(1105) Resident Perceptions of PGY-1 Pediatric Critical Care Rotations

Introduction: By the end of Post Graduate Year (PGY) 1, fewer than 25% of pediatric residents are deemed entrustable to resuscitate, stabilize, and triage a patient with remote supervision. However, early PGY2 residents are often the most senior in-house physician on pediatric units. We identified that PGY1 pediatric critical care (PICU) rotations may contribute to self-perceived clinical skills, enhancing trainee competence. Only 16.3% of pediatric residency programs require PGY1 PICU rotations, down from 23% in 2003. We conducted a qualitative study of senior pediatric residents to explore the impact and experience of a PGY1 PICU rotation.

Methods: We performed interviews with residents at six programs that required 4-week PGY1 PICU rotations. The programs varied in size, geographical location, and PICU fellow presence. Interviews were coded using the constant comparative method.

Results: We conducted 18 interviews between April and June 2024. Participants included 10 PGY2s and 8 PGY3s planning varied careers.
Key themes included: skill development, improved confidence, and impact of the learning climate. Residents described learning how to recognize and manage sick patients, care for medically complex patients, efficiently manage hospital workflow, and lead difficult conversations. These skills helped residents feel more prepared for the senior resident transition.
The learning climate directly impacted reported PICU experience. A positive experience was dependent on both a strong culture of support and a sense of belonging in the clinical team. PGY1s typically experienced high support, but were sometimes devalued. Several residents described themselves as “useless” and “a liability” in the PICU, a perception occasionally reinforced by supervisors’ actions. Supervisors who taught, supported and valued the PGY1 were seen as facilitating tremendous growth.

Conclusions: PGY1 PICU rotations are perceived as valuable for developing vital senior resident skills, especially within a supportive and inclusive learning environment. This finding is crucial given the 2025 ACGME changes to general pediatrics training, which functionally reduce total PICU rotations. Future efforts will evaluate the impact of PGY1 PICU rotations on entrustment and optimize the PICU learning environment.