P3.239: Identifying the Need for a Clinical Reasoning Curriculum for Residents Rotating Through the Pediatric Intensive Care Unit

Background: Clinical reasoning is considered a core skill developed during residency but is known to be challenging to teach and to measure. Curriculums designed to teach clinical reasoning skills have been received favorably by learners and facilitators. To our knowledge, there is no clinical reasoning curriculum specifically designed for pediatric residents going through their critical care rotation. The goal of this project is to conduct a needs assessment for a clinical reasoning curriculum for pediatrics residents on their pediatric intensive care unit rotation using a survey distributed to pediatric critical care faculty and fellows at an academic stand-alone children’s hospital.

Methods: Investigators used the modified Delphi method to develop a survey examining clinical reasoning skills of pediatric residents using a 5-point Likert scale in 16 domains and to investigate clinical reasoning teaching strategies of facilitators. The survey was distributed to pediatric critical care faculty and fellows at an academic stand-alone children’s hospital in 2024. Averages with standard deviations were calculated to assess residents’ skills.

Results: The survey response rate was 84% (16/19) total. The average clinical reasoning skill of pediatric residents was estimated by faculty and fellows to be 3.3 ± 0.3. Fellows rated overall resident skill level higher than faculty (3.5 vs. 3, p = 0.002). Residents were rated highest in history and physical exam skills (avg 3.9 ± 0.4) and asking appropriate questions to make a diagnosis (3.6 ± 0.6). Residents were rated lowest in accurately ranking differential diagnosis (2.9 ± 0.5) and clarifying family goals (2.8 ± 0.9). Only 42% (8/19) respondents identified that they do teach clinical reasoning skills to residents. The most used strategies to teach clinical reasoning skills were didactic (100%), simulation (45%), faculty role modeling (55%), direct observation with immediate feedback (64%), and experiential learning with retrospective feedback (82%).

Conclusion: The average pediatric resident has room for improvement in developing clinical reasoning skills especially in regards to prioritizing differential diagnosis and communication with families. Fellows and faculty have variable approaches to how (if at all) they currently teach clinical reasoning. Development of a clinical reasoning curriculum for pediatric residents focusing on these identified skills and measuring its effectiveness are important next steps.