Foundation Programme and GP trainees on psychiatry placement within Kent and Medway attend a teaching programme on core topics. The GP training and new Foundation Programme curricula require key mental health content to be covered. This quality improvement project (QIP) aimed to improve the delivery of mental health teaching to Foundation and GP trainees on psychiatry placement.

The existing teaching programme was fortnightly, full-day teaching, online via zoom. Drivers for change included: reduction in duplication of teaching; new curricula; changes to training patterns, including GP trainees moving to Integrated Training Posts (ITP); and promoting sustainability.

The project team included Medical Education team members, trainee representative and clinical staff involved in education. In the first QIP cycle between March and August 2022, a Medical Education Working Group reviewed teaching content for congruence with GP and Foundation curricula and to reduce duplication with other training settings. Medical education teams from other local mental health trusts were contacted to gather examples of best practice, and teachers and trainee supervisors were consulted. Qualitative trainee feedback for teaching between December 2020 and April 2022 was evaluated. Teaching delivery was revised to half a day fortnightly, and session length standardised to 75 minutes. After the new programme commenced in August 2022, a second QIP cycle evaluated trainee qualitative feedback and there was further engagement with teachers.

First cycle trainee feedback revealed several themes: teaching was too long; content was useful, especially focus on primary care; presenters were engaging. Suggestions for improvements included using interactive teaching tools such as online polls or quizzes, increasing case-based teaching, and small group breakout sessions. Shortening the teaching day preserved clinical exposure, especially for ITP trainees. Online format reduces travel time and expense, promotes sustainability, and reduces impact on clinical experience. Second cycle trainee feedback identified some sessions could be shortened. Consultation with education teams from neighbouring acute trusts identified schedule overlap with other mandatory training, so teaching was condensed to one 75-minute session weekly. Delivering teaching more efficiently releases time for direct patient care.

We used a quality improvement approach to improve a teaching programme offered to GP and foundation trainees in Kent and Medway. Our outcome delivers an efficient teaching strategy, responding to trainee feedback, which meets curriculum objectives more efficiently, preserving time for direct patient care and to implement learning. Additional learning is the importance of liaison with medical education teams in acute trusts to optimise teaching.

To determine whether engaging in advance care planning (ACP) using a formal tool, Voicing My CHOiCES (VMC), would alleviate adolescent and young adults (AYAs) anxiety surrounding ACP and increase social support and communication about end-of-life care preferences with family members and health care providers (HCPs).

A total of 149 AYAs aged 18–39 years receiving cancer-directed therapy or treatment for another chronic medical illness were enrolled at seven US sites. Baseline data included prior ACP communication with family members and HCPs and measures of generalized anxiety, ACP anxiety, and social support. Participants critically reviewed each page of VMC and then completed three pages of the document. ACP anxiety was measured again immediately after the completion of VMC pages. One month later, participants repeated anxiety and social support measures and were asked if they shared what they had completed in VMC with a family member or HCP.

At baseline, 50.3% of participants reported that they previously had a conversation about EoL preferences with a family member; 19.5% with an HCP. One month later, 65.1% had subsequently shared what they wrote in VMC with a family member; 8.9% shared with an HCP. Most (88.6%) reported they would not have had this conversation if not participating in the study. No significant changes occurred in social support. There was an immediate drop in anxiety about EoL planning after reviewing VMC which persisted at 1 month. Generalized anxiety was also significantly lower 1 month after reviewing VMC.

Having a document specifically created for AYAs to guide ACP planning can decrease anxiety and increase communication with family members but not necessarily with HCPs. Future research should examine ways ACP can be introduced more consistently to this young population to allow their preferences for care to be heard, respected, and honored, particularly by their healthcare providers.

Parents of seriously ill children worry about their vulnerable child contracting COVID-19, whether their child's palliative care providers will be able to continue to provide the same quality of care to their child, and who can be with the child to provide comfort. For providers, shifts in healthcare provision, communication formats, and support offerings for families facing distress or loss during the pandemic may promote providers’ moral distress. This study aimed to define the ways that the COVID-19 pandemic has impacted end-of-life care and approach to bereavement care in pediatric palliative care (PPC).

The Palliative Assessment of Needed DEvelopments and Modifications In the Era of Coronavirus (PANDEMIC) survey was developed to learn about the PPC experience during COVID-19 in the United States. The survey was posted with permission on seven nationally focused Listservs.

A total of 207 PPC team members from 80 cities within 39 states and the District of Columbia participated. In the majority of hospitals, admitted pediatric patients were only allowed one parent as a visitor with the exception of both parents or nuclear family at end of life. Creative alternatives to grief support and traditional funeral services were described. The high incidence of respondents’ depicted moral distress was often focused on an inability to provide a desired level of care due to existing rules and policies and bearing witness to patient and family suffering enhanced by the pandemic.

The COVID-19 pandemic has had a profound impact on the provision of end-of-life care and bereavement for children, family caregivers, and PPC providers. Our results identify tangible limitations of restricted personal contact and the pain of watching families stumble through a stunted grieving process. It is imperative that we find solutions for future global challenges and to foster solidarity in PPC.