Go Run That Code: Developing Trust in Trainees to Lead Pediatric Resuscitations

Background: Cardiopulmonary resuscitation is a high-acuity, low-frequency event. Studies show gaps in trainee confidence and experience. Resuscitation has been proposed as an entrustable professional activity for general pediatric and pediatric critical care trainees. Supervisor entrustment of trainees to lead pediatric resuscitations can be challenging given the characteristics of this professional activity. Previous studies investigating the development of trust have not focused on pediatric resuscitation or the impact of clinical context or models of supervision. Purpose: To describe trust development in pediatric resuscitation highlighting the impact of context and supervision model. Methods: Qualitative, multi-institutional study using semi-structured interviews of trainees and supervisors. Interviews elucidated roles and expectations of trainees and supervisors involved in pediatric resuscitation teams and factors impacting entrustment. Results: Ten interviews were conducted, 5 trainees and 5 supervisors. Thematic analysis to achieve saturation conducted by two coders. Themes about trust development differed significantly between supervisors and trainees. Context affected the development of trust. No significant difference was noted across different supervision models. Conclusions: The development of trust in trainees to lead pediatric resuscitations is complex and multi-faceted with clinical context an important factor. Training programs may be able to incorporate curricular and institutional changes to enhance trust development.