Medical Education: Resident
Medical Education 14: Resident 5
Jacob D. Rotter, MD (he/him/his)
Chief Resident
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Glen Oaks, New York, United States
As widely reported, there has been a significant increase in verbal and physical abuse directed at health care providers. Pediatric residents have not been spared this wrath. Many residents report they are ill equipped to manage these situations. Additional effective training in de-escalation techniques and situational awareness is critical.
Objective: To create and assess a longitudinal curriculum designed to assist residents in the development of the knowledge and skills necessary to manage verbal or physical abuse directed at them from their patient’s caretakers
Design/Methods: The curriculum consists of 6 workshops. Each session couples a formal presentation and a case-based discussion. The didactics were led by chief residents, social workers, security leadership, and others. Topics included an (1) introductory session; (2) understanding how to anticipate, prepare, and protect in times of crisis; (3) actively eliciting and exploring concerns with escalating families; (4) expressing empathy and understanding; (5) negotiating a mutually acceptable plan of action and providing closure; and (6) a summary session. The pediatric residents perceived comfort in the management of escalating families are being evaluated through pre- and post-surveys. Residents also participated in RCDP sessions to allow for improvement upon each iterative cycle. OSCEs, which have been validated to assess situational awareness, will be used to evaluate competence.
Results: 49 residents completed a self-assessment survey. Prior to the intervention, senior residents (PGY2, PGY3) have had more exposure to verbally and physically abusive caregivers relative to PGY1s. PGY1s have experienced an average of 3.8 encounters, whereas seniors have experienced an average of 5.1. Based on a 5-point Likert scale, senior residents were similar to interns in defining situational awareness (3.3 vs 3.19, p = 0.6) and in defining de-escalation (2.98 vs 3.125, p = 0.6). All residents appear to be more confident in identifying escalating caregivers than actively managing these scenarios (3.44 vs 2.16, p < 0.001).
Conclusion(s): Pediatric residents have been exposed to an increasing number of aggressive patients and families. Residents have identified a desire for focused training in de-escalation techniques and situational awareness. There are few, if any, longitudinal curricula that serve this need. Residents have shown confidence in being able to identify escalating patients but lack confidence and the necessary skills to help actively manage these situations. A longitudinal curriculum which focuses on these issues is an urgent need.