Pediatric Emergency Medicine (PEM) Core Procedure Comfort Level Among Current and Incoming Fellows

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ESPR179
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Abstract: :

Pediatric Emergency Medicine (PEM) Core Procedure Comfort Level Among Current and Incoming Fellows 


Background: There are no current standardized procedural education programs that all PEM fellows are expected to complete at the beginning of their fellowship. The Accreditation Council for Graduate Medical Education (ACGME) outlines core procedures for PEM fellows but some of the listed procedures are not encountered often and many PEM physicians express some discomfort with them. 


Objective: This is a survey study with an aim to assess the comfort level of current and incoming PEM fellows with common pediatric emergency department (PED) procedures. We hope to determine which procedures have perceived discomfort to understand how best to create a procedural education curriculum that all fellows would complete at the start of fellowship. 


Methods: We compared the procedures outlined by the ACGME for both pediatrics residency and PEM fellowship and selected procedures with significant overlap. We selected thirteen procedures and organized these into five categories: anesthesia, infectious analysis, orthopedics, trauma/medical resuscitation and wound care. The survey was developed on REDCap and the comfort level for each procedure was graded on a 5-point Likert scale. Respondents were required to identify their year of training: third-year pediatric resident matched into PEM or first, second or third-year PEM fellow. We created a demographics section inquiring about location of the training hospital, annual PED volumes or prior medical work experience. The survey was approved by the PEM Program Directors (PDs) Survey Committee and distributed to all PEM PDs to send out to their current and incoming PEM fellows. A second survey on SurveyMonkey was also sent to all the PEM PDs to indicate the total number of trainees to whom they sent the survey. 


Results: There were 227 survey responses with a response rate of 49.5%. About 90.6% of respondents were trained at urban, university hospital programs. Level of perceived comfort appeared to increase with higher levels of training. The procedures with the majority of responses in the uncomfortable or very uncomfortable categories were chest tube placement (66%) and central line placement (73%). The procedures with the most responses in the comfortable or very comfortable categories were lumbar puncture (93%), simple laceration repairs (97%) and abscess incision and drainage (91%). 


Conclusion: This study provides an overview of comfort levels for a broad range of PED procedures among all current and incoming PEM fellows. While there is variability in the perceived comfort levels with certain procedures among PEM fellows, there are some procedures with which most trainees feel uncomfortable. These results demonstrate a need for increased procedural education, specifically for incoming PEM fellows.

Icahn School of Medicine at Mount Sinai Hospital
Icahn School of Medicine at Mount Sinai
Icahn School of Medicine at Mount Sinai

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