Thursday, April 12, 2018

General Pediatricians’ Procedural Performance: Do national guidelines and actual practice align?

Maya Iyer
Nationwide Children's Hospital
 Background: In 2013, the Accreditation Council for Graduate Medical Education (ACGME) and the Pediatric Residency Review Committee (RRC) provided guidelines regarding 13 clinical procedures residents should master. Prior studies suggest that procedure guidelines utilize the perspectives of program directors and residents. The literature on which procedures general pediatricians actually perform in practice is limited.

Objective: To determine whether general pediatricians perform the 13 recommended procedures, how prepared they felt to perform them, and whether they believe the procedures are important to their practice.

Methods: We polled 543 general pediatricians within 150-miles of an Ohio tertiary-care children’s hospital. Stratified random sampling was used to draw a sample needed to achieve a 95% confidence interval with +3% sampling error. We developed, piloted, and administered a survey based upon the recommended procedures. Procedures were categorized as emergent, urgent, or office-based. Physician practices were categorized as urban, suburban or rural and were compared using the Welch ANOVA and post-hoc tests.

Results: The response rate was 60.8%. Pediatricians almost never performed 8 of 13 recommended procedures and yet felt prepared to perform them all and believed all were important. Compared to their urban and suburban counterparts, rural pediatricians performed more emergent and office based procedures and rated them as more important.

Conclusion: Findings suggest a discrepancy between current national guidelines and the procedures pediatricians perform in practice, even though practitioners believe the recommended procedures are important and feel prepared to perform them. Additional research is needed to improve continuity between procedural training and practice.