13. PREPARING FOR THE PICU: A QUALITATIVE STUDY OF RESIDENTS FIRST TIME

Background Learning in the pediatric intensive care unit (PICU) can be stressful and complex. While theoretical models and innovative resources have been developed with the trainee in mind, few studies seek to characterize their voices and experiences. In this study, we aim to describe the resident learner as they prepare for their first pediatric critical care rotation. Methods Using a grounded-theory approach, pediatric (PM) and emergency medicine residents (EM) were interviewed before and after their rotation. The interviews were audio-recorded and transcribed. Two researchers independently coded the pre-rotation transcripts and discussed the coding system until agreement. The transcripts were then analyzed for emerging themes. Results 6 EM and 8 PM participated and emergent themes were: i) Emotions (see fig. 1): Residents feel anxious (some have yet to witness a patient death), but excited for a “really good learning experience”. ii) Preparation: Residents admit to scant formal preparation. They rely on ad-hoc methods, with the intensity of their efforts often motivated by fear from past experiences. When prompted, they report great efforts to ready significant others, clean, and plan ahead for meals. Linguistically, they prepare as one deploying for war (e.g. “put on armor”). iii) Learning goals: EM anticipate specific disease processes they may face in their career, while PM focus more on acquiring skills for future rotations. Both gravitate towards topics based on perceived commonality, chronology, and enigmatic quality. iv) Survival: Residents’ main “wellness strategy” is to sleep and eat when able. Afterthoughts include exercise, meditation, spending time with friends or pets, and mental health appointments. v) Information gaps and myths: Residents begin their rotation disoriented to PICU protocols and team roles. They also harbor conflated beliefs, for instance about their expected entrustability and being alone overnight. Conclusions Residents enter their PICU rotation with intense emotions, myths, and a survival approach in common, although they vary in their preparation methods and development of learning goals.