• M S Jellinek, I D Todres, E A Catlin, E H Cassem, and A Salzman.
• Psychiatry Service, Massachusetts General Hospital, Boston 02114.
• Crit. Care Med. 1993 May 1;21(5):775-9.

PurposeTo describe the dark side of pediatric intensive care fellowship training and offer educational approaches for understanding feelings of fallibility, anger, frustration, and loss.Data SourcesListening and observing fellows in the courses of their pediatric intensive care training and later careers.Study SelectionStudies that discussed pediatric residency and fellowship training, especially in the context of intensive care.Data ExtractionFrom group meetings, unit conferences, rounds, individual discussions, and child psychiatric consultations.Results Of Data SynthesisPediatric intensive care unit (ICU) fellows gain a sense of mastery from the nature of their work: complex, technological, and frequently lifesaving. They face the usual personal stresses of extended training, including long work hours, limited financial resources, and relative isolation from family and friends. Pediatric ICU fellows confront deeper, "dark" feelings regarding their own high expectations, fallibility, anger, sense of loss, frustration, limited control, and the need to work closely with tense, grieving families. If the dark side is not acknowledged, fellows, team members, and faculty are likely to experience anger, detachment, and depression that may extend beyond work into their personal lives.ConclusionsSince the dark side is expected, normal, and inevitable, fellowship training programs should help fellows cope with and understand these feelings. Such understanding requires a sense of trust among intensive care staff and can be gained through group discussions, mentorship, specific team conferences, and child psychiatric consultation.

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