Educational Benefits of Allowing Pediatrician Supervision of Emergency Medicine Residents

• Published in: Journal of graduate medical education 2020-04, Vol.12 (2), p.185-192
• Main Authors: Rustici, Matthew J, Moreira, Maria, Buchanan, Jennie, Rodrigues, Kristine Knuti, Roosevelt, Genie E
• Format: Article
• Language: English
• Subjects: Child; Colorado; Emergency Medicine - education; Emergency Service, Hospital - organization & administration; Focus Groups; Guideline Adherence - statistics & numerical data; Humans; Internship and Residency - organization & administration; Length of Stay - statistics & numerical data; Medical Staff, Hospital; Original Research; Patient Readmission - statistics & numerical data; Pediatric Emergency Medicine - education; Pediatric Emergency Medicine - statistics & numerical data; Pediatricians; Surveys and Questionnaires
• ISSN: 1949-8349; 1949-8357
• DOI: 10.4300/JGME-D-19-00426.1

According to the Accreditation Council for Graduate Medical Education emergency medicine (EM) program requirements, EM residents on EM rotations must be supervised by board-certified/board-prepared EM or pediatric EM (PEM) faculty. We sought to understand the effect of allowing EM residents to be supervised by attending pediatricians while caring for pediatric urgent care patients. The EM residents were permitted to staff pediatric urgent care patients with either an EM/PEM attending or an attending pediatrician from August 2017 to July 2018. Outcomes were assessed through resident focus groups, a mixed-methods survey of EM residents and EM/PEM/pediatrician attendings, and clinical outcomes, including length of stay, best evidence/clinical care guideline adherence, and 48-hour return visits requiring admission. Qualitative data were inductively coded using a phenomenological framework, with themes emerging from consensus discussion. Ninety percent of residents participated in 1 of 7 focus groups. Four key themes emerged from qualitative analysis of focus group transcripts: (1) pediatricians have unique skills that complement those of EM physicians; (2) EM resident education improved; (3) patients may get better care with dual staffing; and (4) other PEM department and urgent care team members may have benefited from the change. The survey response rate was 72%, and it did not uncover additional themes. Length of stay was shorter for patients supervised by attending pediatricians (114 versus 128 minutes,