Introduction: The importance of Palliative Care (PC) and End of Life (EOL) Care for children in the PICU is recognized. Census data indicate that over 50% of PICU admissions have conditions necessitating PC (1). However, staff struggle providing this care with notable outcomes (2-4). Families without robust PC suffer inferior outcomes by symptom scores, cost, and length of life (5-7). This lapse is partly attributable to knowledge and skills gaps of Pediatric Critical Care Medicine (PCCM) providers. Pediatricians report low confidence managing EOL symptoms, conflict, emotional distress, and communicating difficult news. Most respondents would value more training (8-9). PCCM fellows have not been specifically evaluated. Consequently, we produced and evaluated curricula for PCCM fellows to address these gaps and to assess their experiences providing PC. Methods: This is a single-center, prospective, cohort study of PCCM fellows surrounding a workshop-based curriculum commiserate with the educational environments of most PCCM training programs including low time and resource costs. Primary aims were to characterize PCCM fellows’ PC attitudes, knowledge, and skills and the influence of maturation and exposure to formal PC curriculum on those indices. Two, validated, adapted tools, the Knowledge and Attitude Survey (KAS) and a Communication Assessment (CA) were used to evaluate endpoints. Graduating fellows (GF)(n=5) not exposed to the curriculum completed the KAS. The current fellow cohort (CFC) (n=11) completed the survey before and after intervention. Via simulation workshop, faculty raters (n=2) using the CA evaluated CFC fellows (n=9) across two scenarios (Table 1). Secondary aims include validation of the CA and KAS in these environments (9, 10) allowing for ongoing assessment of fellows’ skills acquisition, attitudes, curricular feedback, and comparison to other fellow competency assessments such as Milestone data. Results: Post-workshop, PCCM fellows found PC education helpful (90 v 60% (p < 0.05) and reported new openness to workshops, online modules, and role-play. The communication workshop was perceived the most helpful to clinical practice. The KAS and CA also demonstrated objective knowledge gaps and inferior communication skills commiserate with self-reported comfort amongst PCCM fellows. Maturation did not improve these endpoints. Objective knowledge scores by fellowship year were unchanged (1st 54%; 2nd 46%; 3rd 51%; GF 65%; NS) as were communication skills (scale 0-4)(1st 2.2; 2nd 2.6; 3rd 2; NS). PC exposure, gauged by care conferences (cc) led and recalled deaths on clinical duty (cc range 1-25; M= 8.5; deaths range 5-36; M 13.5), did not correlate with comfort, communication skills, or knowledge. Conclusions: These findings indicate that PCCM fellows want and need specific curricula to affect competent knowledge and performance of PC and EOL care. This study serves as example of one such type of curricula and a means to implement and assess its affects on learners.