76 Characterization of Pediatric Procedural Competency in Emergency Physicians

Abstract

The goal of this study was to determine emergency physicians’ self-reported competency with pediatric procedures and to describe the practice environments conducive to maintaining emergency physicians' competency. This study described the demographics and methods of competency maintenance employed by emergency physicians with regards to pediatric procedures. This survey was sent to 403 emergency physicians from the Indiana University School of Medicine Emergency Medicine and Emergency Medicine/Pediatrics residency programs. Demographic factors of these physicians were collected in conjunction with their self-reported competency in several pediatric procedures, including intubation, lumbar puncture, tube thoracostomy, peripheral IV placement, central venous catheter placement, and IO needle placement. The annual number of these procedures performed and the means for maintaining competency in each of these procedures was determined. Competency in each of these procedures was measured using a 10-point Likert scale. These data were used to describe emergency physicians' strategies for maintenance of pediatric procedural competency. We received 181 responses (44.9%) during an 8-week period. Despite the majority of responders only having performed the aforementioned procedures less than twice in the past year while seeing < 25,000 pediatric patients per year, 37.6% reported feeling at least somewhat confident in all of the above procedures. Learner presence in the emergency department did not significantly affect physicians’ procedural competency. Not surprisingly, physicians who have a greater number of years in practice express greater competency in tube thoracostomies and lumbar punctures compared to those with less years in practice. Providers at hospitals with a greater annual number of pediatric visits state a greater comfort with pediatric lumbar punctures. Work environment, namely academic versus community setting, did not significantly affect physicians’ self-reported competency in pediatric procedures. In summary, self-reported competency in certain pediatric procedures among emergency physicians varied depending on training background, years in practice, and number of pediatric visits at their clinical site. Emergency physicians have employed varying methods in order to maintain competency in pediatric procedures, including direct patient care, simulation, operating room time, educational opportunities, and other practice settings, such as ICU time. Notably some emergency physicians report not performing specific procedures since completing residency training. As providers in a field in which resuscitation and procedures are core components of practice, procedural competency in low frequency pediatric procedures is critical. Provider characteristics associated with decreased self-reported procedural competency should be targeted as potential sources for improvement in skill enhancement.