474 - Emergency Medicine Residents Perceived Gaps in Education Regarding Pediatric Emergencies: A Needs Assessment

Greater than 90% of pediatric patients in the United States (US) are evaluated and treated in community-based emergency departments (EDs).  Evidence suggests mortality outcomes may be worse for critically ill pediatric patients treated at centers not designated as a children’s hospital and/or without pediatric trauma designation. Part of this variability may be due to the considerable heterogeneity in pediatric emergency medicine (PEM) education provided to emergency medicine (EM) residents.  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.


Objective:

Identify perceived gaps in PEM education during EM residency training


Design/Methods:

This was a prospective, survey-based, descriptive cohort study.  We surveyed a representative cohort of recently graduated (less than 5 years) EM physicians from 9 institutions across the US.  Surveys were sent via email and were de-identified.  Responses were reported and themes analyzed.


Results:

166 responses were obtained from 521 eligible participants (37%).  Most respondents trained at urban academic medical centers (90.4%).  Non-emergency pediatric rotation experiences varied: pediatric ICU (50.6%), pediatric wards (20.5%), neonatal ICU (31.3%) and pediatric anesthesia (26.5%).  Topics perceived to be inadequately covered during residency included: neonatal jaundice, neonatal resuscitation, pediatric airway, and cardiac arrest.  Many reported feeling uncomfortable managing neonates (40.36%) and placing chest tubes on pediatric patients (53.01%). Most reported feeling comfortable performing bag-mask ventilation (BVM) (88.55%).  We noted a positive association between completing NICU rotations and comfort level caring for neonates and infants (p = 0.041).


Conclusion(s):

This survey-based cohort study found considerable variation in residency experiences and perceived comfort for various pediatric emergency topics. In general, participants were less comfortable managing younger children. While some topics, (respiratory failure and BVM) were reported to be covered adequately in residency, other critical aspects of pediatric EM (cardiac arrest, tube thoracostomy) were not. This study found the most significant perceived deficit in PEM education is with 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, to promote future educational initiatives.