P3.Q337: Developing the After Critical Events Educational Debrief (ACE-ED) Tool in the Neonatal Intensive Care Unit

Background: Pediatric residents experience multiple resuscitation events in the neonatal intensive care (NICU) and throughout other units in the hospital. Despite the frequency of these events, there is no standardized practice to provide a dedicated debrief following these events for pediatric residents. While there is literature supporting the role of education with debriefing for simulation scenarios, there is little to no literature on the role for educational debriefs for residents after real-life critical events. In 2021, a limited Problem Identification survey/interview of pediatric residents showed residents reported participating in debriefs less than 50% of the time. On average, only 44% of these residents were satisfied with debriefs. This highlights a current gap in resident education, and providing a standardized debrief tool may address this need. This project’s aim was to develop a standardized educational debrief tool for resident physicians for use after acute critical events in the NICU.

Methods: First, we described current resident experience of clinical debriefs through a Needs Assessment Survey. The survey inquired about frequency and participation of debriefs amongst the residents and used Likert Scales to rate their current confidence level and medical knowledge for managing these acute events, and their satisfaction with debriefs. Finally, the residents were asked to provide free text responses on their ideas for improvements.

Next, we aimed to address findings of the Needs Assessment by developing an educational debrief tool for the residents. We started with an extensive literature review looking for existing tools to serve as a foundation and applied several educational theories into our theoretical framework for the development of our tool. A Delphi consensus model with expert physician input was used to finalize tool.

Results: A total of 22 resident physicians completed the Needs Assessment survey where 54% reported participating in debriefs less than 50% of the time. Only 57% reported being satisfied with debriefs during their pediatric residency and 22% report having confidence and the medical knowledge to manage these acute pediatric resuscitations. Lastly, 43% felt their NICU rotation provided sufficient debriefing after resuscitations. Common themes included residents’ desire to discuss clinical interpretations, pathophysiology, and interventions from the case. With these findings, along with expert opinion from expert faculty, the debrief tool was developed.

Conclusion: Our needs assessment revealed residents at our institution continue to experience insufficient consistency and quality/depth of debriefing sessions after a critical incident. From our work, we have discovered that residents desire a learner-centered debrief experience, a standardized process, and for more consistent debriefing. After the extensive work developing this unique educational tool, it is now being used by resident physicians in the Texas Children’s Hospital NICU. Data evaluating the validity of the tool is currently being collected through surveys and semi-structured interview sessions with the residents.