Procedural Competency for Pediatric Residents in the Contemporary Training Environment: An Unachievable Goal?

Abstract

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.

The Need for Simulation-Based Procedural Skills Training to Address Proposed Changes in Accreditation Council for Graduate Medical Education Requirements for Pediatric Residency Programs

“…Pediatric residents in the United States already experience fewer opportunities to attain procedural experience now than they did a decade ago 4 . Recent data suggest that by the time they graduate, residents only perform an average of three of each procedure currently required by the ACGME 5 . While programs such as the Neonatal Resuscitation Program and Pediatric Advanced Life Support are commonly used to teach critical resuscitation skills, current research shows that simple participation does not guarantee competency 6,7 .…”

“…4 Recent data suggest that by the time they graduate, residents only perform an average of three of each procedure currently required by the ACGME. 5 While programs such as the Neonatal Resuscitation Program and Pediatric Advanced Life Support are commonly used to teach critical resuscitation skills, current research shows that simple participation does not guarantee competency. 6,7 As pediatricians and medical educators, we have concerns that eliminating training in lifesaving procedures, such as those still excluded within the current draft of the ACGME guidelines, will compound these already serious limitations.…”

Comparison of a dichotomous versus trichotomous checklist for neonatal intubation

“…Given concerns for limited clinical procedural exposure for trainees [1,2], medical educators must identify effective strategies to ensure procedural proficiency. Simulation is frequently utilized for skills training with numerous authors reporting improved patient outcomes after rigorous simulation-based procedural training [3][4][5].…”