(1116) Mind the Gap: Pediatric Team Leadership Skills and Self-Perceptions in Simulated Resuscitations

Introduction: Team leadership and communication are key skills of an effective physician. Trainees are still developing competence in these abilities and may have inaccurate self-reporting of their performance. Faculty observation and assessment of leadership behaviors during simulated clinical emergencies provides a source of objective feedback. Our goal was to evaluate trainee leadership skills during a simulated scenario and identify common areas of unrecognized weaknesses and strengths.

Methods: Pediatric trainees performed a simulated resuscitation scenario. Leadership skills were scored using a valid and reliable 12 question, 4-point rating scale by an instructor and trainees. A gap analysis was calculated as the difference between self and instructor scores. A significant gap threshold was defined as 0.5 for self-over appraisal and -0.5 for self-under appraisal.

Results: A total of 22 pediatric residents and 8 acute care fellows had paired assessments. Median gap was 3 (IQR: -1.25, 8); p=0.017. Median gap for residents was higher compared to fellows (4 [IQR: 1.8, 9.5] vs -3.5 [IQR: -9.1, 2.5], p = 0.008). Specific tasks which trainees over-valued their leadership abilities were sharing their mental model and briefing the team, frequent reassessing of the situation, and anticipation of future needs. Trainees under-valued their performance in refraining from active participation. The trainee was most accurate in their self-assessment of managing team resources appropriately.

Conclusions: Pediatric trainees inaccurately evaluate their leadership skills during simulation regardless of level of training. Gap analysis may be useful to identify unrecognized weaknesses and strengths both in trainees and in training programs. Pediatric trainees lack self-awareness of their deficits in sharing their mental model, re-evaluation of events and updating the team, and anticipation of future needs. Educators may review their curriculum to ensure adequate emphasis on these key team leadership and communication skills.