J Pediatr Intensive Care 2023; 12(03): 210-218
DOI: 10.1055/s-0041-1731431
Original Article

Preparing for the PICU: A Qualitative Study of Residents as They Prepare for Their First Pediatric Critical Care Rotation

1   Division of Pediatric Critical Care Medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, United States
2   Division of General Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science Universality, Portland, Oregon, United States
3   Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
4   Department of Emergency Medicine, Faculty Development, Oregon Health and Science University, Portland, Oregon, United States
1   Division of Pediatric Critical Care Medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, United States
› Author Affiliations


Learning critical care medicine in the pediatric intensive care unit (PICU) can be stressful. Through semistructured interviews (n = 16), this study explored the emotions, perceptions, and motivations of pediatric medicine (PM) and emergency medicine (EM) residents, as they prepared for their first PICU rotation. Qualitative data were collected and analyzed using the grounded theory method. Three resultant themes emerged: (1) residents entered the PICU with a range of intense emotions and heightened expectations; (2) they experienced prior history of psychologically traumatic learning events (adverse learning experiences or ALEs); and (3) informed by ALEs, residents prepared for their rotation by focusing heavily on their most basic level of physiological needs and adopting a survival mindset prior to the start of the rotation. These three themes led to a substantive, or working, theory that ALE-associated events may affect how residents approach upcoming learning opportunities. Consequently, adapting a trauma-informed approach as a component of medical education may improve resident learning experiences in the PICU and beyond.

Authors' Contributions

A.J.K. conceived and designed the study, collected the data, took responsibility for the data analysis, and was the principal author. B.W.S. made major contributions to the data analysis and interpretation, and he critically revised and made important contributions to the manuscript. L.M.Y. provided major contributions to the study design and data analysis and critically revised and made important contributions to manuscript revisions. S.P.K. was the study's principle investigator and critically revised and made important contributions to manuscript revisions. All authors approved the final manuscript for submission.

Publication History

Received: 23 March 2021

Accepted: 17 May 2021

Article published online:
01 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Bhave M, Brzezinski M. Teaching in the ICU: a comprehensive review. ICU Dir 2013; 4 (06) 270-278
  • 2 Austin W, Kelecevic J, Goble E, Mekechuk J. An overview of moral distress and the paediatric intensive care team. Nurs Ethics 2009; 16 (01) 57-68
  • 3 Wolfe KK, Unti SM. Critical care rotation impact on pediatric resident mental health and burnout. BMC Med Educ 2017; 17 (01) 181
  • 4 Tainter CR, Wong NL, Bittner EA. Innovative strategies in critical care education. J Crit Care 2015; 30 (03) 550-556
  • 5 Eraut M. Informal learning in the workplace. Stud Contin Educ 2004; 26 (02) 247-273
  • 6 Hauer J, Quill T. Educational needs assessment, development of learning objectives, and choosing a teaching approach. J Palliat Med 2011; 14 (04) 503-508
  • 7 Pugh CM, DaRosa DA, Glenn D, Bell Jr RH. A comparison of faculty and resident perception of resident learning needs in the operating room. J Surg Educ 2007; 64 (05) 250-255
  • 8 Bricker DA, Markert RJ. Night float teaching and learning: perceptions of residents and faculty. J Grad Med Educ 2010; 2 (02) 236-241
  • 9 Biondi EA, Varade WS, Garfunkel LC. et al. Discordance between resident and faculty perceptions of resident autonomy: can self-determination theory help interpret differences and guide strategies for bridging the divide?. Acad Med 2015; 90 (04) 462-471
  • 10 Yarris LM, Linden JA, Gene Hern H. et al; Emergency Medicine Education Research Group (EMERGe). Attending and resident satisfaction with feedback in the emergency department. Acad Emerg Med 2009; 16 (Suppl. 02) S76-S81
  • 11 Bryant A. The grounded theory method. In: Leavy P. ed. The Oxford Handbook of Qualitative Research. New York, NY: Oxford University Press; 2014: 117-137
  • 12 Yin RK. Qualitative Research from Start to Finish. 2nd ed.. New York, NY: The Guilford Press; 2016
  • 13 Bryant A. Grounded Theory and Grounded Theorizing: Pragmatism in Research Practice. New York, NY: Oxford University Press; 2017
  • 14 Post TW. UpToDate. Waltham, MA: 2020. www.uptodate.com
  • 15 Knowles MS. Self-Directed Learning: A Guide for Learners and Teachers. New York, NY: Association Press; 1975
  • 16 Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: a scoping review. Acad Med 2018; 93 (04) 648-656
  • 17 Substance Abuse and Mental Health Services Administration. SAMHSA's concept of trauma and guidance for a trauma-informed approach. Accessed June 15, 2020 at: https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
  • 18 Racine N, Killam T, Madigan S. Trauma-informed care as a universal precaution: beyond the Adverse Childhood Experiences Questionnaire. JAMA Pediatr 2020; 174 (01) 5-6
  • 19 Van der Kolk BA. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Viking; 2014
  • 20 Felitti VJ, Anda RF, Nordenberg D. et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14 (04) 245-258
  • 21 Kelly AR. Impact of adverse clinical training experiences on the career development of medical and psychology students. Accessed July 4, 2020 at: https://collections.lib.utah.edu/ark:/87278/s6kh3wnc
  • 22 Markman JD, Soeprono TM, Combs HL, Cosgrove EM. Medical student mistreatment: understanding ‘public humiliation’. Med Educ Online 2019; 24 (01) 1615367
  • 23 Haglund ME, aan het Rot M, Cooper NS. et al. Resilience in the third year of medical school: a prospective study of the associations between stressful events occurring during clinical rotations and student well-being. Acad Med 2009; 84 (02) 258-268
  • 24 Kemper KJ, Schwartz A. Pediatric Resident Burnout-Resilience Study Consortium. Bullying, discrimination, sexual harassment, and physical violence: common and associated with burnout in pediatric residents. Acad Pediatr 2020; 20 (07) 991-997
  • 25 Hu YY, Ellis RJ, Hewitt DB. et al. Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med 2019; 381 (18) 1741-1752
  • 26 Hu YY, Fix ML, Hevelone ND. et al. Physicians' needs in coping with emotional stressors: the case for peer support. Arch Surg 2012; 147 (03) 212-217
  • 27 Beck J, Randall CL, Bassett HK. et al. Moral distress in pediatric residents and pediatric hospitalists: sources and association with burnout. Acad Pediatr 2020; 20 (08) 1198-1205
  • 28 Bynum IV WE, Goodie JL. Shame, guilt, and the medical learner: ignored connections and why we should care. Med Educ 2014; 48 (11) 1045-1054
  • 29 Paice E, Rutter H, Wetherell M, Winder B, McManus IC. Stressful incidents, stress and coping strategies in the pre-registration house officer year. Med Educ 2002; 36 (01) 56-65
  • 30 Heru A, Gagne G, Strong D. Medical student mistreatment results in symptoms of posttraumatic stress. Acad Psychiatry 2009; 33 (04) 302-306
  • 31 Liang ZC, Ooi SBS, Wang W. Pandemics and their impact on medical training: lessons from Singapore. Acad Med 2020; 95 (09) 1359-1361
  • 32 Batley NJ, Makhoul J, Latif SA. War as a positive medical educational experience. Med Educ 2008; 42 (12) 1166-1171
  • 33 Baer TE, Feraco AM, Tuysuzoglu Sagalowsky S, Williams D, Litman HJ, Vinci RJ. Pediatric resident burnout and attitudes toward patients. Pediatrics 2017; 139 (03) e20162163
  • 34 Thomas NK. Resident burnout. JAMA 2004; 292 (23) 2880-2889
  • 35 Guadagnoli M, Morin MP, Dubrowski A. The application of the challenge point framework in medical education. Med Educ 2012; 46 (05) 447-453
  • 36 Trowbridge A, Bamat T, Griffis H, McConathey E, Feudtner C, Walter JK. Pediatric resident experience caring for children at the end of life in a children's hospital. Acad Pediatr 2020; 20 (01) 81-88
  • 37 Williams BW, Welindt D, Hafferty FW, Stumps A, Flanders P, Williams MV. Adverse childhood experiences in trainees and physicians with professionalism lapses: implications for medical education and remediation. Acad Med 2021; 96 (05) 736-743
  • 38 Overstreet S, Chafouleas SM. Trauma-informed schools: introduction to the special issue. School Ment Health 2016; 8 (01) 1-6
  • 39 Wilson PM, Kemper KJ, Schubert CJ. et al; Pediatric Resident Burnout and Resilience Study Consortium (PRBRSC). National landscape of interventions to improve pediatric resident wellness and reduce burnout. Acad Pediatr 2017; 17 (08) 801-804