Teaching emergency medicine to pediatric residents: a national survey and proposed model

To assess how emergency medicine is taught to pediatric residents, a cross-sectional survey was performed using a written questionnaire distributed to the chief residents of accredited pediatric residency programs throughout the continental United States. Information requested included the demographics of the training program, the structure of the emergency department (ED) rotation, and the chief residents' perceptions of the quality of precepting in the ED. Eighty three percent of 149 institutions responded. The mean number of pediatric patients/year is 21,241 (range 500-100,000), supplying approximately 500 to 700 patients/resident/year. A freestanding pediatric ED serves as the main training site in 50% of programs, and 3% do not use an ED at all. Case-by-case, one-on-one precepting occurs in 91% of EDs. Precepting is performed mostly by pediatric attendings (74%) and general emergency medicine attendings (38%). Seventy-four percent of programs provide a formal orientation, and 88% provide end-rotation evaluations. Twenty-two percent of the chief residents consider their pediatric ED rotation as "average" when compared with the case-by-case precepting delivered in other hospital rotations; 39% consider the ED rotation as "above average," and 33% as "below average." Programs with core lecture series, skills workshops, and formal orientation and evaluation procedures are more likely to be regarded as "above average." Pediatric emergency medicine rotations provide ample opportunity for case-by-case precepting. Programs with an established curriculum and pediatric attending presence are more likely to be successful in this regard. The full potential of the ED rotation can be realized through faculty training in precepting and evaluation methods.