Loftus Kirsten V, Schumacher Daniel J, Mittiga Matthew R, McDonough Erin, Sobolewski Brad
Department of Pediatrics Northwestern University Feinberg School of Medicine & Division of Pediatric Emergency Medicine Ann and Robert H. Lurie Children's Hospital of Chicago Chicago IL USA.
the Department of Pediatrics University of Cincinnati College of Medicine & Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA.
AEM Educ Train. 2020 Jun 25;5(2):e10462. doi: 10.1002/aet2.10462. eCollection 2021 Apr.
Most children seeking emergency care are evaluated in general emergency departments (EDs). The cumulative pediatric clinical experiences of emergency medicine (EM) residents are largely unknown. This study examined EM resident pediatric clinical experience through the lens of the Accreditation Council for Graduate Medical Education requirements and the Model of the Clinical Practice of Emergency Medicine.
Retrospective, observational study of the cumulative clinical experience of two classes of EM residents from a 4-year training program at two pediatric EDs of a quaternary care pediatric center. A database of resident patient encounters was generated from the electronic medical record. Experiences classified included: diagnosis categories per the Model of the Clinical Practice of Emergency Medicine, procedures, and resuscitations. Results were stratified by age, acuity, and disposition.
Twenty-five EM residents evaluated 17,642 patients (median = 723). Most patients (73.5%) were emergent acuity (Emergency Severity Index triage level 2 or 3 or non-intensive care admission); 2% were critical. Residents participated in 598 (median = 22) medical resuscitations and 483 (median = 19) trauma resuscitations. Minor procedures (e.g., laceration repair) were commonly performed; critical procedures (e.g., intubation) were rare. Exposure to neonates was infrequent and pediatric deaths were rare. Abdominal pain (5.7%), asthma exacerbation (4.6%), and fever (3.8%) were the most common diagnoses.
Emergency medicine residents encountered a wide array of pediatric diagnoses throughout training and performed a substantial number of common pediatric procedures. Exposure to critical acuity and procedures, neonatal pathology, and certain pediatric-specific diagnoses, such as congenital heart disease, was limited despite training in a large, quaternary care children's hospital. Curriculum development and collaboration should focus on these areas.
大多数寻求急诊治疗的儿童在综合急诊科接受评估。急诊医学住院医师积累的儿科临床经验在很大程度上尚不为人所知。本研究通过研究生医学教育认证委员会的要求以及急诊医学临床实践模式来审视急诊医学住院医师的儿科临床经验。
对一家四级护理儿科中心的两家儿科急诊科为期4年培训项目中的两类急诊医学住院医师的累积临床经验进行回顾性观察研究。从电子病历中生成住院医师患者诊疗记录数据库。分类的经验包括：根据急诊医学临床实践模式的诊断类别、操作和复苏。结果按年龄、急症程度和处置方式进行分层。
25名急诊医学住院医师评估了17642名患者（中位数=723）。大多数患者（73.5%）为急症（急诊严重程度指数分诊级别为2或3或非重症监护病房入院）；2%为危重症。住院医师参与了598次（中位数=22）医疗复苏和483次（中位数=19）创伤复苏。常见的是进行小手术（如伤口缝合）；关键手术（如插管）很少见。接触新生儿的情况不常见，儿科死亡病例也很少见。腹痛（5.7%）、哮喘加重（4.6%）和发热（3.8%）是最常见的诊断。
急诊医学住院医师在整个培训过程中遇到了各种各样的儿科诊断，并进行了大量常见的儿科手术。尽管在一家大型四级护理儿童医院接受培训，但接触危重症、手术、新生儿病理学以及某些儿科特定诊断（如先天性心脏病）的机会有限。课程开发与合作应聚焦于这些领域。
