In the study, the residents said 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,” said the study’s lead investigator Chris Yang, M.D., a critical-care specialist at Hopkins Children’s. “Yet, most residency programs lack such training.”
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 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 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 say, including role-play involving situations specific to pediatric intensive care.
Co-authors on the study included Jennifer Leung, M.D., Elizabeth Hunt, M.D., Ph.D., Janet Serwint, M.D., Matt Norvell, and Lewis Romer, M.D., all of Hopkins; and Elizabeth Keene, of St. Mary’s Health System in Lewistown, Maine.
Founded in 1912 as the children’s hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children’s Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. Hopkins Children’s is consistently ranked among the top children’s hospitals in the nation. Hopkins Children’s is Maryland’s largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. For more information, please visit www.hopkinschildrens.org
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