May 3, 2010
Pediatric residents unprepared for emotional turmoil with critically ill
Pediatric residents say they are unprepared to deal with some of the intense emotions they face when caring for critically ill children in the pediatric intensive care unit, according to a survey led by scientists at the Johns Hopkins Children’s Center.
In the study, the residents said that the sudden death of a patient, a parent’s grief and anger, and discord within the medical team about how to best manage the illness were the most disturbing scenarios and the ones they felt least prepared to handle.
The findings, the researchers say, underscore the need for training programs—including role play—that prepare pediatricians to manage the emotional turmoil inherent in their work.
“Successfully tackling the tough emotional issues involving critically ill children is as much a true marker of a good physician as basic medical knowledge, yet most residency programs lack such training,” said the study’s lead investigator, Chris Yang, a critical-care specialist at the Johns Hopkins Children’s Center.
In the study of 51 pediatric residents at the Johns Hopkins School of Medicine, 32 said they had faced the sudden death of a child, but only five said they felt prepared to manage the event. Twenty-two said they had experienced conflict within the medical team about how to treat a patient, but only 10 said they knew what to do when such conflict arises.
Some 28 out of 40 did not know how to manage the grief and anger of parents who have a critically ill child, and 26 out of 47 were frustrated and confused about managing a child with a terminal illness when there is no defined treatment plan.
Team discussions with fellow residents and with senior physicians in the PICU were the most helpful learning tools, the residents said.
The Johns Hopkins PICU team has instituted monthly debriefings and preemptive orientation of all incoming PICU residents, but more training is coming, the researchers said, including role play involving situations specific to pediatric intensive care.
Co-authors on the study were Jennifer Leung, Elizabeth Hunt, Janet Serwint, Matt Norvell and Lewis Romer, all of Johns Hopkins; and Elizabeth Keene, of St. Mary’s Health System in Lewistown, Maine.
The findings were presented May 1 at the annual meeting of the Pediatric Academic Societies, held in Vancouver, British Columbia.