Pediatric Emergency Medicine Fellows' Procedural Experiences during Training

Introduction: Pediatric Emergency Medicine (PEM) fellows are expected to perform many procedures during their fellowship, but they often have limited opportunities to practice rare procedures. The number of procedures required to achieve competence remains unclear; however, research suggests that increased practice correlates with skill development. The objective of this study is to quantify the frequency of procedures performed by fellows. Also, we describe how programs currently track their trainees' experiences. Methods: This was a retrospective, multicenter, cross-sectional, descriptive study exploring procedures performed by PEM fellows enrolled in ACGME-accredited programs between July 2019 and June 2020. Fellow and program demographics were collected. We analyzed procedural tracking collected through self-reported logs and documentation within the electronic medical record. In addition, we explored how programs currently track these experiences. Procedures were standardized based on the ACGME list of required procedures. Results: Eleven fellowship programs submitted the self-reported procedure logs of 104 fellows. Of those, 2 sites reported electronic medical record-based logs. The most frequently documented procedures included medical and trauma resuscitations, procedural sedations, and intubations. The most infrequently reported were nasal packing for nosebleeds and cardiac pacing. Most participating programs tracked experiences through fellow self-report and many offer opportunities for faculty to assess competence. Conclusions: PEM fellows do not consistently report performing all ACGME-required procedures during the fellowship. In addition, there is significant variation in how fellowship programs track trainees' procedural experiences. This study may inform the development of supplemental educational curricula and the potential revision of the ACGME list of required procedures. Future research could focus on assessing procedural competence.