Aims Paediatric trainees will likely encounter the death of a child during their training, but there has been little investigation into the impact of this on their psychological well-being. The aim of this national survey was to explore the magnitude of this problem.
Methods All UK Health Education Deaneries were invited to send out a survey to RCPCH trainees. The survey was designed to identify trainees’ previous experiences of child death and randomly presented questions to identify features of Acute Stress Reactions (ASR) or Post-Traumatic Stress Disorder (PTSD). Data collection was anonymous and quantitative interpretation was with a Chi-square test. A p value of<0.05 was considered significant.
Results 604 surveys were distributed and 303 surveys completed (50% return). 67% of trainees report no specific training in child death, yet 90% of trainees have been involved with the death of a child. A debrief was held in 48% of these cases. In 21% of these occasions the trainee could not attend (for reasons of clinical provision in 56%). 17% of trainees did not feel supported by senior staff after a child had died. After involvement with a child death, 81% of trainees had one or more of the individual features required for the diagnosis of PTSD; 9% of trainees met the full criteria for ASR and 5% for PTSD. Worryingly, following the death of a child, 49% reported feelings of guilt and 2% of trainees had to take time off work. There was no statistical association between gender, seniority, less than full time trainees, being a parent or having worked on PICU and the risk for developing PTSD/ASR. However, attending a formal debrief seemed to increase the risk of PTSD/ASR (p=0.036)
Conclusions Child death negatively impacts on the psychological well-being of paediatric trainees. This needs to be addressed so that trainees are able to work safely and effectively. The provision of training in child death is variable and there is huge scope for improvement. Further work to (1) explore the debrief and (2) the effect on other staff members involved in these situations, including the consultant body is required.
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