P2A355: Assessing Resident Preparedness for the Pediatric Intensive Care Unit Rotation

Background: Throughout medical training, residents rotate through varying clinical environments at a rapid pace. The pediatric intensive care unit (PICU) is one of high acuity, heterogeneity, and complex pathophysiology. As such, the learning curve for pediatric residents is steep, and it is even more notable for off-service residents from anesthesiology or emergency medicine programs who have less pediatric experience. Thus, it is imperative that residents can start their PICU rotations with some understanding of expectations and basic clinical concepts. We therefore sought to assess current perceptions of resident preparedness for PICU rotations and develop methods to improve unit orientation.

Methods: Pediatric, anesthesiology, and emergency medicine residents who rotated through the PICU over a single academic year (July 2021 – June 2022) were surveyed regarding their orientation and readiness to start the rotation. Beside PICU nurses were also surveyed about their perceptions of resident preparedness for the PICU.

Results: Of 42 residents who rotated through the PICU, 23 (55%) responded to our survey. Of those, 52% (12) were pediatric residents, 35% (8) were anesthesiology interns, and 13% (3) were emergency medicine interns. Six residents had rotated through the PICU previously, and 15 residents (65%) rotated through another ICU prior to their PICU rotation. Residents endorsed general discomfort with the care of critically ill patients of any age, with 61% (14) reporting feeling somewhat or very uncomfortable and none feeling very comfortable. Only 35% of residents reported satisfaction with their orientation to the PICU, and 44% reported understanding faculty expectations. Despite this, 77% of residents endorsed understanding how to place orders in the PICU, and 59% reported understanding the PICU daily schedule, tasks, and structure. In regard to basic clinical concepts, very few residents expressed comfort with management of vasopressors (23%), sedation (22%), or mechanical ventilation (14%).

Surveys were completed by 53% (63/120) of bedside PICU nurses. Only 36% agreed that residents were well-prepared for their PICU rotation, with 51% somewhat or strongly disagreeing. Specifically, nurses commented that residents should understand dosing of medications, how to place orders, and how to communicate effectively with nurses at the bedside or via messaging applications.

Conclusion: Residents and nurses agree that improvements to resident orientation to the PICU are needed and are of critical importance given the high acuity and complexity of our patient population. To achieve this, a video series was created to introduce residents to the PICU and relevant clinical concepts, including order entry and basics of vasoactive medications, sedation, and mechanical ventilation. The video orientation series was implemented this past academic year, and data collection regarding resident and nursing perspectives on preparedness for the PICU is ongoing.