Gaps in Pediatric Emergency Medicine Education of Emergency Medicine Residents: A Needs Assessment

Abstract

Background Greater than 90% of pediatric patients in the United States (US) are evaluated and treated at community-based emergency departments (EDs). Yet, recent data shows emergency medicine (EM) attending physicians have minimal exposure to critically ill pediatric patients and perform few pediatric critical procedures. Evidence suggests mortality outcomes may be worse for critically ill pediatric patients treated at centers not designated as a children’s hospital and/or centers without pediatric trauma designation. Part of the variability in clinical care may be due to the considerable heterogeneity in pediatric emergency medicine (PEM) education provided to emergency medicine (EM) resident physicians. Limited previous data has shown that EM residency program directors report deficiencies in PEM education and suboptimal confidence in resident ability to perform critical pediatric procedures. Research Question Identify perceived gaps in current PEM education provided to EM residents physicians. Methodology This was a prospective, survey-based, descriptive cohort study. We surveyed a representative cohort of recently graduated EM attending physicians (less than 5 years) from 9 institutions across the US. Surveys were sent via email and were de-identified. Responses were reported and themes analyzed. Results 167 responses were obtained from 521 eligible participants (37%). Most respondents trained at urban academic medical centers (90.4%). Most reported satisfaction with engagement by PEM faculty during residency (89.1%). Non-emergency pediatric rotations varied with proportions as follows: pediatric intensive care (50.6%), pediatric wards (20.5%), neonatal intensive care unit (31.3%) and pediatric anesthesia (26.5%). Topics perceived to be adequately covered during residency included: febrile neonate, sepsis, seizure, and respiratory failure. Topics perceived to be inadequately covered included: neonatal jaundice, neonatal resuscitation, pediatric airway, and cardiac arrest. Most reported feeling uncomfortable managing neonates (40.36%) and placing chest tubes on pediatric patients (53.01%). Whereas most reported feeling comfortable performing bag-mask ventilation (88.55%). We noted a positive association between completing NICU rotations and comfort level caring for neonates and infants (p = 0.041). Conclusion/Discussion This survey-based cohort study found considerable variation in residency experiences and perceived comfort for various pediatric emergency topics. In general, participants were more comfortable managing older children. While some topics (such as respiratory failure and BVM) were reported to be covered adequately in residency, other critical aspects of pediatric emergency care (cardiac arrest, tube thoracostomy) were not. This study found that the most significant perceived deficit in PEM education to EM trainees appears to be neonatal medicine/resuscitation. Similarly, there appears to be wide variation in comfort level managing pediatric cardiac arrest. Future research will continue to address larger cohorts, representative of the PEM education provided to EM physicians in the US to promote future educational initiatives.