(1103) The Role of the Resident Physician in the Pediatric Intensive Care Unit: A 360-Degree View

Introduction: The perception of autonomy, or supported independence, enhances acquisition of resident physician knowledge and skills, and residents perceive autonomy to be important in their progression to independent practice. There is a paucity of literature describing the factors that enhance or inhibit the resident experience of autonomy in the pediatric intensive care unit (PICU). We aim to:
1. Identify factors influencing the resident experience of autonomy in the PICU, from multiple stakeholder perspectives
2. Describe behaviors that increase the likelihood of a resident being granted developmentally appropriate autonomy in the PICU.

Methods: Using grounded theory methodology, we performed semi-structured interviews with pediatric residents, PICU attendings and fellows, and PICU nurses in a freestanding tertiary care children’s hospital. Deidentified transcripts were subjected to open thematic coding to identify factors that define, augment or detract from resident autonomy in the PICU setting. Codes were then organized into themes and sub-themes.

Results: Four pediatric residents, eight PICU attendings, four PICU fellows, and two PICU nurses were interviewed. Participants identified acuity, both in terms of patient and overall unit acuity, as the key driver that can either augment or limit resident autonomy. Three themes describe the specific resident behaviors noted to augment autonomy in the highly acute ICU environment: (1) being highly present at bedside, (2) developing relationships with all ICU team members - including patient and family, (3) building trust through clear communication, help-seeking, and task completion.

Conclusions: Although resident autonomy is highly impacted by unit-specific and patient-specific acuity, residents can influence their level of autonomy by demonstrating specific behaviors. These findings should be disseminated to all PICU team members and pediatric residents to ensure optimal learning and professional development during the PICU experience.