(873) National Survey of Debriefing Education and Practices in Pediatric Critical Care Fellowship

Introduction: Many organizations including the American Academy of Pediatrics (AAP) have highlighted the benefits of debriefing including processing emotional responses, identifying areas of improvement, strengthening communication, and reducing physician burnout. While the debriefing education and practices of pediatric residents have been investigated, there is a knowledge gap among pediatric critical care (PICU) fellows, which we investigated via national survey. We hypothesized that less than 30% of PICU fellows have had formal training to lead debriefs.

Methods: We defined a debrief as a collaborative, reflective conversation with at least two people following a clinical event to review performance and/or emotional support within a month of the event, excluding Morbidity and Mortality Conferences. After a literature review, we created a survey to evaluate current debriefing practices and elicit recommendations for ideal debriefs. The survey asked about events prompting debriefs, the roles of the participants, timing, goals, barriers, efficacy, confidence level, and formal training. The survey was piloted with Pediatric Emergency Medicine fellows and PICU attendings. The REDCap survey was distributed to current PICU fellows via email to fellowship program directors in the United States, and it was open from January to April 2024.

Results: Overall, 126 of the 600 PICU fellows responded (21%): 63% have led a debrief and 20% have received formal training on how to lead a debrief. On average, fellows who led a debrief rated their effectiveness 3.6 and their confidence 3.1 on a 5-point Likert scale. Fellows reported an average of 14.4 distressing events in the last three months with 3 being debriefed. No fellows reported having zero distressing events, but 26% reported having no debriefs. Fellows desire more debriefs on non-accidental traumas, difficult families, clinical errors, and ethical dilemmas. Regarding debriefing goals, fellows wanted to focus more on team wellbeing and mental health.

Conclusions: Our survey revealed a paucity of debriefing education in PICU fellowship curricula, as less than 20% of fellows reported receiving formal training. Results from this survey can be used in the future to guide curricular efforts in this area. Over 90% of fellows favored a formal debriefing education.