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Pediatric residents in the emergency department: what is their experience?
M A Del Beccaro1, R P Shugerman
1Department of Pediatrics, University of Washington School of Medicine, Seattle, USA. delb@u.washington.edu
Insights
Pediatric residents rotating through the emergency department (ED) see a wide variety of patients, but experience with certain conditions varies greatly. Tracking patient encounters can help identify educational gaps for residents.
Area of Science:
- Pediatric Emergency Medicine
- Medical Education
- Clinical Informatics
Background:
- Pediatric residents gain clinical experience during emergency department (ED) rotations.
- The spectrum of illnesses and patient volume encountered can vary significantly among residents.
Purpose of the Study:
- To describe the range of illnesses and patient numbers seen by pediatric residents during ED rotations.
- To identify potential variations in resident exposure to critical pediatric conditions.
Main Methods:
- Retrospective review of ED database from a children's hospital (July 1992 - June 1995).
- Analysis of patient encounters for 19 pediatric residents over 3 years and 91 residents completing rotations.
- Categorization of diagnoses and procedures encountered by residents.
Main Results:
- Over 70,000 ED visits occurred during the study period.
- Residents saw a median of 467 patients, with wide ranges for specific diagnoses like asthma (35-86) and fever/sepsis (17-62).
- Significant proportions of residents did not encounter critical conditions such as pyloric stenosis (37%), intussusception (32%), or diabetic ketoacidosis (32%).
Conclusions:
- Significant variability exists in the patient cases encountered by pediatric residents during ED rotations.
- Clinical experience alone may not ensure competence in all necessary pediatric conditions.
- A trackable ED database can guide educational strategies and document resident experience for credentialing.
Study Objective:
We sought to describe the spectrum of illness and number of patients seen by pediatric residents rotating through a pediatric ED.
Methods:
Our study was set in the ED of a 200-bed referral children's hospital providing services exclusive of major trauma. We conducted a retrospective review of the database of all visits to the ED between July 1992 and June 1995. Our subjects were 19 pediatric residents who started residency in July 1992 and ended residency in June 1995. Ninety-one other pediatric residents completed individual ED rotations during the same period.
Results:
The study ED had 70,129 visits between July 1, 1992, and June 30, 1995. The study residents saw a median of 467 patients per resident (range, 290 to 604) during their 3-year residencies. The range of patients seen per resident for the diagnosis of asthma was 35 to 86, that for otitis media was 16 to 110, and that for fever or sepsis was 17 to 62. Similarly large ranges were seen for other diagnoses evaluated and procedures performed by residents. The proportions of the study residents who never saw a case of pyloric stenosis, intussusception, or diabetic ketoacidosis in the ED were 37%, 32%, and 32%, respectively.
Conclusion:
The number and type of patients seen by individual residents in this study showed significant variation. Many illnesses were not seen frequently enough for every resident to develop competence solely on the basis of clinical experience during ED rotations. A computerized, easily accessible ED database can be used to track the experience of individual residents or groups of residents. Such tracking would allow residents and program directors to identify areas that may require alternate educational strategies and would also document the residents' experience for future credentialing.