557 - Pediatric Emergency Medicine Fellows' Procedural Experiences during Training

Pediatric Emergency Medicine (PEM) fellows must be trained to perform a wide variety of numerous procedures during fellowship. Studies of trainees in pediatrics and other specialties show they have insufficient opportunities to practice procedures that occur infrequently. The number of procedures physicians must perform to develop procedural competence is unclear, however, frequency of opportunities to practice procedures seems to correlate with skill attainment.

Objective: The objective of this study is to quantify the frequency of procedures a fellow may experience during their PEM fellowship training.

Design/Methods: This was a retrospective, multicenter, cross-sectional study exploring PEM fellows' procedural experiences during three years of training (2017-2020). Fellow and program demographics, including how procedural data is tracked at the institution, were collected.  All the participating fellowship programs submitted self-reported procedure logs and/or data extracted from the Electronic Medical Record (EMR) via an electronic data repository. Self-reported and EMR procedure logs were standardized and organized into categories based upon the list of ACGME-required procedures. Associations between demographic factors and procedure frequency were evaluated.

Results:

Eleven US-based fellowship programs participated, submitting self-reported procedure logs for a total of 104 fellows. Two sites also reported their EMR procedures. Program sizes ranged from six to eighteen fellows. Most participating programs track experiences through fellow self-report (81.8%) and require or encourage their fellows to log their experiences (100%). Third-year fellows (OR=1.39; p-value< 0.001) and Emergency Medicine residency-trained fellows (OR=1.87; p=0.04) were more likely to report a higher frequency of procedures. The most frequently reported ACGME-required procedures included intubations, resuscitations, and laceration repairs. The most infrequently reported procedures were cardiac pacing, tracheostomy tube replacement, and vaginal delivery.  

Conclusion(s): Identification of procedures PEM fellows have fewer opportunities to practice may inform supplemental educational opportunities to optimize skill development. How programs track fellows’ procedures and which procedures they track vary widely between programs. This study lays the groundwork for future investigations, including standardization of procedural documentation among programs and investigation of procedural competency assessments.