271 - Evaluating Pediatric Residents’ Reported Comfort With Critically Ill Children Prior To PICU Rotations

Publication Number: 271.5051

Patrick Murday, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Adrian D. Zurca, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States

Background: Pediatric residents have limited exposure to critical illness outside their pediatric intensive care unit (PICU) rotations. It is unknown how residents’ experiences before their PICU rotations impact their comfort in caring for critically ill children.

Objective: To analyze residents’ reported comfort caring for critically ill children before their first PICU rotations and to compare differences between residents’ prior experiences.

Design/Methods: Pediatric residents at six programs completed surveys prior to the start of their PICU rotations that assessed their comfort with: (1) recognizing, (2) planning the initial management for, and (3) executing a care plan while awaiting a higher level of care for a critically ill child. Residents who had not yet completed a PICU rotation in residency were included in the initial data analysis.

Results: 651 residents responded to the pre-rotation survey; 539 had not previously rotated through the PICU as a resident and were included for analysis. Among these residents, 87% felt comfortable recognizing pediatric critical illness, 60% felt comfortable planning initial management, and 32% were comfortable initiating the care plan while awaiting a higher level of care. Compared to categorical or pediatric neurology residents, Medicine-Pediatrics residents were significantly more likely to report comfort initiating management (75% vs. 55%; P < 0.01) and providing care until other providers arrived (47% vs. 28%; P < 0.01). Residents with prior neonatal ICU (NICU) experience were significantly more likely to report comfort recognizing pediatric critical illness (91% prior NICU vs. 77% no prior NICU; P < 0.01). Residents with previous adult ICU (MICU) experience were significantly more likely to feel comfortable planning the initial management of a critically ill child (70% prior MICU vs. 56% no prior MICU; P < 0.05). There were no significant differences found between residents who had rotated through the PICU during medical school compared to those who had not.

Conclusion(s): Trainees with prior NICU experience are more likely to feel comfortable recognizing critical illness in children. Those with previous MICU experience are more likely to be comfortable initially managing critical illness. Medicine-Pediatrics residents are more likely to feel comfortable planning the initial and subsequent management for critically ill children. Understanding the impact of residents’ prior experiences may help programs better support trainees in learning how to recognize and initially manage critically ill children, especially as they transition to less time in the PICU during residency.