The impact of structured training on the management of agitated pediatric patients in the emergency department: changes in knowledge and self-efficacy perceptions of physicians

BACKGROUND: Children and adolescents presenting with acute behavioral agitation are increasingly admitted to pediatric emergency departments. Agitation management requires a structured and multidisciplinary approach that integrates effective communication strategies with pharmacological and non-pharmacological interventions. However, evidence-based guidance in this field remains limited, and healthcare professionals' knowledge and training levels are heterogeneous. OBJECTIVE: This study aimed to evaluate the impact of a structured training program on pediatric and child psychiatry residents' knowledge and perceived self-efficacy in the management of agitation. METHODS: This quasi-experimental educational study was conducted in a tertiary pediatric emergency department between January and August 2025. A total of 39 physicians, including pediatric residents, pediatric emergency medicine fellows, and child psychiatry residents, participated in a training program developed using the ADDIE instructional design model. The program combined theoretical instruction with case-based workshops focusing on verbal de-escalation, pharmacological management, and ethical application of physical restraint. Knowledge and self-efficacy were assessed before and after the intervention using structured questionnaires. RESULTS: Thirty-nine physicians completed the study. Post-test knowledge scores were significantly higher than pre-test scores (Z = - 3.56; p < 0.001; r = 0.56), and score improvement was observed in 64.1% of participants. No significant association was found between professional experience and pre-test or post-test scores; however, a significant negative correlation was identified between professional experience and score difference (post-test - pre-test) (r = - 0.480; p = 0.002). This finding indicates that participants with lower baseline knowledge levels achieved greater gains from the training. CONCLUSIONS: Structured, case-based, and multidisciplinary training significantly enhances physicians' knowledge and self-efficacy in managing agitated pediatric patients in emergency settings. These findings demonstrate that systematically designed, institution-specific training programs can support physician competency in pediatric emergency departments.