(1105) A Pediatric Critical Care Fellow-Driven QI Initiative to Optimize Pediatric Resident Orientation

Introduction: Pediatric residents feel underprepared for working in the new, stressful environment of the pediatric intensive care unit (PICU) when starting their rotation. In our old model, orientation materials were available online for residents to review asynchronously; however, it was unclear how many residents used these materials. In this fellow-driven QI project to improve resident preparedness for their PICU rotation, a novel orientation curriculum delivered to pediatric residents was created and refined. Our SMART aim was to improve resident self-reported comfort level by 20% for 2021-22.

Methods: Our novel orientation curriculum included an interactive conference in the spring for the incoming PGYIIs and monthly one-hour interactive virtual sessions to review unit policies, expectations and high yield basic physiology. Our outcome measure was resident comfort after participating in the orientation curriculum. Our process measures included percentage of residents participating in the orientation and resident self-reported preparedness via surveys. The process was refined via iterations of several PDSA cycles. We collected pre-and post-orientation surveys of the residents to track comfort.

Results: Residents reported feeling less nervous about the rotation- in response to “I am nervous for my upcoming PICU rotation”, 25% of residents strongly agreed on the pre survey, decreasing to 11% on the post survey. There also was an increase in understanding the expectations- in response to “I understand the expectations of me as a resident in the PICU”, 41% of residents said they disagree on the pre survey and 0% responded that they disagree on the post survey. Residents reported an increase in feeling adequately prepared; in the pre survey 33% disagreed, with 0% disagreeing on the post survey. In the post-orientation survey, 83% reported the orientation as helpful. In that survey residents suggested including high-yield PICU basics into the orientation and to change the timing; both suggestions informed iterations of our PDSA cycles.

Conclusions: Pediatric resident preparedness for their PICU rotation can be improved via multi-modal approach with a group interactive session at the beginning of the year and via monthly fellow-led orientation virtual sessions. This curriculum has maintained sustainability.