The e-Journal of Neonatology Research

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We think you should be familiar with the ACGME’s vision for the future of pediatric procedural competency as well as their attempt to introduce increased pediatric subspecialty preparatory education.

Excerpts taken from (with emphasis per underline added by e-JNR):

ACGME Program Requirements for Graduate Medical Education in Pediatrics

(draft sent to all pediatric residency program directors nationally)

Proposed Effective Date: July 1, 2013

Regarding the ACGME’s vision of procedural competency…

Residents

IV.A.5.a).(1) must be able to competently perform procedures used by a pediatrician in general practice. This includes being able to describe the steps in the procedure, indications, contraindications, complications, pain management, post procedure care, and interpretation of applicable results. Residents must demonstrate procedural competence by performing the following procedures:

IV.A.5.a).(1).(a) bag-mask ventilation;

IV.A.5.a).(1).(b) bladder catheterization;

IV.A.5.a).(1).(c) giving immunizations;

IV.A.5.a).(1).(d) incision and drainage of abscess;

IV.A.5.a).(1).(e) lumbar puncture;

IV.A.5.a).(1).(f) reduction of simple dislocation;

IV.A.5.a).(1).(g) simple laceration repair;

IV.A.5.a).(1).(h) simple removal of foreign body;

IV.A.5.a).(1).(i) temporary splinting of fracture;

IV.A.5.a).(1).(j) umbilical venous catheter placement; and,

IV.A.5.a).(1).(k) venipuncture.

IV.A.5.a).(2) must complete training and maintain certification in Pediatric Advanced Life Support, including simulated placement of an intraosseous line, and Neonatal Resuscitation, including the simulated placement of an umbilical catheter.

IV.A.5.b) Medical Knowledge

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care.

Residents:

IV.A.5.b).(1) must be competent in the understanding of the indications, contraindications, and complications for the following procedures:

IV.A.5.b).(1).(a) arterial line placement;

IV.A.5.b).(1).(b) arterial puncture;

IV.A.5.b).(1).(c) chest tube placement;

IV.A.5.b).(1).(d) circumcision;

IV.A.5.b).(1).(e) endotracheal intubation;

IV.A.5.b).(1).(f) peripheral intravenous catheter placement;

IV.A.5.b).(1).(g) thoracentesis; and,

IV.A.5.b).(1).(h) umbilical artery catheter placement.

IV.A.5.b).(2) When these procedures are important for resident’s post-residency position, residents should receive real and/or simulated training

This seems like a recipe for extended procedural remediation after our future fellows actually enter fellowship training.

Another section we think you need to read…

IV.A.6.b) The overall structure of the (pediatric residency) program must include:

IV.A.6.b).(1) a minimum of six educational units of an individualized curriculum;

IV.A.6.b).(1).(a) The individualized curriculum must be determined by the learning needs and career plans of the resident and must be developed through the guidance of a faculty mentor.

IV.A.6.b).(2) a minimum of 10 educational units of inpatient care experiences, to include:

IV.A.6.b).(2).(a) two educational units of pediatric critical care;

IV.A.6.b).(2).(b) two educational units of neonatal intensive care;

IV.A.6.b).(2).(c) five educational units of inpatient pediatrics; and,

IV.A.6.b).(2).(d) one educational unit of term newborn care.

IV.A.6.b).(3) no more than 16 educational units of inpatient experiences;

If it is possible for our future fellows to do an additional 4 months of NICU “educational units” then this is an interesting change. After years of the NICU moratorium, it’s hard to imagine that will be allowed. It seems more likely that the culture of resident competency in the NICU will become progressively worse due to minimal exposure and fewer competency requirements. However, if our best and brightest recruits are allowed to rise to their true potential through an additional four NICU educational units, then perhaps this is a compromise we could embrace.

Conversely, this new moratorium of 16 months on total inpatient experience means that pediatric residents will spend no more than 2/5ths of their residency in the hospital. This is likely to adversely affect GME support for pediatric residencies (something that is already happening in smaller programs), because hospitals will no longer be able to rely upon these residents as a reliable work force. In essence, these changes could ultimately reduce the number of pediatricians we train. We note the following change as well (under the resident appointments section).

Finally, with regard to continuity clinics…

IV.A.6.b).(6).(b) PGY-3 residents should continue this (continuity clinic) experience at the same clinical site or, if appropriate for an individual resident’s career goals, sessions in the final year may take place in a longitudinal subspecialty clinic or alternate primary care site.

Based on this wording, our future fellows could do NICU follow up, pulmonary or cardiac clinics as applicable education options in their PGY-3 year.

The 2013 changes are open for comment by  program directors for the next few weeks. We believe all physicians involved in pediatric resident and fellow education should have access to this information and have the opportunity to voice their opinions. A copy of the entire document is available online (click here). Here is how you can contact the ACGME if you wish: (August 31st is their final date for feed back).

(The e-JNR editorial staff)

PII: eJNR21606072v1i2p2y2011