Leadership and Communication Skills Used by Pediatric Residents in the First 5 Minutes of Simulated High-Acuity...

Effective leadership enhances clinical team performance through collaboration, resource management, and communication. Currently, most resident physicians learn leadership skills through informal apprenticeship.

This observational study quantifies the leadership and communication skills (LCS) demonstrated by pediatric residents leading interdisciplinary teams in simulated life-threatening events at a single institution using retrospective video review. Using a checklist of LCS, 3 authors each scored the occurrence of 12 LCS skills within the first 5 minutes of response, plus binary outcomes related to appropriate diagnosis, team formation, appropriate interventions, and a shared mental model. Intraclass correlation coefficients assessed interrater reliability. Wilcoxon rank-sum and Fisher's exact tests compared LCS scores to scenario types and outcomes.

Thirty-one residents led interprofessional teams in 16 cardiogenic shock and 15 status epilepticus scenarios. Average intraclass correlation coefficients were 0.68 to 0.96. Total scores for the 12 LCS skills ranged from 7 to 26 (median 15, interquartile range 11-19). Residents performed most LCS skills less than half of the time, scoring highest in reassessment, soliciting team input, and refraining from active participation. Only 13% of residents declared themselves team leaders at any point, and core skills of resource management, anticipation, and seeking help were infrequently demonstrated. Overall, team leader behaviors resulted in 15 (48%) appropriate diagnoses, 18 (58%) team formations, 16 (52%) appropriate interventions, and 8 (26%) shared mental models.

Pediatric residents inconsistently demonstrate LCS, regardless of familiarity with the simulated scenario, highlighting that these skills may not be effectively learned through traditional curricula. Our findings underscore the need for a targeted leadership curriculum.