502 - Impact of Debriefs and Provider-Family Relationships on Resident Coping

Publication Number: 502.5325

Aashish V.. Shah, New York University Grossman School of Medicine, New York, NY, United States; Sarah Fleishaker, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Danielle Key, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Kristyn Pierce, New York University Grossman School of Medicine, New York, NY, United States; Kelley A. Groves, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Ami Shah, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Linda Tewksbury, New York University Grossman School of Medicine, New York, NY, United States

Background: The wellbeing of pediatric residents influences quality and effectiveness of patient care and team functioning. Increased exposure to the ICU environment is associated with high levels of moral distress. This may be due to the ICU serving as a primary source of exposure to end of life events and challenging experiences.

Objective: The primary aim of the study is to assess the impact of formalized end of ICU rotation debriefings on pediatric resident resilient coping. The secondary aim is to assess for factors which promote or mitigate moral distress in pediatric residents.

Design/Methods: This is a mixed methods study consisting of surveys and qualitative analysis of semi-structured interviews at a single-center academic pediatric residency program from July 2023 to June 2024. All pediatric residents rotating in the NICU/PICU were eligible to participate and completed a survey at the start of the academic year or ICU rotation and again after ICU debrief participation. The surveys include demographic information and the Brief Resident Coping Scale (BRCS). Virtual interviews were performed and recorded with a purposive sample of participants at conclusion of the academic year. All transcripts were coded by pairs of research team members then collectively discussed as a study team to develop themes once saturation was achieved.

Results: 23 residents completed the pre-rotation and 16 completed the post-debrief survey. Demographics were representative of the resident population: female (70%), Caucasian (70%) and non-Hispanic (87%). BRCS results, analyzed using Mann-Whitney U test, showed 74% of residents were medium/high resilient copers before rotation with an increase to 94% post-debrief (p=0.21) (table 1). Paired results (n=6) analyzed using McNemar’s test show a trend toward significance (p=0.16) when comparing low resilient copers to medium/high resilient copers pre/post debrief (table 2). Qualitative analysis identified medical complexity, stresses in relationships, competing priorities and end of life care as factors promoting moral distress; debrief sessions, peer and team support, external coping skills and positive moments in the ICU helped mitigate moral distress (Figure 1).

Conclusion(s): The study results demonstrate a trend toward significance in the enhancement of resilient coping skills of residents after implementation of standardized debriefs in the ICU. Residents identified debrief sessions, peer and team support and reflection on positive moments in the ICU as sources of comfort that can be incorporated into residency programs.

Table 1
Pre-post debrief BRCS score comparison, unpaired (n=39)

Table 2
Pre-post debrief BRCS score comparison, paired (n=6)

Figure 1
Moral Distress for Pediatric Residents