(257) Leadership Skills in the First 5 Minutes of a High-Acuity Event Among Pediatric Residents

Introduction: Effective leadership is associated with improved team performance and favorable patient outcomes, yet opportunities for leading interdisciplinary teams remain rare in pediatric residency. With the ACGME reduction in minimum requirement for intensive care time, the need for exposure to high acuity situations is critical to development of leadership skills. We aim to quantify which leadership skills are demonstrated by pediatric residents leading interdisciplinary teams during simulation. We postulate that pediatric residents do not demonstrate crisis resource management (CRM) skills.

Methods: Pediatric intensivists and simulation educators from 3 institutions reviewed 31 videos of pediatric resident led interdisciplinary simulations. We measured 12 CRM skills using a published non-technical skills checklist. Each skill scored from 0-3 (maximum score 36). Outcomes were assessed for each resident team leader performance to determine whether they: led the team to appropriate diagnosis, fostered formation of a team, called for appropriate interventions, and promoted a shared mental model. Analysis included: intraclass correlation coefficients to assess interrater reliability, descriptive statistics, and Fisher’s exact test to evaluate CRM scores and relate them to 4 binary outcomes.

Results: Total scores representing all 12 CRM skills ranged from 7-26 (median 15, IQR 11-19). 87% of team leaders did not declare themselves team leaders, and core skills of resource management/seeking help and resource anticipation were infrequent. Residents performed remaining CRM skills less than half of the time. Overall, 26% of team leader performances resulted in team members sharing a mental model, 52% led to appropriate interventions for patient stabilization, and 48% resulted in appropriate diagnosis and the formation of a high functioning team. Higher CRM total score associated with team formation, shared mental model, and appropriate interventions (P < 0.05).

Conclusions: None of the 12 CRM skills are well executed by residents. Higher CRM total scores are more likely to foster team formation, shared mental model, and appropriate actions for patient stabilization. Our results highlight the need for a team leader curriculum that encourages self-identification, self-awareness, seeking help, and team management.