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Background: Pediatric residents do not get adequate experience with the procedural skills required by the Accreditation Council for Graduate Medical Education (ACGME). This lack of procedural experience can impair procedural competency prior to entering unsupervised practice.Objective: Describe procedural experience of pediatric residents at diverse tertiary care academic centers in United States, and how procedural experience was impacted by year of training, program size and career choice. Methods: Anonymous survey was emailed between September 2017-July 2018 to current pediatric residents (2 nd /3 rd year) and recent graduates of nine demographically and geographically diverse programs. Subjective recall of procedural experience, self-perceived proficiency in procedural skills and preferred training methods were explored.Results: Response rate was 28% (173/622). Only 6% (11/173) had completed >/= 1 of each procedure recommended by the ACGME. Residents who were more advanced in their training, from smaller and medium sized programs and with defined plans post-residency completed more procedures. Most (90%) desired additional procedural exposure.Conclusions: Majority of recently graduated pediatric residents had not attempted all ACGME required procedures, and were unlikely to have achieved procedural competency. Developing objective standards to ensure competency in ACGME-required procedures prior to entry into unsupervised practice remains an important task for pediatric educators.

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