I would also like to believe that I was trained by competent pediatric emergency physicians. However, the specialty's own literature suggest that fellows are not adequately trained in procedures.
http://pemcincinnati.com/blog/wp-co...of-critical-procedures-performed-in-a-PED.pdf
Thanks for bringing it up. I think this paper demonstrates this point really well.
To highlight a specific part: (this is them looking at the preceding 12 months) "no fellow performed a central venous line placement, needle thoracostomy, or pericardiocentesis in the pediatric ED during the study period. Only half of the fellows performed an intraosseous line placement, and just 30% performed a tube thoracostomy. Fellows performed a median of 2.5 orotracheal intubations compared with a faculty median of zero, but 40% of the fellows performed 1 or fewer. The adult anesthesia literature suggests that approximately 50 to 60 intubations are required to achieve competence."
The Cincinnati PEM fellowship is generally regarded as an excellent program. And they deserve a lot of credit for publishing this paper (which made quite a stir when it came out). But the bottom line is that even at this excellent program, the median fellow would graduate with <10 intubations in the ER. Sure, they may have 'procedural electives' and time in the OR and such to augment it, but we all know that's not equivalent.
Perhaps more importantly, and not addressed in this paper, is the non procedural aspect of resuscitative decision making. That's a lot harder to track and figure out how much exposure they are getting, but considering that resuscitations make up 0.22% of their volume, I suspect that PEM fellows also don't get a huge amount of exposure to that type of critical decision making either.
