A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

Kirsten V Loftus; Daniel J Schumacher; Matthew R Mittiga; Erin McDonough; Brad Sobolewski

doi:10.1002/aet2.10462

A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

AEM Educ Train. 2020 Jun 25;5(2):e10462. doi: 10.1002/aet2.10462. eCollection 2021 Apr.

Authors

Kirsten V Loftus^{1

2}, Daniel J Schumacher², Matthew R Mittiga³, Erin McDonough⁴, Brad Sobolewski²

Affiliations

¹ 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.
² the Department of Pediatrics University of Cincinnati College of Medicine & Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA.
³ and the Department of Pediatrics University of Colorado School of Medicine & Section of Emergency Medicine Children's Hospital Colorado Aurora CO USA.
⁴ and the Department of Emergency Medicine University of Cincinnati College of Medicine Cincinnati OH USA.

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.