Discovering What Works Well: Exploring Primary Palliative Care Education in Pediatrics Residency Programs in Canada.

Background: Pediatricians require primary palliative care (PC) skills - communication, pain and symptom management, and psychosocial support - to provide care that mitigates suffering for children with serious illnesses. Residents may not develop skills adequately, and little is known about how they learn those that they do have.

Objective: To explore effective primary PC learning in Canadian pediatrics residency programs.

Methods: Using Appreciative Inquiry methodology, we focused on 'what is working well' to explore resident learning. We purposively sampled 17 trainees (post-graduate years 3-5), representing 13/17 programs. Participants engaged in semi-structured interviews, which we transcribed and analyzed iteratively through an inductive thematic process.

Results: The findings highlighted two predominant themes: a) Embracing incidental learning in the workplace, and b) Scaffolding learning through balanced structure and autonomy. Subthemes included: Recognizing the value of informal and unexpected learning opportunities; Strategies for harnessing incidental learning; Fostering interprofessional collaboration for learning; Integrating PC throughout training; Balancing structured learning with workplace-based opportunities for skill development; and the importance of graduated responsibility in workplace learning.

Conclusions: The residency learning environment provides a rich milieu to develop primary PC skills, but it is often difficult to make use of the fragmented learning opportunities. Residents rely significantly on unplanned clinical opportunities and must actively engage in planning, monitoring, and reflecting on their experiences to develop these skills. Our study underscores the importance of a multi-faceted approach to acquisition of PC skills - through experiential learning, reflective practice, graded responsibility, mentorship opportunities - spread throughout the duration of training.