P3.R342: Needs Assessment for a Verbal De-escalation Curriculum for Pediatric Residents

Background: Pediatric residents are often the first providers called to address patient or caregiver agitation. However, verbal de-escalation is not commonly taught in pediatric residency curricula. The few prior studies of de-escalation trainings for pediatric residents have demonstrated improved resident self-assessment of their de-escalation skills.

Methods: A needs assessment survey was written and reviewed by local experts and cognitive interviews were conducted with 2 pediatric residents and 1 chief resident. The survey was distributed to all pediatrics, medicine-pediatrics, and child neurology residents via listserv email. Descriptive statistics were used to report survey findings. Fisher’s exact test was used for comparison of confidence ratings. Spearman’s correlation coefficient was used to assess associations.

Results: 36 out of 104 residents completed the survey (35% completion rate). 30 (83%) of the residents had not completed any prior verbal de-escalation training. 25 (70%) residents experienced patient agitation at least once per week and 34 (94%) residents experienced caregiver agitation at least once per week.

On a 5-point scale, the average resident rating of their confidence in their ability to de-escalate an agitated patient and caregiver was 2.6 and 2.7, respectively (between slightly and somewhat confident). Only 4 (11%) residents felt fairly or completely confident in their ability to verbally de-escalate an agitated patient and only 5 (14%) residents felt fairly or completely confident in their ability to verbally de-escalate an agitated caregiver. There was no difference in confidence ratings for de-escalation of an agitated patient or caregiver by class year (P=0.09 and P=0.24, respectively). There was no association between frequency of experiencing patient agitation and confidence ratings for de-escalation of an agitated patient (P=0.96). There was also no association between frequency of experiencing caregiver agitation and confidence ratings for de-escalation of an agitated caregiver (P=0.81).

28 (78%) residents felt that it was very or extremely important for residents to receive verbal de-escalation training and 27 (75%) residents were very or extremely interested in receiving such training. The most preferred teaching methods were simulation (61%), didactic lecture (58%), and group discussion (56%).

Conclusion: This needs assessment highlights that pediatric residents are frequently exposed to both patient and caregiver agitation, but do not feel highly confident in their ability to perform verbal de-escalation. Additionally, given that there is no difference in confidence across class years and that there is no association between frequency of experiencing agitation and confidence, it is clear that “on the job” training is insufficient for the development of de-escalation skills. Most residents feel that verbal de-escalation training is important and are interested in receiving such training. Given the needs revealed by this study, we will develop a verbal de-escalation curriculum for pediatric residents utilizing the identified preferred teaching methods.