BACKGROUND: In pediatric oncology and critical care, physicians give difficult news, including discussions regarding palliative care and comfort measures, but there are minimal data regarding fellowship program preparation for this task. PURPOSE: We surveyed graduates of pediatric hematology/oncology and critical care fellowships regarding communication training to describe teaching methods, assess which were helpful, and determine whether comfort level is related to training experiences. METHODS: A 12-question Web survey was sent to physicians completing fellowship in the previous 5 years. RESULTS: Of 345 fellows identified, 171 (50%) responded. Prior training included observing senior physicians (100%), being observed (78%), reading (56%), lectures (46%), role-play (20%), workshops (16%), simulation (13%), and videos (13%). Observing senior physicians was thought most helpful. More years since training (p < 0.0005) and frequent difficult conversations (p = 0.009) were predictors of current comfort. Only workshops were associated with feeling better prepared at the end of training (p = 0.019). CONCLUSIONS: Training may help physicians feel prepared for difficult conversations, but ongoing experience was strongly associated with comfort level.