A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

Abstract

Objectives: Most children seeking emergency care are evaluated in general emergency departments (EDs). The cumulative pediatric clinical experiences of emergency medicine (EM) residents are largely unknown. This study examined EM resident pediatric clinical experience through the lens of the Accreditation Council for Graduate Medical Education requirements and the Model of the Clinical Practice of Emergency Medicine. Methods: Retrospective, observational study of the cumulative clinical experience of two classes of EM residents from a 4-year training program at two pediatric EDs of a quaternary care pediatric center. A database of resident patient encounters was generated from the electronic medical record. Experiences classified included: diagnosis categories per the Model of the Clinical Practice of Emergency Medicine, procedures, and resuscitations. Results were stratified by age, acuity, and disposition.Results: Twenty-five EM residents evaluated 17,642 patients (median = 723). Most patients (73.5%) were emergent acuity (Emergency Severity Index triage level 2 or 3 or non-intensive care admission); 2% were critical. Residents participated in 598 (median = 22) medical resuscitations and 483 (median = 19) trauma resuscitations. Minor procedures (e.g., laceration repair) were commonly performed; critical procedures (e.g., intubation) were rare. Exposure to neonates was infrequent and pediatric deaths were rare. Abdominal pain (5.7%), asthma exacerbation (4.6%), and fever (3.8%) were the most common diagnoses.Conclusions: Emergency medicine residents encountered a wide array of pediatric diagnoses throughout training and performed a substantial number of common pediatric procedures. Exposure to critical acuity and procedures, neonatal pathology, and certain pediatric-specific diagnoses, such as congenital heart disease, was limited despite training in a large, quaternary care children's hospital. Curriculum development and collaboration should focus on these areas.

A pirate ship sailed into the yacht club: How we built a novel pediatric emergency medicine curriculum for an emergency medicine training program

“…Leaders in PEM have long identified the need for a standardized longitudinal PEM curriculum for EM trainees. [6][7][8][9][10][11][13][14][15]18,19,22,24,[43][44][45] We sought to create and implement a comprehensive and pedagogically sound PEM curriculum for our EM residents. The curriculum pilot was well received, and we were able to detect early evidence of program effectiveness.…”

“…5 Nevertheless, EM residents experience limited exposure in terms of breadth and acuity of pediatric presentations. [6][7][8][9][10][11] Additionally, the American Board of Emergency Medicine (ABEM) Model of Clinical Practice references age among "modifying factors" affecting patient management, which may minimize the distinctiveness of important PEM diagnoses. 12,13 Addressing these educational shortcomings, the 2018 Academic Emergency Medicine (AEM) Consensus Conference "Advancing Pediatric Emergency Medicine Education" concluded that currently there is "no clearly defined core PEM curriculum that unifies and drives the learning process" for trainees.…”

“…12,13 Addressing these educational shortcomings, the 2018 Academic Emergency Medicine (AEM) Consensus Conference "Advancing Pediatric Emergency Medicine Education" concluded that currently there is "no clearly defined core PEM curriculum that unifies and drives the learning process" for trainees. [6][7][8][9][10][11][13][14][15]…”

“…Nationwide, PEM education for EM residents is highly variable. [6][7][8][9][10][11]13,14 Thus, in June 2018, we initiated a targeted needs assessment in our department to identify gaps in our existing PEM curriculum. We conducted semistructured interviews with focus groups of graduating EM residents and PEM and EM faculty who staff our pediatric ED.…”

“…For EM training, the Accreditation Council of Graduate Medical Education (ACGME) mandates that 20% of patient encounters be dedicated to patients less than 18 years of age 5 . Nevertheless, EM residents experience limited exposure in terms of breadth and acuity of pediatric presentations 6–11 . Additionally, the American Board of Emergency Medicine (ABEM) Model of Clinical Practice references age among “modifying factors” affecting patient management, which may minimize the distinctiveness of important PEM diagnoses 12,13 .…”