A Mixed-methods Survey of the Medical Student Experience in the Pediatric Intensive Care Unit: "Start Early, Be Less Scared!"

Background: Required intensive care training during medical school has been a long-standing debate. Despite a lack of standardization of intensive care experience during medical school, residents and program directors feel that this training is important for residency preparation. The specific experience of medical students in the pediatric intensive care unit (PICU) has not been explored. This study aimed to 1) explore perceptions of pediatric interns about medical school PICU rotations, and 2) determine whether PICU rotations uniquely prepare students for core entrustable professional activities (EPAs).

Methods: This was a cross-sectional study of pediatric interns. After development and pilot testing, an electronic survey was distributed to all categorical and combined training pediatric interns three times over a one-month period from January to February 2021. Participants listed all pediatric and formative non-pediatric medical school rotations, then rated how well each rotation prepared them for 13 core EPAs via a 4-point Likert scale. Responses for PICU vs. non-PICU rotations were compared using the Mann-Whitney U test. Participants described via free text response their reasoning to complete or not complete a PICU rotation, benefits and challenges of a PICU rotation, and why they would or would not recommend a PICU rotation to a medical student. Codes and themes were elicited via content analysis.

Results: Twenty-five of 28 interns (89%) completed the survey. Perceived preparedness for EPAs was reported for 140 rotations. Twelve respondants (48%) completed a PICU rotation as a medical student. Sixteen (64%) interns would recommend a PICU rotation to students, 7 (28%) might recommend it, and 2 (8%) would not recommend it. PICU rotations prepared students significantly better than non-PICU rotations in six of the thirteen EPAs (Figure 1). There were no EPAs in which the perceived preparation from PICU rotations was significantly worse than non-PICU rotations. Qualitative analysis revealed benefits and the challenges of a PICU rotation in eight areas (Table 1). All of these contributed to both participants’ own choice, and their recommendation to other students, to complete or not complete the rotation.

Conclusion: Pediatric interns generally recommend that medical students consider completing a PICU rotation. PICU rotations prepare medical students for many aspects of residency and may provide superior training in some EPAs as compared to other rotations. However, PICU rotations are reported, at times, as having a challenging and intimidating environment, where students can feel marginalized. This information can be used by pediatric-bound students choosing rotations, academic advisors who guide those same students, and PICU educators striving to enrich students’ educational experience. In the future, we hope to both explore the perceptions of PICU rotations among students and their advisors, and also better characterize the unique elements of the PICU learning environment.