• Mildred Z Solomon, David M Browning, Deborah L Dokken, Melanie P Merriman, and Cynda H Rushton.
• Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. msolomon@edc.org
• Arch Pediatr Adolesc Med. 2010 Apr 1; 164 (4): 315-22.

ObjectiveTo determine the impact of an innovative professional educational approach on clinicians' confidence and ability to make institutional improvements in pediatric palliative care.DesignEvaluation to assess impact of educational intervention on participants and participant institutions.SettingRetreats lasting 2.5 days.ParticipantsPhysicians, nurses, psychosocial staff, and bereaved parents.Intervention"Relational learning across boundaries" pedagogy.Main Outcome MeasuresAnalysis of participant questionnaires (n = 782, response rate of 84%), team leader surveys (n = 72, response rate of 71%), and follow-up interview with subsample (n = 21, response rate of 81%). Outcomes included confidence to act and institutional improvements achieved.ResultsSeventy-four percent of team leaders reported significant or moderate improvement in pediatric palliative care after the retreat; only 1% reported no improvement. Ninety-one percent credited the retreat experience as being somewhat or very instrumental to the improvements, which included the establishment of pediatric palliative care and bereavement programs, improvements in interdisciplinary communication, care coordination, clinician-family interaction at the bedside, and educational programs. Participants attributed the impact of the 2.5-day retreat to its key pedagogical features, involvement of family members as equal participants and participation of colleagues from other disciplines and care settings, as well as the ground rules used for the small group seminars.ConclusionsThe intervention was successful in improving clinicians' confidence and catalyzed improvements in pediatric palliative care within participating institutions. Relational learning holds promise for professional learning, especially when the educational goal is tied to enabling a shift in social and ethical norms.

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