10. GRIEF DEBRIEFS: PROVIDING DEBRIEFS FOR RESIDENTS AFTER PEDIATRIC PATIENT DEATHS

Abstract

Background The inability to process grief in response to the death of a patient contributes to burnout in medicine. Pediatric residents are directly involved in caring for children with life-limiting disease. A 2017 survey of pediatric residents at the University of Minnesota revealed shared reactions to patient death including work avoidance, decreased productivity, questioned decision-making, loss of confidence, depression, and anxiety. Formal debriefs for our residents were infrequent. Methods A secure email account was used to notify residents of a patient death. Chief residents aimed to facilitate an optional debrief for all trainees within 72 hours. During the debriefs, an additional chief resident held all pagers to ensure protected time with limited distractions. We followed a published bereavement debriefing template. When possible, a chaplain or palliative care attending was present. Results To date, we have held 24 debriefs for 31 patients. Themes discussed included futility of care, personal guilt, helplessness or the sense of providing unfounded optimism, communication breakdown, medical ambiguity, self-care, and honoring the memory of our patients. When surveyed in December 2018, 47% of residents had attended a debrief, and 100% found them helpful or extremely helpful in processing patient deaths. Residents reported that the debriefs promoted “long term wellness”, “insight into emotions”, and “practical ways to process grief”. Time and location of debriefs were factors that both facilitated and prevented attendance. Conclusions We have held a debrief after the majority of inpatient pediatric deaths. Debriefs enable residents to process grief together and enhance community in our program. Since our residents train at four different hospitals, we will continue to identify times and locations that promote attendance. We will continue to gather data from residents on process improvement and effects on well-being in medicine in the hopes that interventions such as these can positively impact the culture of medicine.