Competency in neonatal endotracheal intubation: mission impossible?

Abstract

The Accreditation Council for Graduate Medical Education Program Requirements (PRs) for Pediatrics require that residents be able to competently perform neonatal endotracheal intubation (NET).1 In this issue of Pediatrics, DeMeo et al2 defined competency as a 75% likelihood of intubation success; only a minority of residents (23%) were able to achieve competency during the study period. Four cumulative NET successes were needed to achieve competency; the median number of NET opportunities for their subjects, however, was 3 (range: 1–13). There are 2 lists of procedures in the current version of the PRs. The first list requires residents to “competently perform,” and the second list requires “competent understanding.” During the PR revision process, the Accreditation Council for Graduate Medical Education Residency Review Committee initially recommended that NET be moved to the second list of procedures. However, feedback from the pediatric community overwhelmingly urged the committee to move NET back to the first list. Advocates for preserving NET as a skill noted that some pediatricians will practice in remote areas, where they could be solely responsible for NET. Responding to the pediatric community, NET was moved … Address correspondence to Joseph Gilhooly, MD, 1900 SW River Dr, Unit 701, Portland, OR 97201. E-mail: gilhooly{at}ohsu.edu