across 7 Retreats aScale: 1 = not at all; 5 = very. bPsychosocial staff include those who identified themselves as child life specialists, psychologists, and social workers. cSome cells have fewer than 5 individuals. dSignificant differences between some groups at the 95% confidence level (P ≤ .05).

6. ResultsRetreat Participants’ Assessment of Pedagogical Features

7. ResultsIPPC Impact Survey Respondent Characteristics Abbreviations: IPPC, Initiative for Pediatric Palliative Care; NICU, neonatal intensive care unit; PICU, pediatric intensive care unit.

8. Results Online Survey With 72 Team Leaders • 74% of team leaders reported improvement in pediatric palliative care in their organizations after the retreat. • 91% credited the retreat experience as being somewhat or very instrumental to the improvements. • Improvements included establishment of pediatric palliative care and bereavement programs, enhanced interdisciplinary communication, care coordination, clinician-family interaction at the bedside, and educational programs. • 70% crafted formal linkages between hospital-based and non–hospital-based providers to coordinate care across settings.

9. Comment • Participants attributed the power of their experience at the retreats to learning across boundaries, especially between clinicians and parents, but also among clinicians from different disciplines and disparate care settings. • The retreats appeared to help clinicians regain their aspirational ideals and strengthen their sense of agency both as individual leaders and as members of interdisciplinary teams. • This renewal and interdisciplinary engagement, in turn, led a large proportion of participants to engage in efforts to improve clinical practice and bring about change within their organizations. • Relational learning across boundariesholds promise for professional learning with health care professionals, especially when the educational goal is tied to enabling a shift in social and ethical norms.

10. Contact Information • If you have questions, please contact the corresponding author: Mildred Z. Solomon, EdD, Education Development Center, Inc, 55 Chapel St, Newton, MA 02458 (msolomon@edc.org; telephone: 617-618-2404). Funding/Support • Development of the Initiative for Pediatric Palliative Care curriculum was funded by the Nathan Cummings Foundation, the Open Society Institute’s Project on Death in America, and the Kohlberg Foundation. The retreats were funded by the Aetna Foundation, the Argosy Foundation, the Kenneth B. Schwartz Center, the Sidney and Esther Rabb Charitable Foundation, the Sidney R. Rabb Charitable Trust, participant fees, institutional retreat sponsors, and individual donors.