Delgado Eva M, Fischer Jason, Scott Kevin R, Mamtani Mira, Xiong Ruiying, Tay Khoon-Yen, Verma Archana, Franco Marleny, Szydlowski Ellen, Toto Regina L, Conlon Lauren, Posner Jill C
Perelman School of Medicine Philadelphia Pennsylvania USA.
Department of Pediatrics Children's Hospital of Philadelphia (CHOP) Philadelphia Pennsylvania USA.
AEM Educ Train. 2023 Jul 30;7(4):e10898. doi: 10.1002/aet2.10898. eCollection 2023 Aug.
General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pediatric emergencies to better inform PEM curricula design.
In 2021, senior EM residents and graduates from the classes of 2020 and 2019 across eight EM programs with PEM rotations at the same children's hospital were recruited and surveyed electronically to assess perceived preparedness for 42 pediatric emergencies and procedures by age: infants under 1 year, toddlers, and children over 4 years. Preparedness was reported on a 5-point Likert scale with 1 or 2 defined as "unprepared." A chi-square test of independence compared the proportion of respondents unprepared to manage each condition across age groups, and a -value < 0.05 demonstrated significance.
The response rate was 53% (129/242), with a higher response rate from senior residents (65%). Respondents reported feeling unprepared to manage more emergency conditions in infants compared to other age groups. Respondents felt least prepared to manage inborn errors of metabolism and congenital heart disease, with 45%-68% unprepared for these conditions across ages. A heat map compared senior residents to recent graduates. More graduates reported feeling unprepared for major trauma, impending respiratory failure, and pediatric advanced life support algorithms.
This study, describing the perspective of EM senior residents and recent graduates, offers unique insights into PEM curricular needs during EM training. Future PEM curricula should target infant complaints and conditions with lower preparedness scores across ages. Other centers training EM residents could use our findings and methods to bolster PEM curricula.
在美国，普通急诊医生提供了大部分儿科急诊护理，但他们报告称，与成人急诊相比，处理儿童急诊面临更多挑战。针对标准化儿科急诊医学（PEM）课程的建议，旨在解决因急诊医学（EM）培训期间儿科接触机会不同而导致的教育差距，但缺乏学习者的意见。本研究调查了急诊医学高年级住院医师和近期毕业生对处理儿科急诊的自我认知准备情况，以便为PEM课程设计提供更充分的信息。
2021年，招募了来自八所急诊医学项目的高年级急诊医学住院医师以及2020届和2019届毕业生，这些项目在同一家儿童医院设有PEM轮转，并通过电子方式进行调查，以评估他们对42种儿科急诊和按年龄划分的操作的自我认知准备情况：1岁以下婴儿、幼儿和4岁以上儿童。准备情况采用5分李克特量表报告，1分或2分定义为“未准备好”。独立性卡方检验比较了各年龄组中对每种情况处理未准备好的受访者比例，P值<0.05表示有显著性差异。
回复率为53%（129/242），高年级住院医师的回复率更高（65%）。与其他年龄组相比，受访者表示对处理婴儿的更多急诊情况感到未准备好。受访者对处理代谢性先天性疾病和先天性心脏病的准备程度最低，各年龄段中45%-68%的人对这些情况未准备好。通过热图比较了高年级住院医师和近期毕业生。更多毕业生表示对重大创伤、即将发生的呼吸衰竭和儿科高级生命支持算法未准备好。
本研究描述了急诊医学高年级住院医师和近期毕业生的观点，为急诊医学培训期间的儿科急诊医学课程需求提供了独特见解。未来的儿科急诊医学课程应针对各年龄段准备得分较低的婴儿疾病和情况。其他培训急诊医学住院医师的中心可以利用我们的研究结果和方法来加强儿科急诊医学课程。
