Kristin Loftus
Cincinnati Children's Hospital
Background: Most children seeking emergency care in the Unites States are seen in general emergency departments (EDs) and present with diagnostic and therapeutic challenges that emergency medicine (EM) physicians may feel unprepared for. The cumulative pediatric clinical experiences of EM residents are largely unknown. The aim of this study is to examine the depth and breadth of EM resident clinical experiences through the lens of Accreditation Council for Graduate Medical Education (ACGME) and Model of the Clinical Practice of EM recommendations.
Methods: This was a retrospective, descriptive study of pediatric clinical experiences of 2 classes of EM residents from a single 4-year training program at the urban and suburban PEDs of a quaternary-care pediatric center. A database of resident patient encounters was generated from the electronic medical record. Experiences analyzed included diagnoses (determined by primary billing diagnoses categorized per the Model of the Clinical Practice of EM), procedures, and resuscitations, stratified by patient age, acuity, and disposition.
Results: A total of 17,642 patients were evaluated by 25 EM residents (median 723/resident); 1 did not complete training. Abdominal pain (5.7%), asthma exacerbation (4.6%), and fever (3.8%) were the most common diagnoses evaluated. The most common traumatic diagnoses were closed extremity fracture (2.9%) and closed head injury (1.6%). Most patients were <12 years old (67.6%) and emergent acuity (73.5%). The overall admission rate was 21.6%. Minor procedures were commonly performed, critical procedures were rare. Residents performed a total of 598 (mean 23.9/resident) medical resuscitations and 483 (mean 19.3/resident) trauma resuscitations.
Conclusion: EM residents in our study were exposed to a wide array of pediatric diagnoses throughout training, performed a substantial number of minor procedures, and were involved in many medical and trauma resuscitations. Though we did not evaluate individual resident performance, similar data could be utilized in an ongoing basis to develop individualized, adaptive curricula and rotational experiences that address identified gaps and assure exposure to the spectrum of conditions specified in the Model of Clinical Practice of EM.
