Helping pediatric residents cope with trauma of treating children

February 19, 2016
Ashley Jupin

Amother walks into the pediatrician’s office with her child who is experiencing headaches. Not much appears to be wrong. But after a few tests, the pediatric resident knows that a dire prognosis will need to be delivered. This situation is a nightmare for any parent, but also stressful and incredibly sad for the physician.

Dr. Jessica Lloyd, assistant clinical professor of pediatrics at UCLA, remembers such situations all too well from her own residency, completed at UCLA in 2009.

“I feel so grateful to be doing what I am doing,” she said. “Working with children and families is something that I always wanted, and I enjoy seeing the difference that I make each and every day,” Lloyd said. “But that is not to say that this job is not difficult. Working with children who are experiencing medical challenges and seeing the effect it has on their family is very emotional, and it is often tough to handle those feelings of sadness and trauma.”

Last quarter, Lloyd coordinated a team of veteran UCLA health care providers who taught pediatric residents how to balance their passion for helping children and families with the difficult realities of their profession.

“I take my responsibilities as a mentor very seriously, and I want to make sure each resident is prepared to overcome the challenges that they will face,” Lloyd said.

The result was the UCLA Pediatric Residency Resilience Training Program, a pilot project funded by UCLA’s Healthy Campus Initiative and the Department of Pediatrics. Developed in collaboration with the Semel Institute of Neuroscience and Human Behavior’s Division of Population Behavioral Health, the program drew 96 residents last fall from Olive View-UCLA Medical Center, UCLA Medical Center-Santa Monica, Cedars-Sinai Medical Center and Reagan UCLA Medical Center.

“Exposure to death is a known predictor of depression for physicians,” said Brenda Bursch, a professor of clinical psychiatry and pediatrics who developed the curriculum and co-led workshops at Reagan UCLA Medical Center. “The pediatric residents who participated in this program learned key skills and strategies that help address the ongoing stress of caring for ill and dying children.”

According to recent study published in JAMA last year, roughly 20-40 percent of medical residents experience some form of depression. Physician depression can lead to medical errors; loss of job satisfaction; burn-out and frustration; poor dietary, exercise and sleep habits; and physical or emotional illnesses. While residents in most departments experience stressful work environments that are characterized by prolonged or difficult medical procedures, seriously distressed patients and death, the additional challenge of seeing young patients suffer could place pediatric residents at higher risk.

Creating resilient residents has the potential to produce happier, healthier and more empathetic providers and to improve care and reduce errors, program organizers said.

“The moment a physician emotionally disconnects from her patients is one of the first signs of physician burn-out, which can lead to mistakes and distress,” Lloyd said. “At UCLA we know that taking care of our resident physicians allows them to be the best doctors they can be and enables them to provide the highest quality of care to our community.”

The pediatric training program is an adaptation of Families OverComing Under Stress (FOCUS), a UCLA-developed program that helps individuals cope with exceptionally tough situations by mastering approaches to goal-setting in the face of frustration, problem-solving and stress management; regulating potentially self-defeating emotions; and communicating effectively under challenging conditions. Originally designed to help military service men and women and their families cope with challenges, this new adaptation emphasizes how these strategies can be used to manage workplace stressors and the effects of traumatic experiences.

Participants attended six workshops featuring interactive presentations and activities designed to build on the residents’ strengths while exploring each FOCUS skill. Led by UCLA clinicians and faculty, the workshops allowed residents to engage with their colleagues and learn from each other’s experiences.

“We learned techniques to diffuse tense situations with parents frustrated by some aspect of their child’s care, and we practiced these tools in role-play scenarios,” said Dr. Kathryn Bradford, a pediatric resident who participated in the program.

“We are all impacted by a wide variety of challenges encountered in caring for very ill children,” Bradford said. “The workshops broke down many of the frequently encountered challenges and gave us practice with tools to reflect on past experiences and prepare for future situations.”

Currently under consideration is a plan to adapt the program for nurses and other health system employees.