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. 2018 Nov 30:6:365.
doi: 10.3389/fped.2018.00365. eCollection 2018.

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

Branden M Engorn  1 , Christopher J L Newth  2 , Margaret J Klein  3 , Elizabeth A Bragg  2 , Rebecca D Margolis  1 , Patrick A Ross  2
Affiliations

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

Branden M Engorn et al. Front Pediatr. .

Abstract

Background: Pediatric Critical Care Medicine Fellowship trainees need to acquire skills to perform procedures. Over the last several years there have been advances that allowed for less invasive forms of interventions. Objective: Our hypothesis was that over the past decade the rate of procedures performed by Pediatric Critical Care Medicine Fellowship trainees decreased. Methods: Retrospective review at a single institution, tertiary, academic, children's hospital of patients admitted from July 1, 2007-June 30, 2017 to the Pediatric Intensive Care Unit and Cardiothoracic Intensive Care Unit. A Poisson regression model with a scale adjustment for over-dispersion estimated by the square root of Pearson's Chi-Square/DOF was applied. Results: There has been a statistically significant decrease in the average rate of central venous lines (p = 0.004; -5.72; 95% CI: -9.45, -1.82) and arterial lines (p = 0.02; -7.8; 95% CI: -13.90, -1.25) per Fellow per years in Fellowship over the last 10 years. There was no difference in the rate of intubations per Fellow per years in Fellowship (p = 0.27; 1.86; 95% CI:-1.38, 5.24). Conclusions: There has been a statistically significant decrease in the rate of central venous lines and arterial lines performed by Pediatric Critical Care Medicine Fellowship trainees per number of years in Fellowship over the last 10 years. Educators need to be constantly reassessing the clinical landscape in an effort to make sure that trainees are receiving adequate educational experiences as this has the potential for an impact on the education of trainees and the safety of the patients that they care for.

Keywords: arterial line; central venous access; fellowship; intubation; medical education; pediatric critical care.

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Figures

Figure 1
Figure 1
Median and interquartile range of intubations per Fellow per year and admissions per Fellow year over 10 years.
Figure 2
Figure 2
Median and interquartile range of central venous lines per Fellow per year, total nursing PICC lines per year, and admissions per Fellow year over 10 years.
Figure 3
Figure 3
Median and interquartile range of arterial lines per Fellow per year and admissions per Fellow year over 10 years.
See this image and copyright information in PMC

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