Pediatric Residents’ Critical Care Training and the Challenge of the New Accreditation Council for Graduate Medical Education Guidelines

Objective: Our objective was to explore the difference in confidence levels reported in pediatric residency program directors' evaluations compared to pediatric residents' self-evaluations with regard to performance of eight critical care related skills. Our secondary objective was to determine if spending extra time in a critical care setting had an effect on the residents' confidence level and perceived competency in those skills. We elected to perform this survey prior to the adaptation of the new Accreditation Council for Graduate Medical Education (ACGME) recommendations in regard to the number of educational units (four week blocks) spent in a pediatric intensive care unit (PICU) setting. Methods: We sent an online survey questioning resident exposure to critically ill children and the skills gained during residency to all United States pediatric program directors (PD). The elective anonymous survey targeted program directors and resident physicians in ACGME accredited pediatric training programs. Responses were collected over a two month period. We performed a Chi- Square analysis using IBM SPSS 22.0 and set a significance level of 0.05. The 95% confidence interval was calculated at 95%. Results: A total of 547 PRs and 124 (49%) PDs responded. Of those, 352 residents had spent at least three months in a critical care setting. Overall, resident confidence in their competency in all categories was lower than the opinion of PDs. Residents required to provide critical care coverage outside of a structured rotation had a significantly higher level of confidence in five of the eight surveyed skills. Conclusions: Although the PDs had higher confidence in their residents' competency than the residents' self evaluations, the survey showed that residents with more exposure to critical care settings had a higher level of confidence in their competency level than those with less exposure. The new ACGME regulations may decrease the critical care training time; we suggest that less time in those settings is unlikely to raise these competencies or the residents' self-confidence.