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Hilgenberg SL, Bogetz AL, Leibold C, Gaba D, Blankenburg RL. Acad. Pediatr. 2019; 19(3): 283-290.


Department of Pediatrics, Lucile Packard Children's Hospital, Stanford School of Medicine, 725 Welch Road, MC 5906, Palo Alto, CA 94304. Electronic address:


(Copyright © 2019, Academic Pediatric Association, Publisher Elsevier Publishing)






OBJECTIVE: Medical providers struggle when communicating with angry patients and their caregivers. Pediatric residents perceive communication competencies as an important priority for learning, yet they lack confidence and desire more training in communicating with angry families. Few curricula exist to support trainees with de-escalation skill development. We developed, implemented, and evaluated the impact of a novel de-escalation curriculum on pediatric resident communication skills.

METHODS: Randomized controlled trial of a 90-minute de-escalation curriculum for pediatric residents in August-September 2016. Trained standardized patient (SP) actors rated residents' communication skills following two unique encounters before and after the intervention/control session. Residents completed a retrospective pre-post communication skills self-assessment and curriculum evaluation. We used independent and paired t-tests to assess for communication improvements.

RESULTS: 84 of 88 (95%) eligible residents participated (43 intervention, 41 control). Residents reported frequent encounters with angry caregivers. At baseline, interns had significantly lower mean SP-rated de-escalation skills than other residents (P = .03). Intervention residents did not improve significantly more than controls on their pre-post change in mean SP-rated de-escalation skills. Intervention residents improved significantly on their pre-post mean self-assessed de-escalation skills (P ≤.03).

CONCLUSIONS: Despite significant self-assessed improvements, residents' SP-rated de-escalation skills did not improve following a skills-based intervention. Nevertheless, our study illustrates the need for de-escalation curricula focused on strategies and peer discussion, suggests optimal timing of delivery during fall of intern year, and offers an assessment tool for exploration in future studies.

Copyright © 2018. Published by Elsevier Inc.

Language: en


C, Control; De-escalation; I, Intervention; ICC, intraclass correlation coefficient; List of Abbreviations: SP, Standardized patient; Medical education; PGY, Postgraduate year; Pediatrics; RCT, Randomized controlled trial; Residency; curriculum


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