Perspectives on preparedness for pediatric emergencies after residency: A needs assessment

Abstract

Background

General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pediatric emergencies to better inform PEM curricula design.

Methods

In 2021, senior EM residents and graduates from the classes of 2020 and 2019 across eight EM programs with PEM rotations at the same children's hospital were recruited and surveyed electronically to assess perceived preparedness for 42 pediatric emergencies and procedures by age: infants under 1 year, toddlers, and children over 4 years. Preparedness was reported on a 5‐point Likert scale with 1 or 2 defined as “unprepared.” A chi‐square test of independence compared the proportion of respondents unprepared to manage each condition across age groups, and a p‐value < 0.05 demonstrated significance.

Results

The response rate was 53% (129/242), with a higher response rate from senior residents (65%). Respondents reported feeling unprepared to manage more emergency conditions in infants compared to other age groups. Respondents felt least prepared to manage inborn errors of metabolism and congenital heart disease, with 45%–68% unprepared for these conditions across ages. A heat map compared senior residents to recent graduates. More graduates reported feeling unprepared for major trauma, impending respiratory failure, and pediatric advanced life support algorithms.

Conclusions

This study, describing the perspective of EM senior residents and recent graduates, offers unique insights into PEM curricular needs during EM training. Future PEM curricula should target infant complaints and conditions with lower preparedness scores across ages. Other centers training EM residents could use our findings and methods to bolster PEM curricula.

INTRODUCTION

In the United States, 85% of pediatric emergency care is provided in nonpediatric emergency departments (EDs) by emergency medicine (EM)‐trained physicians. ¹ Practicing EM providers have reported that their preparedness to care for emergencies in pediatric patients is less than their preparedness for similar situations in adults. Pediatric arrest and caring for infant patients are two of the top identified most challenging situations reported by first‐year attending EM physicians. ² Therefore, the Accredited Council of Graduate Medical Education (ACGME) continues to emphasize the importance of pediatric education in EM residency training, with the most current EM residency review committee indicating that 20% of all residency ED encounters must be pediatric. ³ However, realization of this goal may be difficult to guarantee for the individual trainee. Pediatric volume and case type seen by individual EM residents throughout training is vastly different, with up to half missing out on diagnoses felt to be essential as determined by the American Board of Emergency Medicine (ABEM) Model of Clinical Practice of Emergency Medicine. ⁴ , ⁵ Practicing EM providers are least comfortable with examining, diagnosing, and treating younger ages, and exposure to infants during training was reported the least in prior studies. ⁵ , ⁶ Together, these data identify a key problem for EM residents with respect to PEM preparedness: they are unlikely to encounter the full spectrum of pediatric conditions and ages recommended during training to prepare them for pediatric emergencies in practice, representing a gap in EM education.

Expert panels have reviewed the content in the EM Model to identify areas of PEM‐specific content for inclusion in a more standard curriculum. ⁷ , ⁸ Further collaborative efforts by EM and PEM experts have suggested content appropriate for simulation to gain exposure to low‐frequency, high‐acuity pediatric scenarios. ⁹ , ¹⁰ However, the perspectives of EM resident trainees and recent graduates, who represent key stakeholders in EM education and preparation for practice, are scant and not widely included in most recommendations. The purpose of this study was to survey senior EM residents and recent graduates to assess their perceived preparedness to manage pediatric emergencies to better inform future PEM curricula for EM residency training programs.

METHODS

This study was classified as exempt by the Children's Hospital of Philadelphia Institutional Review Board and was supported by an internal grant from the Division of Emergency Medicine.

Survey development

The survey questions were developed to satisfy each of Messick's accepted validity constructs (content, response process, reliability, and internal consistency). ¹¹ , ¹² The authors utilized an iterative process for survey creation (Figure S1). The survey‐development group, referred to as the PEMnEM working group, was composed of six PEM faculty, three EM faculty, one dual‐boarded PEM/EM faculty, and one registered nurse simulation educator. The pediatric emergency conditions and procedures queried in the survey were derived from the content listed in the ABEM model of clinical practice, recognized as important by prior expert panels, and viewed as challenging scenarios for new EM attendings. ² , ⁴ , ⁷ , ⁸ A modified set of age ranges was derived from published surveys of pediatric exposure and preparedness to focus specifically on younger ages since those are the ages first‐year EM attendings find most challenging. ² , ⁵ , ⁶

The PEMnEM working group identified 42 different pediatric emergencies and procedures for this survey. The 5‐point Likert scales used in prior survey studies were modified to assess preparedness (1 = extremely unprepared, 2 = unprepared, 3 = neither prepared nor unprepared, 4 = prepared, 5 = extremely prepared) to manage pediatric emergency conditions or procedures in three different age groups: (1) infants (0–1 years), (2) toddlers (1–4 years), and (3) children (>4 years). ² , ⁶ Age groups not applicable to a specific condition were omitted from that question. Similarly, an adolescent age group was added to questions where applicable. Perceptions of procedural preparedness were assessed by the same three predetermined age groups for procedures with an approach that might vary by age (example: lumbar puncture). For five procedures with a more standard approach across all ages, preparedness was measured for the procedure itself (example: gastrostomy tube replacement).

Demographic data collection was designed to characterize the PEM education and exposure of participants. This included duration of EM residency training; specific training program and type; and years since graduation, zero, one, or two. Participants were asked to describe their future or current practice site type (example: academic, community, etc.) and anticipated or known pediatric volume at that site.

Through an iterative process, the PEMnEM working group created a preliminary survey instrument which was then reviewed for clarity and content by local stakeholders including area academic and community EM physicians. The revised survey instrument was pilot tested with 21 EM attending physicians and residents and modifications were made accordingly. Finally, a group of PEM research faculty distinct from the PEMnEM working group pilot tested the survey and provided additional feedback that resulted in the final study survey (Appendix S1).

Survey distribution, inclusion criteria, and data analysis

In April 2021, the survey was electronically distributed via Qualtrics software (Qualtrics) to senior residents and recent graduates from the eight different residency programs that rotated at our single, large, urban academic pediatric ED during their training. Our pediatric ED typically treats 100,000 children per year, and about 20% of that volume is managed by EM residents with supervision from PEM attending physicians. Contact information for all eligible participants was obtained from their residency programs, and an email invitation was sent prior to the survey link to alert them to the study and to test and correct any erroneous or deactivated emails. The electronic survey was accessible for 3 months, reminders were sent to potential respondents, and an incentive of a $20 Amazon gift card was offered for survey completion. Consent was obtained from all respondents, and responses were anonymous.

All senior residents from the class of 2021, in their final year of training, and all recent graduates from the classes of 2020 and 2019, 1 and 2 years after residency completion, were included to best capture the population that would understand the gaps in EM training on account of their close proximity to the completion of training. We excluded those earlier in training as they may be unable to anticipate the gaps in their training given the limited scope of their exposure. Those later in their careers were also excluded since this group has been shown to feel even less prepared to manage pediatric emergencies than those earlier in their careers, which could be due to knowledge decay or training gaps that have been modified since their graduation. ² The respondents represent a convenience sample of those who chose to respond to the survey invitation, and their residency programs are diverse in terms of training duration, size, setting, and characteristics of their pediatric patient populations. Four of the programs are described as urban academic, and one of the programs is a community academic program. While most programs are EM residencies, two combined EM programs (one with family medicine and one with internal medicine) were included. These two programs, in addition to an affiliated EM residency, are classified as community programs. Exposure to pediatric patients outside the time spent in our academic, pediatric ED is variable, ranging from rare encounters to regular based on program and available rotation sites. Two of the four urban academic sites rely on our pediatric ED or other area pediatric hospitals for most, but not all, of their pediatric emergency exposure, and a third site relies solely on our pediatric ED. The remaining urban academic site provides slightly more PEM experience in non–pediatric‐specific sites compared to pediatric hospitals. Most of the pediatric emergency exposure of the community academic program occurs in their local, community sites, with time in our pediatric ED providing only a small supplement. The three community programs, including the combined programs, provide trainees a similar split to that offered by the urban academic sites. One of the combined programs also gives trainees exposure to pediatric patients in nonemergent settings and all programs offer exposure to critically ill pediatric patients in a pediatric intensive care unit for at least 1 month of training. Table S1 further elaborates on the pediatric emergency exposure of the EM training programs represented in the study population.

Demographic data were analyzed using descriptive statistics and chi‐square tests for between‐group comparisons (seniors to graduates). Five‐point Likert categories were collapsed, with rankings of 1 (extremely unprepared) or 2 (unprepared) combined to represent “unprepared.” A chi‐square test of independence was used to compare the proportion of respondents reporting they were unprepared to manage each condition across age groups, with a p‐value < 0.05 demonstrating significance. Heat maps were created to characterize the proportion of respondents who self‐identified as unprepared to manage a given condition in each age group. R was used for data analysis. ¹³

RESULTS

Response rate and demographics

Of the 242 eligible participants, 129 (53%) responded to the survey. Senior residents had a response rate of 65% (55/85) compared to recent graduates, who had a response rate of 47% (74/157). The response rate was similar across 3‐year, 4‐year, and combined residency programs. There were responses from all eight residency programs included in the study. Tables 1 and 2 shows participant characteristics. More of the respondents trained in 3‐year programs (49.6%) than in 4‐year (38.8%) or longer, combined programs (11.6%), yet there was no significant difference between senior residents and graduates with respect to duration of training. Respondents reported that the majority of their anticipated (senior residents) or current (graduates) clinical practice occurs or will occur in academic (29%) or community (36%) EDs compared to other site types. A separate pediatric ED was part of the main clinical site for 29% of all respondents, but less than one‐third of those with this separate pediatric setting currently practice or plan to practice there. Respondents were also characterized by pediatric volume at their future or current practice sites, with graduates reporting that actual pediatric visits to their sites are higher than what seniors anticipated (chi‐square, p = 0.02).

TABLE 1.

Demographics: Training characteristics.

Training characteristics	All respondents		Senior residents		Graduates
	%	N = 129	%	N = 55	%	N = 74
Training program a
A	5	6	7	4	3	2
B	6	8	5	3	7	5
C	5	7	5	3	5	4
D	19	24	22	12	16	12
E	15	19	16	9	14	10
F	20	26	16	9	23	17
G	19	24	15	8	22	16
H	11	14	13	7	9	7
Duration of training
3 years	50	64	51	28	49	36
4 years	39	50	38	21	39	29
>4 years	12	15	11	6	12	9

^a One added respondent, a graduate, transferred training programs and so is not represented here.

TABLE 2.

Demographics: Practice characteristics.

Practice characteristics	All respondents		Senior residents			Graduates
	%	N = 129	%	N = 55		%	N = 74
Practice site pediatric visit volume per year (anticipated or current) a
<1800	29	37	40	22		20	15
1800–4999	33	43	35	19		32	24
5000–9999	12	15	7	4		15	11
>10,000	6	8	0	0		11	8
Unsure	20	26	18	10		22	16
Practice site with pediatric ED	29	37	24	13		32	24
Primary practice site type (>50% time, anticipated or current) a
Academic center	29	37	24	13		33	24
Community affiliate of academic center	16	20	15	8		17	12
Community hospital	36	46	36	20		35	26
Freestanding	4	5	6	3		3	2
Other	2	3	4	2		1	1

^a Anticipated = senior residents' perspectives; current = graduates' current clinical practice.

Perceived preparedness

Table 3 shows the proportion of respondents reporting that they felt unprepared to manage each condition or emergency by age group. For most conditions, 75% (27 of 36), there was a significant difference in this proportion (p < 0.05) across age groups. As shown in Table 3, there were higher rates of low preparedness scores for infants across all conditions, but the degree of discrepancy of the proportion reporting they were unprepared for infants versus other ages was greater for some conditions than for others. No differences were detected across age groups for the two conditions respondents were most unprepared for: Inborn Errors of Metabolism (IEM) and Congenital Heart Disease (CHD). Of all respondents, 45%–68% reported feeling unprepared for IEM and CHD across age groups. There was also no difference in the proportion unprepared for hematuria, jaundice, rashes, and Brief Resolved Unexplained Event (BRUE) across ages.

TABLE 3.

Proportion unprepared (1 or 2 on Likert scale) to manage given condition.

Pediatric condition/emergency	Infants (0–1 year)	Toddlers (1–4 years)	Children (>4 years)	p‐value
IEM	88 (68)	85 (66)	81 (63)	0.66
CHD	73 (57)	67 (52)	58 (45)	0.17
Sexual assault	37 (29)	22 (17)	19 (15)	0.01
Hematuria	29 (23)	22 (17)	18 (14)	0.19
Tachycardia	35 (27)	20 (16)	11 (9)	<0.001
Major trauma	33 (26)	19 (15)	12 (9)	0.002
Altered mental status	36 (28)	14 (11)	11 (9)	<0.001
Jaundice	19 (15)	20 (16)	19 (15)	0.98
Impending respiratory failure	29 (23)	16 (12)	11 (9)	0.005
Tachypnea	35 (27)	14 (11)	8 (6)	<0.001
PALS	27 (21)	13 (10)	12 (9)	0.01
BRUE/syncope	18 (14)	17 (13)	14 (11)	0.74
ECG	25 (19)	14 (11)	9 (7)	0.01
Cervical‐spine injury	24 (19)	11 (9)	8 (6)	0.003
Sickle cell crisis	32 (25)	8 (6)	1 (1)	<0.001
Seizure	27 (21)	8 (6)	5 (4)	<0.001
Rashes	19 (15)	12 (9)	9 (7)	0.11
Diabetic ketoacidosis	29 (23)	4 (3)	2 (2)	<0.001
Acute abdomen	24 (19)	8 (6)	2 (2)	<0.001
Genitourinary emergencies	24 (19)	7 (5)	4 (3)	<0.001
Child maltreatment	12 (9)	10 (8)	10 (8)	0.87
Toxins	18 (14)	7 (5)	7 (5)	0.02
Limp	NA	22 (17)	8 (6)	0.01
Fractures	20 (16)	4 (3)	1 (1)	<0.001
Fever of unknown origin	16 (12)	5 (4)	5 (4)	0.01
Procedural sedation	23 (18)	1 (1)	0 (0.0)	<0.001
Upper airway pathology	16 (12)	4 (3)	4 (3)	0.002
Vomiting	15 (12)	2 (2)	0 (0)	<0.001
Systemic analgesia	14 (11)	2 (2)	0 (0)	<0.001
Lumbar puncture	8 (6)	6 (5)	3 (2)	0.31
Kawasaki's disease	NA	9 (7)	7 (5)	0.80
Lower airway pathology	9 (7)	2 (2)	2 (2)	0.02
Fever	10 (8)	1 (1)	1 (1)	0.001
Sepsis	9 (7)	2 (2)	1 (1)	0.01
Head injury	9 (7)	0 (0)	0 (0)	<0.001
Local analgesia	7 (5)	1 (1)	0 (0)	0.004

Note: Data are reported as n (%).

Abbreviation: BRUE, brief resolved unexplained event; CHD, congenital heart disease; IEM, inborn errors of metabolism; PALS, Pediatric Advanced Life Support.

Figure 1 is a heat map that represents the proportion of respondents who reported feeling unprepared to manage specific conditions or emergencies by age. This figure demonstrates that respondents felt least prepared to manage IEM and CHD across all age groups, as was noted in Table 3. Sexual assault, hematuria, tachycardia, major trauma, and altered mental status were among the top conditions that respondents felt unprepared to manage. Figure 1 illustrates that respondents also reported feeling unprepared for more conditions in infants than in other age groups. Rates of respondents who felt unprepared to manage sickle cell crisis, seizures, diabetic ketoacidosis, fractures, and procedural sedation in infants were all over 10% higher than the rates reported for these conditions in other ages. The heat maps in Figure 2 show the separate responses of senior residents compared to recent graduates. A higher proportion of graduates reported feeling unprepared to manage major trauma, impending respiratory failure, or Pediatric Advanced Life Support (PALS) algorithms compared to the senior resident respondents.

FIGURE 1.

Heat map of total respondents.

FIGURE 2.

Heat maps by respondent type: senior resident versus recent graduate.

Each of the graduating classes were also examined separately due to the reduction in pediatric patients seeking emergency care after the onset of the COVID‐19 pandemic, and the possibility that the impact of this crisis may have affected perceived pediatric preparedness in different ways depending on a respondent's stage of training or practice. A greater percentage of participants from the class of 2020 reported feeling unprepared to manage CHD, jaundice, and toxic ingestions compared to the other two groups of trainees. Compared to the other graduates, those from the class of 2019, a higher proportion of the class of 2020 reported feeling more unprepared for emergencies in infants. Figure S2 shows heat maps measuring the proportion unprepared for each condition separated by graduation year.

Procedural preparedness was incorporated into Table 3 and the heat maps for procedures with responses by age group, given their potential for a varied approach for different ages. The proportion of respondents who reported feeling unprepared to manage procedures that are not likely to vary in approach by age is small: 1% unprepared for suture repair, 1% unprepared for foreign body removal, 5% unprepared for nursemaid's reduction, 5% unprepared for intraosseous needle insertion, and 16% unprepared for gastrostomy tube replacement.

DISCUSSION

This study was designed to describe the perspectives of EM senior residents and recently graduated EM physicians who are close enough to training for their input regarding pediatric emergency‐preparedness to serve as suggestions for PEM‐focused additions or modifications to the current residency curricula. By including this demographic, we were able to confirm the findings of prior work while also expanding the understanding of PEM gaps in training. The finding that more respondents in our study were unprepared to manage emergency conditions in infants compared to the same conditions in other age groups is consistent with prior studies that have shown that practicing EM physicians feel less comfortable with infants as opposed to children of older ages. ² , ⁶ , ¹⁴ Our data include the perspectives of EM senior residents, which suggests that this lack of preparedness for infants is not likely to be due to knowledge decay after graduation. Insufficient exposure to infants during training might seem to be to blame for this sentiment, since Li et al. ⁵ found that infants were the age group that EM trainees from the class of 2015 were exposed to the least during residency, but exposure is always variable. ED visit rate was actually highest for infants in 2020 compared with all other age groups in a sample of 20,000 national ED visits, and most children present to ED settings staffed by general EM physicians. ¹⁵ Since volume is ever changing, we suggest that education regarding infants and infant complaints during training is likely insufficient to generate a sense of preparedness in many EM physicians as they enter the workforce. A focus on infants as a key component of education both during EM residency and after graduation as continuing medical education is warranted.

Unique to this study is that respondents were asked to rate their preparedness to manage each pediatric emergency condition in each age group. This allowed us to determine the conditions that our respondents felt unprepared for regardless of age. Most reported that they were unprepared to managed CHD‐ and IEM‐related emergencies across all age ranges presented, and this finding was similar across all groups as shown in the heat maps. The discomfort with CHD emergencies validates the results of prior studies that suggest cardiac emergencies as key elements of PEM education for the EM trainee, but none of these took age at patient presentation into account. ⁸ , ¹⁴ While there was a slightly higher percentage of respondents who felt unprepared for CHD emergencies in the youngest children compared to those over age 4, the difference was minimal, suggesting that education on this topic should cover management in all age groups. Similarly, conditions like hematuria and rashes might best be taught across all ages, since there was little difference in reported preparedness by age. Teaching about other conditions, like sickle cell crisis, seizures, diabetic ketoacidosis, fractures, and procedural sedation, should focus more on management of infants than older children since the rate of respondents who felt unprepared for these conditions was over 10% higher for infants than for other age groups. We suspect that respondents felt less comfortable with these emergencies in infants since they may present differently and warrant different management considerations than older children or adults. Understanding that teaching may need to target age ranges, conditions, or some intersection of both is helpful to guide the development of a more evidence‐based curriculum in which educators can tailor content to learners' needs.

To further hone the recommendations gleaned from this study, we compared the responses of senior EM residents to recent EM graduates, who had the benefit of independent clinical practice to gauge their true preparedness. While most characteristics were similar between these groups, we found that the recent graduates reported a higher pediatric volume at their clinical sites than what senior residents anticipated they would experience. This difference may be due to practice site specifics, pediatric volume trends during training that might impact estimation of future pediatric caseloads or some other factor. Recent graduates also reported feeling less prepared for some of the most emergent situations across all age ranges compared to senior residents. We suspect that this finding reflects the inability of trainees to predict future knowledge gaps. This is very helpful when considering modifications to current PEM curricula, as senior residents may overestimate their own comfort with emergent situations. Future PEM education should focus more on the areas that recent graduates feel less prepared to manage.

The strength and novelty of this study is that we recruited participants from eight training programs with varied characteristics, thereby optimizing generalizability. Respondents represented all eight programs, and all rotated at our large, urban, academic pediatric ED during their training, but their residencies were otherwise diverse in training duration, practice setting, program size, and community pediatric exposure. Several programs rotated at other pediatric hospitals, and all but one program offered several weeks of pediatric emergency experience in community or academic general ED settings. Two of the programs represented offered trainees more pediatric emergency exposure in non–pediatric‐specific ED sites, while the remainder relied more heavily on PEM at pediatric hospitals for this training. Our results provide suggestions for PEM curricular changes for a broad spectrum of EM residency programs since the programs in our study population represent a subset of the national landscape of EM training.

LIMITATIONS

There are several limitations to our study. We used a convenience sample of EM senior residents and recent graduates who completed clinical rotations in our pediatric ED, so we lack the perspectives of those who chose not to participate in the study. To reduce the selection bias inherent in a convenience sample, we worked to capture as many perspectives as possible by including trainees and graduates from eight training programs that differed from each other in many ways. We also acknowledge the social desirability bias of those who chose to respond to a survey conducted by PEM and EM educators involved in their training, and we worked to limit this by communicating that the survey was anonymous. We also intentionally sought the input of experts who were not involved in the education of the respondents when pilot testing and iteratively editing the survey instrument to ensure the questions were clear and generalizable. Many of these limitations would be further mitigated by replicating and validating this study with a population that does not spend time in our pediatric ED during training. Lastly, this study included self‐reported perceptions of preparedness, so there may be additional gaps in PEM preparedness that respondents are unable to recognize. Future studies could include direct observation of EM residents and recent graduates to determine whether additional gaps exist in their understanding and care of pediatric patients.

It is important to note that this study was conducted during the COVID‐19 pandemic, which imparted unexpected and significant changes to ED volume and EM resident education nationally and locally. While we included the class of 2019 in our recent graduate sample to try to capture a group of EM physicians whose training was not impacted by the pandemic, we acknowledge that their experiences as practicing physicians most certainly were affected by the 50% drop in pediatric volume noted the following year. ¹⁶ Importantly, when compared to 2019, the volume at our pediatric ED dropped by 12% in 2020 and by 37% in 2021, and our EM residents managed 50% fewer patients in our ED in 2021 than in 2019. Pediatric volume seen in general ED settings staffed by the residency programs represented in this study also dropped during this time: one EM residency program recorded half the pediatric volumes in 2021 that they experienced in 2019, and another noted a drop in pediatric volume of about one‐third in that same time frame. We constructed heat maps by graduating class to look at possible differences between these groups, and we noted a larger proportion of the class of 2020 reported feeling unprepared for infants as well as a few conditions across ages when compared to those who graduated in 2019. While less time in practice may explain lower comfort, we must acknowledge the pandemic's interruption in their training and lower pediatric volume once they entered the work force. Senior residents in the class of 2021 did not report feeling as unprepared as the 2020 graduates. While it is likely that this finding reflects the lack of insight and real‐world experience of those not yet in practice, and while it is possible that this group had more exposure to infants during training given the noted national trends, it is also important to consider that perceived preparedness is not solely related to volume and exposure. During 2020, many pediatric lectures and simulations at our affiliated EM residency programs and in our own ED were canceled prior to the increase in virtual learning and renewed educational efforts in the summer of that year. It is not possible to know whether the 2020 educational interruption or drop in pediatric exposure had any impact on perceived preparedness, but it is worth recognizing that education, unlike patient volume, remains within our control. Volume fluctuations will always be a limitation to exposure‐based education in EM. Our pediatric ED volume, for instance, returned to 100,000 for 2022, and it appears to be climbing. The EM residents graduating this year will likely face higher pediatric volumes in practice than they did during residency, which emphasizes the importance of pediatric readiness for all graduates and all ED settings. The pandemic is therefore less of a limitation to this study and more of a catalyst in prompting us to use our results in careful edits to didactic and simulation elements of the pediatric EM curriculum. The reality that volume will always vary also strengthens prior studies' suggestions of simulation, especially, as a teaching tool. ⁹ At our site we have used the data from this needs assessment to design a 1‐day just‐in‐time simulation‐heavy PEM bootcamp for graduating EM senior residents to increase preparedness in caring for pediatric patients in general ED settings.

CONCLUSIONS

In summary, the findings of this study provide a deeper, more nuanced insight into the pediatric emergency medicine educational needs of senior emergency medicine residents and recent graduates from a diverse set of training programs. Future curricula should include supplemental education on infant emergencies given that respondents felt more unprepared to care for emergencies in this age group. Additionally, curricula should prioritize congenital heart disease and inborn errors of metabolism in all age groups as well as conditions such as major trauma, impending respiratory failure, and Pediatric Advanced Life Support algorithms that trainees may not realize as gaps in their education until they are in practice. Pediatric centers training emergency medicine residents could use our findings to bolster their pediatric emergency medicine curricula, and nonpediatric ED sites may benefit from this work as it applies to their efforts to promote pediatric readiness.

AUTHOR CONTRIBUTIONS

Eva M. Delgado: conceptualized the study; recruited members of the PEMnEM team; designed the survey; pilot tested and revised the survey; recruited respondents; collected data; supervised and reviewed data analysis; drafted and delivered the presentations and posters for the conferences cited above; and generated the cover letter, abstract, and manuscript presented here along with necessary revisions. Jason Fischer: assisted with survey design, supervised data analysis, created the original heat maps, revised the presentations and poster for the conferences cited above, and assisted in the generation of and the revisions to the abstract and manuscript presented here. Kevin R. Scott: added expertise to the concept of the study, assisted with survey design, reviewed the data analysis, revised the presentations and poster for the conferences cited above, and assisted in revisions to the abstract and manuscript presented here. Mira Mamtani: assisted with survey design, provided consultative expertise on the data analysis, revised the presentations and poster for the conferences cited above, and assisted in revisions to the abstract and manuscript presented here. Ruiying Xiong: reviewed the full data set, provided consultative expertise on data analysis strategies, and completed the statistical analysis for the study. Khoon‐Yen Tay: assisted with survey design, revised the presentations and poster for the conferences cited above, and assisted in revisions to the manuscript presented here. Archana Verma: assisted with survey design, revised the presentations and poster for the conferences cited above, and assisted in revisions to the manuscript presented here. Marleny Franco: assisted with survey design, revised the presentations and poster for the conferences cited above, and assisted in revisions to the manuscript presented here. Ellen Szydlowski: assisted with survey design, revised the presentations and poster for the conferences cited above, and assisted in revisions to the manuscript presented here. Regina L. Toto: reviewed the data analysis and heat maps to assist with creation of the presentations and poster for the conferences cited above and assisted in revisions to the manuscript presented here. Lauren Conlon: assisted with survey design, revised the presentations and poster for the conferences cited above, and assisted in revisions to the manuscript presented here. Jill C. Posner: added expertise to the concept of the study, assisted with survey design, reviewed the data analysis, revised the presentations and poster for the conferences cited above, and assisted in revisions to the abstract and manuscript presented here.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Supporting information

Appendix S1:

Figure S1:

Figure S2:

Table S1:

Delgado EM, Fischer J, Scott KR, et al. Perspectives on preparedness for pediatric emergencies after residency: A needs assessment. AEM Educ Train. 2023;7:e10898. doi: 10.1002/aet2.10898