Abstract
Background Studies have shown rates of life-sustaining treatments for periviable newborns vary
by center, centers' differing periviability approaches affect trainees' views, and
formal communication training for neonatology fellows is uncommon. Parents of imperiled
newborns report unmet emotional and spiritual needs. This study sought to understand
how fellows learn to support parents and their periviable newborns through exposure
to institutional clinical approaches and by formal curriculum.
Methods All the U.S. neonatology fellowship program directors were invited to complete an
online anonymous survey. Data were analyzed with descriptive statistics.
Results In this study, 56 of 98 directors (57%) responded. Training centers differed in delivery
room options offered and recommended for periviable newborns. Providing parents written
information and neonatology and obstetrics co-counseling were uncommon. Directors
reported weaknesses in training fellows to support parents' spiritual and emotional
needs, and < 50% reported formal policies for involving social workers or chaplain.
Fellows learned periviability counseling in 95% programs by observing attending physicians;
however, only 54% directors reported typical joint daytime counseling with fellows
and attending physicians.
Conclusion Training programs exposed fellows to different periviability care approaches, identified
weaknesses in teaching support provision for parents' needs, and appeared to miss
opportunities for clinical modeling of counseling and comfort care provision.
Keywords
ethics - periviable - antenatal counseling - decision making - resuscitation - neonatology
- education
