504 - Implementing and Evaluating a Verbal De-escalation Curriculum for Pediatric Residents

Publication Number: 504.5273

Julia S. Turock, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Young Bo Sim, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Sarah Gustafson, UCLA David Geffen School of Medicine, Los Angeles, CA, United States

Background: Pediatric residents are often the first medical providers called to address patient or caregiver agitation. However, verbal de-escalation training has largely focused on physicians in emergency medicine or psychiatry settings, or on non-physician staff. The few prior studies of de-escalation training for pediatric residents have demonstrated improved resident self-assessment of their de-escalation skills.

Objective: Implement and evaluate a curriculum to teach verbal de-escalation skills to pediatric residents.

Design/Methods: Incoming pediatrics interns participated in a verbal de-escalation training. The interns received a didactic lecture, participated in 2 standardized patient (SP) simulation encounters, and then debriefed the encounters with a faculty facilitator. The primary outcome of this study was the interns’ self-assessed confidence in their verbal de-escalation skills, measured using a survey administered immediately pre- and post-intervention and at 2-month follow up. Descriptive statistics were used to report survey findings. A paired t-test was used to examine the differences in confidence scores between the pre-intervention, post-intervention, and follow-up assessments.

Results: 31 interns participated in the training and completed the pre-intervention survey. 30 interns completed the post-intervention survey and 10 completed the follow-up survey. Interns demonstrated significant improvement in their confidence scores after implementation of the intervention, with the average confidence score increasing from 10.4 to 16.6 (p < 0.01) (Figure 1). At the follow-up assessment, the average confidence score decreased to 14.5, which was significantly lower than post-intervention (p < 0.01) but was still significantly higher than pre-intervention (p < 0.01). The training was well-received by the interns, with all participants rating the training as good or very good (Table 1). At the 2-month follow-up assessment no residents reported any negative emotional sequelae from the training.

Conclusion(s): Verbal de-escalation training improves residents’ self-assessed confidence in their verbal de-escalation skills. This gain in confidence declined after two months, though did remain significantly above the pre-intervention baseline. This indicates that additional trainings throughout the year may be necessary to maintain confidence in verbal de-escalation skills. Future studies should focus on more objective outcomes, such as SP or faculty evaluations of the residents’ de-escalation skills, or on patient-centered outcomes, such as number of behavioral codes called.

Figure 1
Graph demonstrating intern confidence scores pre- and post-intervention and at the 2-month follow-up. Matched data are presented for individual participants.

Table 1
Interns’ rating of their agreement with the listed statements. Other survey response options included strongly disagree, somewhat disagree, and neither agree nor disagree, but were omitted from the table as they were not selected by any participants.