Pediatric residents do not feel prepared for the most unsettling situations they face in the pediatric intensive care unit.
BACKGROUND
Critical care rotations involve emotionally unsettling situations with greater frequency and intensity than those that are encountered in other portions of residency training. New approaches are needed to optimize the preparation and professionalism of postgraduate medical trainees when managing crisis management scenarios.


METHODS
An anonymous survey was conducted that focused on preparedness for dealing with emotionally unsettling situations, training preferences for these encounters, and the utility of resource personnel. A total of 58% of four classes of pediatric residents responded over a 2-year period.


RESULTS
Pediatric residents in our program identified sudden patient death and conflicts about goals of care within the team as the most unsettling situations. These were also the scenarios with which they had the least experience and for which they felt least prepared. Team discussion was designated as the most helpful educational tool, in addition to a combination of didactic educational programs and end-of-rotation sessions.


CONCLUSIONS
The focus and design of clinical education programming on preparation for crisis management during the care of critically ill patients benefit from the incorporation of trainee perceptions of preparedness and the efficacy of educational formats. Trainee feedback in these areas can be harnessed as a continuous quality improvement tool and as a metric of success in meeting professional training goals.
Department of Anesthesiology and Critical Care Medicine, John Hopkins University School of Medicine , Baltimore, Maryland, USA. cyang32@jhmi.edu
Chris P
CP
Yang
Jennifer
J
Leung
Elizabeth A
EA
Hunt
Janet
J
Serwint
Matt
M
Norvell
Elizabeth A
EA
Keene
Lewis H
LH
Romer
D019260:Expressed Emotion; D019538:Health Care Surveys; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007396:Internship and Residency; D013337:Students, Medical / Q000523:psychology*