From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1578-e1581. doi: 10.1097/PEC.0000000000002121.
Pediatric procedural sedation (PS) has been performed with increasing frequency by pediatric emergency physicians for recent years. Accreditation Council for Graduate Medical Education Pediatric Emergency Medicine fellowship core competency requirements do not specify the manner in which fellows should become proficient in pediatric PS. We surveyed the variety of training experience provided during fellowship and whether those surveyed felt that their training was sufficient.
A 35-question survey offered to pediatric emergency fellows and recent (within 10 years) graduates collected data on pediatric PS training during fellowship. A follow-up questionnaire was sent to fellowship directors at programs where fellow or graduate respondents stated that a sedation curriculum that existed asked details of their program.
There were 95 respondents to the survey, 62% of which had completed pediatric emergency medicine fellowship training. Of respondents, 65% reported having a formal sedation curriculum during fellowship. Of those who participated in a formal curriculum, 82% of respondents felt comfortable performing sedation, whereas the remaining 18% required additional preceptorship and/or more formal training to feel proficient. Fifty-six percent of respondents reported having to complete a set number of sedations before being allowed to sedate independently. Of 17 programs contacted, 9 fellowship directors responded. All 9 included didactics, 6 (66.6%) of 9 included evidence-based medicine literature review, and 6 (66.6%) of 9 included simulation. Other modalities used included supervised clinical experience in a pediatric sedation unit, a 2-week rotation with a hospital sedation team, online sedation modules, and precepted sedations using each pharmacologic agent including nitrous oxide, ketamine, propofol, and ketamine-propofol combination. Ketamine was the most frequently used agent for sedation (87%).
Pediatric emergency medicine fellowship requirements lack a clearly defined pathway for training in PS. Data collected from both current and former fellows depict inconsistency in training experience and suboptimal comfort level in performing these procedures. We suggest that fellows receive a more comprehensive and varied experience with multiple teaching modalities to improve proficiency with this critical and complex aspect of emergency pediatric care.
近年来，儿科急诊医师越来越频繁地进行儿科程序镇静（PS）。毕业后医学教育认证委员会（Accreditation Council for Graduate Medical Education）的儿科急诊医学奖学金核心能力要求并未具体规定研究员应如何熟练掌握儿科 PS。我们调查了奖学金期间提供的各种培训经验，以及接受调查的人是否认为他们的培训足够。
向儿科急诊研究员和最近（10 年内）毕业的研究员提供了一项包含 35 个问题的调查，收集了在奖学金期间进行儿科 PS 培训的数据。向在研究员或毕业生表示存在镇静课程的计划的计划主任发送了后续调查问卷，以了解其课程的详细信息。
共有 95 人对调查做出了回应，其中 62%的人完成了儿科急诊医学奖学金培训。在受访者中，65%的人报告在奖学金期间有正式的镇静课程。在参加正式课程的人中，82%的受访者对进行镇静感到满意，而其余 18%的人则需要额外的指导和/或更正式的培训才能感到熟练。56%的受访者报告说，在被允许独立镇静之前，必须完成一定数量的镇静。在联系的 17 个计划中，有 9 个计划主任做出了回应。所有 9 个计划都包括理论教学，其中 6 个（66.6%）计划包括循证医学文献综述，6 个（66.6%）计划包括模拟。其他使用的模式包括在儿科镇静单位进行监督临床经验、与医院镇静团队进行为期 2 周的轮转、在线镇静模块以及使用每种药理学制剂（包括笑气、氯胺酮、异丙酚和氯胺酮-异丙酚联合）进行指导镇静。氯胺酮是最常使用的镇静剂（87%）。
儿科急诊医学奖学金要求缺乏 PS 培训的明确规定途径。当前和以前的研究员收集的数据描绘了培训经验的不一致性，并且在进行这些程序时的舒适度也不理想。我们建议研究员通过多种教学模式获得更全面和多样化的经验，以提高他们在急诊儿科护理这一关键和复杂方面的熟练程度。
