One goal in the meantime, said Dr. Berlinger, is to "influence the culture of health care so that pediatric palliative care is recognized as ethically mandatory."
The $15,000 awards that Dr. Nageswaran and Dr. Friedrichsdorf received were given by the Hastings Center, a bioethics research institute based in Garrison, N.Y., in partnership with the Cunniff-Dixon Foundation, a foundation that focuses on the doctor-patient relationship near the end of life.
Pediatric Palliative Care Training
In terms of education, pediatric palliative care might be where pediatric subspecialties such as pulmonary care or neonatology were 25 years ago, Dr. Friedrichsdorf said, with an initial cadre of trained physicians having emerged.
In 2008, 47 physicians were certified in Hospice and Palliative Medicine (HPM) by the American Board of Pediatrics after taking the first American Board of Medical Specialties–recognized examination for the subspecialty. In total, 1,274 physicians were certified by various boards in the new subspecialty.
The American Board of Medical Specialties (ABMS) approved the creation of HPM as a subspecialty of 10 participating boards in 2006. Prior to 2006, board certification in hospice and palliative medicine was administered by the American Board of Hospice and Palliative Medicine but not recognized by the ABMS.
Other pediatricians have taken courses and attended educational retreats through organizations such as the Initiative for Pediatric Palliative Care, Dr. Berlinger said.
Ideally, she and Dr. Friedrichsdorf say, both educational tracks – fellowships and educational opportunities for mid-career pediatricians – will grow.
Starting in 2013, physicians who want to sit for the HPM board exam will have to have completed an Accreditation Council for Graduate Medical Education-accredited fellowship – a change that should spur the development of more fellowship programs. Children’s Hospitals and Clinics of Minnesota, Dr. Friedrichsdorf’s hospital, houses one of a handful of fellowship programs in pediatric palliative care. It has applied for ACGME approval.
Dr. Friedrichsdorf is the principal investigator of a National Institutes of Health/National Cancer Institute study on the creation and implementation of a pediatric palliative care curriculum that is slated to be offered to physicians who are in the midst of their careers and not seeking subspecialty training.
"Many professionals working in children’s hospitals are likely to care for a dying child, and need to be comfortable and knowledgeable," said Dr. Friedrichsdorf, who completed a fellowship in pediatric pain and palliative care at the Children’s Hospital at Westmead, Australia, after finishing his pediatric residency in Germany.