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Pediatric Bereavement Workshop

Helps Train Residents to Comfort Grieving Parents

New York, NY (Sep 25, 2009)

Physician and parents talk at table

Physicians are taught to save lives, but sometimes, despite the best efforts of a physician and the entire healthcare team, a patient dies – and delivering that devastating news to parents requires a sensitivity and communications skills that only come through training and experience. To help second-year pediatric residents at NewYork-Presbyterian Hospital/Weill Cornell Medical Center prepare for such a difficult and emotional experience, the Hospital held its fifth annual Pediatric Bereavement Workshop in May, a day-long seminar sponsored by the Cameron Kravitt Foundation, and conducted by the Phyllis and David Komansky Center for Children's Health and Weill Cornell Medical College.

About the Cameron Kravitt Foundation

Beverly and Jason Kravitt founded the Cameron Kravitt Foundation in 1982 in memory of their son who died at birth – a painful and searing experience made worse by the undertrained staff of the hospital where the baby died. "Beverly and Jason had concerns about the way in which the news was delivered to them and how they were treated when their child was born," says Susan B. Bostwick, MD, MBA, Director of Pediatric Graduate Medical Education, and Division Chief of General Academic Pediatrics at NewYork-Presbyterian/Weill Cornell, and Associate Professor of Clinical Pediatrics at Weill Cornell Medical College. The Kravitts believed that the best way to help other families who experience a similarly grievous loss is not just to create support groups, but to also help train doctors how to "speak the hardest words they'll ever have to say."

For over a decade, the Foundation has awarded a grant each year to Johns Hopkins University School of Medicine in Baltimore to help teach young physicians who will become pediatricians how to respond in such a crisis, both to help the grieving parents and to cope with their own loss. Learning how to comfort families at the same time they are experiencing their own frustration and sadness is a difficult skill to learn.

In 2004, the Foundation expanded the program by offering a grant to establish a similar workshop at NewYork-Presbyterian/Weill Cornell. "Dr. Janet Serwint, the pediatrician who developed the program at Johns Hopkins, came here to work with us on developing our curriculum," says Dr. Bostwick.

Pediatric Bereavement Workshop: An Intense Experience

"We were able to bring together three-quarters of the second-year residents for a full-day workshop away from their clinical responsibilities. Their Hospital duties for the day were covered by senior residents," says Dr. Bostwick. "Faculty from such areas as the Pediatric Intensive Care Unit were also invited to attend in order to help make it more of a shared experience. Residents know that these physicians have dealt with similar situations in telling a parent about their child dying."

Dr. Bostwick introduced the program, and then Jason Kravitt, who attends each workshop, gave a moving talk about the experience that he and his wife had from the moment they entered the hospital, until they were told that their child had died, and what inspired them to start the Cameron Kravitt Foundation. Following that, the residents were given a presentation on communications skills, learning the importance of maintaining close eye contact with parents, listening carefully, acknowledging their grief, and responding with empathy and support.

Role-Playing a Difficult Situation

In the next session, the residents broke into four workgroups, and each resident took a turn enacting a scene with "standardized patients" – professional actors who portrayed the parents of a child who has just died. "These simulated scenarios are very real," says Dr. Bostwick. "There are usually two or three parts to a scene, and then afterwards, the standardized patients come back into the room and we talk about what went well and what the resident could have done better. It's a long, grueling morning and very intense."

"As residents, we often deal with a multitude of situations for which we are ill-prepared, and perhaps none prove more difficult than those surrounding death and dying of our patients," says resident Danielle Novetsky Friedman, MD. "After nearly two years of learning by trial and fire, of trying to emulate our superiors or imagining how we would want to be treated as the recipients of bad news, it was helpful to have a dedicated day to learn formally about bereavement, to act out our emotions and receive concrete constructive feedback about how best to deal with these issues. Having an entire day devoted to the subject – physically removed from the Hospital and our clinical duties – gives us space to reflect on our own experiences and learn the fundamentals of treating terminally ill patients – as well as the family members who survive them – with empathy and compassion."

In the afternoon, one group of residents met with a pediatric pathologist who discussed autopsies and preparation of the body, a representative from the New York State Organ Donor Network described the process of organ donation, and nurses from the Hospital's Neonatal Intensive Care Unit talked about their experiences. At the same time, another group met with a social worker, Child Life specialist, and a representative from the Chaplaincy service, who addressed the emotional and spiritual needs of the families. After 45 minute-sessions, each group switched in order that all received the same information.

"I found the bereavement workshop very useful, and completely worth taking a day away from clinical duties to participate," says resident Eleanor V. Tripp, MD. "As pediatricians, we like to think of ourselves as somehow more sensitive to patients and their families, particularly by the nature of our work with children. In reality, the death of a patient is difficult for any physician, particularly when it is the death of a child. We've invested so much of ourselves in keeping the child alive, and very often developed a relationship with the child and their family, that it can often feel like a personal loss when one of our patients dies. "The role-play sessions were particularly valuable in providing an opportunity to practice discussing the difficult topic of a child's death or imminent death with parent actors," continues Dr. Tripp. "We were able to receive feedback from our peers and also take away from their role-play sessions what went well."

In the final sessions of the workshop, a parent whose child had died spoke about her family's personal experience, and a psychiatrist from the Hospital talked to the residents about their own self-care – what they can do for themselves. "It's an emotional day and incredibly tiring," says Dr. Bostwick. "However, the residents' evaluations have been very positive. They feel it is helpful to have these kinds of opportunities."

Says Dr. Tripp, "Some physicians say they feel that they have failed when a patient dies, but instead, I feel that as physicians, we only fail when we have not used our best clinical judgment and abilities when caring for the patient up until their death. The bereavement workshop provided an excellent opportunity to discuss the feelings and difficulties involved with the death of a patient with my peers."

"It was especially useful to hear a personal account of one mother's loss," adds Dr. Novetsky Friedman. "Through her loving and detailed story, she gave a voice to an often voiceless experience. She allowed us to break the silence around these issues, to reflect on our experiences, to think carefully about how we could have done better in the past and how we will do better in the future."

Contributing faculty for this article:

Susan B. Bostwick, MD, MBA, Director of Pediatric Graduate Medical Education, and Division Chief of General Academic Pediatrics at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Associate Professor of Clinical Pediatrics at Weill Cornell Medical College.

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