• Joyce Li, Genie Roosevelt, Kerry McCabe, Jane Preotle, Faria Pereira, James K Takayesu, John J Porter, Michael Monuteaux, and Richard G Bachur.
• Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts.
• J Emerg Med. 2020 Aug 1; 59 (2): 278-285.

BackgroundEighty-eight percent of pediatric emergency department (ED) visits occur in general EDs. Exposure to critically ill children during emergency medicine (EM) training has not been well described.ObjectiveThe objective was to characterize the critically ill pediatric EM case exposure among EM residents.MethodsThis is a secondary analysis of a multicenter retrospective review of pediatric patients (aged < 18 years) seen by the 2015 graduating resident physicians at four U.S. EM training programs. The per-resident exposure to Emergency Severity Index (ESI) Level 1 pediatric patients was measured. Resident-level counts of pediatric patients were measured; specific counts were classified by age and Pediatric Emergency Care Applied Network diagnostic categories.ResultsThere were 31,552 children seen by 51 residents across all programs; 434 children (1.3%) had an ESI of 1. The median patient age was 8 years (interquartile range [IQR] 3-12 years). The median overall pediatric critical case exposure per resident was 6 (IQR 3-12 cases). The median trauma and medical exposure was 2 (IQR 0-3) and 3 (IQR 2-10), respectively. For 13 out of 20 diagnostic categories, at least 50% of residents did not see any critical care case in that category. Sixty-eight percent of residents saw 10 or fewer critically ill cases by the end of training.ConclusionPediatric critical care exposure during EM training is very limited. These findings underscore the importance of monitoring trainees' case experience to inform program-specific curricula and to develop strategies to increase exposure and resident entrustment, as well as further research in this area.Copyright © 2020 Elsevier Inc. All rights reserved.

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