Getting good peds experience in residency

[LadyGrey]

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Almost done with interviews, so the great compare-and-contrast project has begun. (With the caveat that, yes, the intangible "gut feeling" and "fit" stuff is important, and being weighted heavily -- but strangers on the internet can't answer those questions for me 😉).

So, I keep hearing that peds is what people feel uncomfortable with. I want to be comfortable with peds. What should I be looking for to get the best peds training? Some things I can think of:

1. number of peds visits?
2. being at a hospital that has an affiliated children's hospital?
3. a program with a peds EM fellowship?
4. who works in the peds ED (peds EM-trained folks vs others)?
5. PICU and/or NICU rotations?
6. being level I for peds?

Specific program mentions are cool if people want to take it in that direction, but I'm more interested in what kinds of things are and aren't important.

 

[Apollyon]

Per ABEM, 4% of total patient volume has to be peds, and, also, there must be at least 2 ICU rotations in a residency. Most programs (if not all, as I've not checked) combine these with a PICU block. In conjunction, if there are not enough peds patients in your main EM blocks, the program would have to find you more (like sending you to a specific Peds ED).

However, this is not much of a problem, in reality. You will see adequate peds volume. As for the Level I, the amount of Level I peds trauma is so limited, that you would not become "good" at it.

 

[Hercules]

I'm a big believer that peds is one of the most variable experiences from residency to residency and think it's great that you're asking about this. Everyone gets enough trauma to feel comfortable; not everyone gets enough peds/ sick peds to be comfortbale with it. Since 25-30% of your volume in many community EDs will be pediatrics, you need to be comfortable with it.

First my bias is that I'm finishing up at a program that is attached to a Children's hospital with a peds EM fellowship and a level 1 peds ED with a volume of ~60,000. I did an NICU and a PICU rotation and our peds shifts are integrated throughout the year.

I would agree with most of your list. Having done both, I would say the PICU experience is more important than the NICU. I think having a peds EM fellowship is a plus but maybe not a requirement. One other thing that I strongly believe should be on your list is integrated peds. Doing several shifts each month in the ED leads to better training in my opinion than doing a block of peds once per year.

I feel very comfortable with peds as I head into the final months of my training and would list our peds experience as one of the strengths of the program.

 

[BKN]

Per ABEM, 4% of total patient volume has to be peds, and, also, there must be at least 2 ICU rotations in a residency. Most programs (if not all, as I've not checked) combine these with a PICU block. In conjunction, if there are not enough peds patients in your main EM blocks, the program would have to find you more (like sending you to a specific Peds ED).

However, this is not much of a problem, in reality. You will see adequate peds volume. As for the Level I, the amount of Level I peds trauma is so limited, that you would not become "good" at it.

No, by my memory 16% must be Peds with 8% in a critical setting (ED counts). For programs with less than 16% in their ED, you can subtract 4% for each month of training devoted solely to PEDs.

So in a program with large peds population (>16%) no peds months required. In a program with a completely adult ed (if such an animal exists) 4 months of peds training needed.

See the special program requirments in EM at this web page: http://www.acgme.org/acWebsite/navPages/nav_110.asp . It's a good thing to read then entire thing in order to know what each program is supposed to be providing you with.

 

[Apollyon]

Ah...I recalled the 4%, but did not recall that that equaled one month.

Sorry for any misinformation, and thanks to BKN for clarifying.

 

[LadyGrey]

Hercules: I agree, I like the idea of integrated shifts. It seems like it would be harder to forget the peds specific stuff like dosing things for weight when you're doing it regularly.

Also, 60,000 peds visits? Wow. Only one of the programs I'm looking at even comes close (Jacobi-Montefiore).

It's funny how priorities change during this whole process, right? Going in, I was like, I'm glad there are so many peds EDs so when I get out I can just see adults. Peds experience wasn't really on my radar. But I've come around and realized that if it's something I may be doing, I want to be prepared to do it well.

 

[SoCuteMD]

Hercules: I agree, I like the idea of integrated shifts. It seems like it would be harder to forget the peds specific stuff like dosing things for weight when you're doing it regularly.

Also, 60,000 peds visits? Wow. Only one of the programs I'm looking at even comes close (Jacobi-Montefiore).

It's funny how priorities change during this whole process, right? Going in, I was like, I'm glad there are so many peds EDs so when I get out I can just see adults. Peds experience wasn't really on my radar. But I've come around and realized that if it's something I may be doing, I want to be prepared to do it well.

There was a place I interviewed that had 100K. I interviewed at a number of places that were in the 50K range.

 

[LadyGrey]

SoCute: 100K at one site, or adding up visits at multiple sites? And, how many adult visits does that place have? 😱 Not doubting you, just curious because it's different from what I'm seeing in my region.

 

[SoCuteMD]

SoCute: 100K at one site, or adding up visits at multiple sites? And, how many adult visits does that place have? 😱 Not doubting you, just curious because it's different from what I'm seeing in my region.

One site, one children's hospital. I actually double-checked and the volume is about 90K on the Children's side, so a little lower than I initially stated.

The main adult site has about 90K or so. Community sites are about 35K, but a pretty small part of your experience in this particular program.

I noticed that you are mostly applying in NY/NJ - which probably explains why. I've really found myself attracted to programs that are "the only game in town" and that just doesn't happen near big Northeastern cities.

 

[Station51]

A plug for my program... I'm definitely satisfied with the peds experience at my program (Detroit Receiving). Virtually all of our peds experience is actually next door at Children's Hospital of Michigan which has a 50+ bed ED with a volume of 92,000 per year and ACS level-1 peds trauma designation. First-year residents do two months of dedicated peds ED with shifts in all pods. EM-2's and EM-3's have peds ED shifts integrated year-round into their ED schedules and are only assigned to the highest acuity pod. Admission rate in this pod is often similar to that of Receiving's ED and responds to all ED medical/trauma codes. EM-2s have a PICU month. EM-3s also rotate through our community hospital ED which sees both adults and kids.

 

[12R34Y]

Our peds ED (at a children's hospital) sees 65,000/year and level 1 as well. They also have one of the oldest peds EM programs.

You literally see everything. We do one whole month each of the 3 years and then throughout years 2 and 3 we do 2 shifts/month in the peds ER as well.
So, really you're year round in the peds ED and its great.

I moonlight alot and I feel very comfortable with peds in general. Of course everyone puckers with sick kids no matter how many you've seen, but for general peds bread and butter I'm grateful for the training.

later

 

[crewmaster1]

As usual, I'll put in a plug for Cinci...
Cinci Children's is right next door to UC, they see about 90,000/yr (in addition to our 85,000/yr at University). They are a level I and ranked in the top 5 Children's hosp in the nation on a repeated basis. We spend 2 full weeks there in the first 1/2 of intern year, then have integrated shifts for the remaining 3.5 years. Usually carrying the trauma/resus pager when you're there (because the peds guys hate it!). In 3rd and 4th year you can moonlight in the peds ED where you basically work either as the suture/procedure doc or just as an extra resident shift...both of which you still present to the attending, but you're making about 85/hr. In second year you do 1 month of PICU, and after that you can moonlight on the Peds critical care transport team which does both national and international transports. You get paid the carry the pager, if the teams wants an MD to go on the transport, they page you and you go (pay jumps up if you're activated). Also, with our Air care flight program in which you are an integrated member (flight doc plus nurse, no ride-a-long crap) you get plenty of sick peds transfers and scene trauma. Our community hospitals, which you get to spend a total of 4 months at during residency, also see peds. I think the key factor is volume and integrated experience, otherwise you just forget the stuff.