14 Exploring factors contributing to Secondary Traumatic Stress in residents during a child maltreatment paediatrics rotation

Abstract

Abstract Background Secondary Traumatic Stress (STS) refers to the distress and emotional disruption experienced by individuals caring for those who have experienced trauma. STS is increasingly recognised in child serving professions, especially in medical trainees and clinicians working in Child Maltreatment Paediatrics (CMP). Paediatric resident physicians are typically of younger age, work long hours in stressful conditions, and have limited CMP experience. This makes them particularly vulnerable to experiencing STS. In addition to affecting the wellbeing of trainees, STS can impede performance at work and affect patient care. Thus, it is important to understand and mitigate the development of STS among paediatric trainees during their CMP rotation. Objectives This study aims to identify key factors contributing to STS among medical residents at a tertiary care paediatric hospital during a CMP rotation. Design/Methods Qualitative interviews and focus groups were conducted to explore the experiences and perceptions of CMP trainees, staff physicians, and psychologists. Quality Improvement methods including a Fishbone diagram (figure 1), 5-whys analysis, and Pareto analysis (figure 2) were used to analyze the factors that contribute to residents developing STS symptoms. Results Our analysis revealed the following themes contributing to STS symptoms in paediatric residents: (1) limited awareness and education on STS symptoms, (2) lack of planned case debriefing, (3) residency-related burn out, (4) limited experience in CMP, (5) hidden curriculum of residency, and (6) limited opportunity to discuss STS symptoms. Conclusion Our study identified factors related to both limited knowledge around STS, and limited opportunities to debrief cases that may contribute to the development of STS among residents. These factors can, in part, be addressed on a program level. This aligns with existing STS literature which emphasizes implementing program level strategies to support professionals in addition to prioritizing self-care. Next steps involve implementing targeted interventions within the rotation to help mitigate STS effects on trainees.