Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
American Academy of Pediatrics, Elk Grove Village, Ill.
Acad Pediatr. 2018 Jan-Feb;18(1):73-78. doi: 10.1016/j.acap.2017.08.001. Epub 2017 Aug 4.
To determine pediatric resident training and preparation for 14 Accreditation Council for Graduate Medical Education (ACGME)-required procedures.
We included a national, random sample of 1000 graduating pediatric residents in 2015. For each of the ACGME-required procedures, residents were asked if they received training, successfully completed the procedure at least once, were comfortable performing the procedure unsupervised, and desired more training. To examine relationships among these 4 measures of training, we conducted logistic regression models and receiver operating characteristics curves. We used chi-square to examine whether desiring more training varied according to program size or career goal.
Response rate was 55% (550 of 1000). More than half of the residents received training in each procedure (56.4%-99.3% across procedures) and had successfully completed them at least once (59.8%-99.6%). However, 91.3% desired more training in at least 1 procedure, and 30.0% would like more training in more than half of the procedures (≥8). Relationships were found between the 4 training measures, with some relationships stronger than others. Residents with primary care goals were more likely than those with subspecialty or hospital practice goals to desire more training in abscess incision and drainage and temporary splinting of fractures (P < .05). Residents in large programs were more likely than those in smaller programs to desire more training in bladder catheterization, peripheral intravenous catheter placement, and venipuncture (P < .05).
Although pediatric residents are overall well prepared to perform ACGME-required procedures, exceptions exist. Considering the role of program size and resident career goal might help when optimizing and individualizing resident procedural training and preparation.
确定儿科住院医师培训和准备情况，以满足 14 项毕业后医学教育认证委员会（ACGME）要求的程序。
我们纳入了 2015 年 1000 名毕业的儿科住院医师的全国随机样本。对于每项 ACGME 要求的程序，住院医师都被问到是否接受过培训、是否至少成功完成过一次、是否能够在无人监督的情况下进行该程序、是否希望接受更多培训。为了检查这 4 项培训措施之间的关系，我们进行了逻辑回归模型和接收者操作特征曲线分析。我们使用卡方检验来检查是否希望接受更多培训的情况是否因项目规模或职业目标而异。
回复率为 55%（550/1000）。超过一半的住院医师接受了每项程序的培训（56.4%-99.3%），并且至少成功完成过一次（59.8%-99.6%）。然而，91.3%的住院医师希望在至少 1 项程序中接受更多培训，30.0%的住院医师希望在超过一半的程序（≥8）中接受更多培训。这 4 项培训措施之间存在关系，其中一些关系比其他关系更强。与专科或医院实践目标相比，以初级保健为目标的住院医师更有可能希望在脓肿切开引流和骨折临时固定方面接受更多培训（P<.05）。大项目的住院医师比小项目的住院医师更有可能希望在膀胱导管插入术、外周静脉导管放置和静脉穿刺方面接受更多培训（P<.05）。
尽管儿科住院医师总体上准备充分，可以执行 ACGME 要求的程序，但也存在例外情况。考虑项目规模和住院医师职业目标的作用，可能有助于优化和个性化住院医师的程序培训和准备。
