Pediatric Resident Children's National Health System, District of Columbia, United States
Background: In the context of a national youth mental health crisis, pediatric residents are increasingly positioned as frontline providers during behavioral and mental health emergencies. Specific training in first-line verbal and environmental interventions is necessary to optimize the safety and emotional wellbeing of both patients and providers in these situations. Objective: To evaluate a novel curriculum for pediatric residents that combines didactic education, case studies, and simulation to develop skills in leading a behavioral de-escalation. Design/Methods: This curriculum was created by a group of pediatric residents with collaboration from hospital medicine, child psychiatry, simulation education, and nurse educator teams. The curriculum comprises four sessions throughout the academic year, sequentially targeting higher-complexity learning objectives on Bloom’s Taxonomy (Figure 1). The first two sessions are large group didactics taught during residency-wide education hours. The last two sessions are interactive and interprofessional, taking place monthly for the inpatient Adolescent team, including residents, fellows, and nurses. Pre- and post-curriculum surveys utilize a 5-point Likert scale to assess resident confidence in five learning objective areas: Identifying risk factors for behavioral escalation, recognizing early signs of escalation, utilizing appropriate personnel and resources, employing verbal de-escalation strategies, and determining appropriateness of chemical or physical restraints. Unpaired t-tests were used to compare pooled pre- and post-curriculum responses. Results: A total of 37 pediatric residents completed pre-curriculum surveys at the beginning of the academic year, and 11 completed post-curriculum surveys during the first academic quarter. Residents completing the post- survey reported significantly higher confidence in all five learning objective areas than the pre- survey group (p < 0.001) (Figure 2). Residents completing the post-survey also reported increased confidence in their overall ability to lead a behavioral emergency de-escalation after curriculum participation, with mean score increasing from 2.7 to 4.0 on a 5-point scale (p= 0.003) (Figure 3).
Conclusion(s): Residents are more confident leading teams in behavioral emergencies after participating in this focused curriculum. Future study development may include other measures of efficacy such as team performance in simulated exercises, frequency of inpatient use of restraints, and staff and provider wellbeing. thumbnail_Figure 1 PAS.jpeg
