- Email: [email protected]
A national survey of pediatric emergency medicine: A growing subspecialty
19. Schuster HP: Prognostic value of blood lactate in critically ill patients. Resuscitation 1984;11:141-146 20. Ransom KJ, McSwain NE Jr: Metabolic acidosis with pneumatic trousers in hypovolemic dogs. J Am Coll Emerg Phys 1979;8:184-187
A NATIONAL SURVEY OF PEDIATRIC EMERGENCY MEDICINE: A GROWING SUBSPECIALTY To the Editor:-Pediatric emergency medicine as a subspecialty of pediatrics and emergency medicine is relatively new. Although no mechanism for certification has been established, an increasing number of fellowship programs in pediatric emergency medicine are offered, predominantly to physicians eligible or certified by the American Board of Pediatrics. We do not know the information and support that different groups of physicians have about this new area of care. A recent survey was undertaken to assess the awareness of pediatric emergency fellowships and recognition of pediatric emergency medicine as a subspecialty among the directors of pediatric training programs. Questionnaires were mailed in April 1987 to directors of all 244 accredited pediatric residency programs.’ Information was gathered regarding awareness of these fellowships, recognition of pediatric emergency medicine as a subspecialty, training of directors of institutions with pediatric emergency departments, annual number of emergency visits, and number of house staff members in the training programs. One hundred fifty-six questionnaires were returned completed. A total of 136 indicated an awareness of pediatric emergency fellowships, and 119 recognized pediatric emergency medicine as a subspecialty. No differences were noted in these characteristics among programs, with or without pediatric emergency departments or with different annual numbers of emergency visits or numbers of house officers in the programs. Finally, the majority (74%) of the directors were full-time pediatricians with emergency department experience and/or other subspecialty training; some were trained in emergency medicine residency (7%) and pediatric emergency fellowship (18%) programs. Coverage of pediatric emergency departments by full-time physicians began in the early 1970s.*s3 The responsibility of early recognition and initial stablilization of certain pediatric emergency conditions was assumed by these physicians. No longer could children with emergency problems be managed in out-patient clinic settings, and a real need for a specialist in the field, available 24 hours a day, became apparent.4*5 A commitment to develop an educational program in this area of care was reflected with the formation of a Section on Pediatric Emergency Medicine at the American Academy of Pediatrics, proposed by Dr Jerry Foster and approved in March 1981. Fellowship programs were created in the early 1980s to produce pediatric emergency care specialists to staff large children’s hospitals emergency departments across the country, who could in turn provide leadership in the training of emergency medicine and pediatric residents, nurses, and technicians and develop the skills needed for recognition and
initial stabilization of medical-surgical conditions observed in children. Today there are more than 20 pediatric emergency fellowship programs offered,‘j mainly to pediatric residents, at a few academic centers such as The Children’s Mercy Hospital in Kansas City. An effort has been made by all of these programs to adopt a uniform curriculum. A suggested guideline for the fellowship by Jaffe et al was published in 1985,’ contributing to the establishment of common goals and objectives among the different training programs. The majority of fellowships offered 2 years of training, with approximately 50% of the time spent in the pediatric emergency department, in supervising residents, and in direct patient care obligations. General aspects of the fellowship experience include: ‘* The physician assumes an active role in the management of any acute illness, either due to trauma or nontrauma, with the use of modem technology and the appropriate knowledge of pediatric procedures, medications, and dosages. 2. The physician must develop operative skills in the performance of emergency procedures that are modified for the ages of the patients. 3. The knowledge of growth and development, and the emotional and social implications of severely ill children, is essential. 4. The epidemiologic factors of infectious and other disease should be highlighted during all the training. 5. The physican must understand the priorities of care in the prehospital setting and education of different groups involved as well as the implementation of disaster plans for the hospital and community. 6. The physician should be exposed to and involved in legislation of injury prevention programs that affect children and teenagers. In addition, most of the programs include obligatory rotations in anesthesia, surgery, critical care, statistics, adult emergency, transport, emergency department administration, and certifications in advanced cardiac life support and advanced trauma life support. Elective rotations and obligatory research in the areas that are attractive to the fellow are required in most of the programs. In our opinion, the survey shows the degree of awareness and support of an important group of pediatric educators after more than 7 years of information available on the existence of pediatric emergency medicine fellowships. However, we feel that more information is needed in the medical community about the institution of these fellowships, in view of the fact that increasing awareness and recognition will greatly enhance education and clinical research, which is critical to the continued development of the specialty. FRANCISCOA. MEDINA, MD VIDYA SHARMA, MD JANE F. KNAPP, MD
University of Missouri-Kansas of Medicine Kansas City, Missouri
City School
131
AMERICAN JOURNAL OF EMERGENCY MEDICINE m Volume 7, Number 1 m January 1989
References 1. Directory of Residency Training Programs, 1986-1987. Chicago, American Medical Association, 1985, pp 351-364 2. Bushore M: Pediatric emergency care: Where do we go from here? A pediatrician’s view. Pediatr Emerg Care 1986;2:258-260 3. Wasserman G: Pediatric emergency medicine: Birth, growth, and development. Emerg Med 1986;3-10 (editorial)
132
4. Baker MD: Physician coverage in the pediatric emergency room. A national survey. Am J Dis Child 1986;140:755-757 5. Losek J, Walsh-Kelly C, Glaeser P: Pediatric Emergency Departments. Pediatr Emerg Care 1966;2:215-217 6. lzsak E, Jaffe D, Felter R: Pediatric emergency medicine fellowship programs. Pediatr Emerg Care 1988;4:60-62 7. Jaffe D, Ludwig S, Zierserl E, et al: Fellowship training in pediatric emergency care: A sample curriculum. Pediatr Emerg Care 1986;2:45-53
A NATIONAL SURVEY OF PEDIATRIC EMERGENCY MEDICINE: A GROWING SUBSPECIALTY To the Editor:-Pediatric emergency medicine as a subspecialty of pediatrics and emergency medicine is relatively new. Although no mechanism for certification has been established, an increasing number of fellowship programs in pediatric emergency medicine are offered, predominantly to physicians eligible or certified by the American Board of Pediatrics. We do not know the information and support that different groups of physicians have about this new area of care. A recent survey was undertaken to assess the awareness of pediatric emergency fellowships and recognition of pediatric emergency medicine as a subspecialty among the directors of pediatric training programs. Questionnaires were mailed in April 1987 to directors of all 244 accredited pediatric residency programs.’ Information was gathered regarding awareness of these fellowships, recognition of pediatric emergency medicine as a subspecialty, training of directors of institutions with pediatric emergency departments, annual number of emergency visits, and number of house staff members in the training programs. One hundred fifty-six questionnaires were returned completed. A total of 136 indicated an awareness of pediatric emergency fellowships, and 119 recognized pediatric emergency medicine as a subspecialty. No differences were noted in these characteristics among programs, with or without pediatric emergency departments or with different annual numbers of emergency visits or numbers of house officers in the programs. Finally, the majority (74%) of the directors were full-time pediatricians with emergency department experience and/or other subspecialty training; some were trained in emergency medicine residency (7%) and pediatric emergency fellowship (18%) programs. Coverage of pediatric emergency departments by full-time physicians began in the early 1970s.*s3 The responsibility of early recognition and initial stablilization of certain pediatric emergency conditions was assumed by these physicians. No longer could children with emergency problems be managed in out-patient clinic settings, and a real need for a specialist in the field, available 24 hours a day, became apparent.4*5 A commitment to develop an educational program in this area of care was reflected with the formation of a Section on Pediatric Emergency Medicine at the American Academy of Pediatrics, proposed by Dr Jerry Foster and approved in March 1981. Fellowship programs were created in the early 1980s to produce pediatric emergency care specialists to staff large children’s hospitals emergency departments across the country, who could in turn provide leadership in the training of emergency medicine and pediatric residents, nurses, and technicians and develop the skills needed for recognition and
initial stabilization of medical-surgical conditions observed in children. Today there are more than 20 pediatric emergency fellowship programs offered,‘j mainly to pediatric residents, at a few academic centers such as The Children’s Mercy Hospital in Kansas City. An effort has been made by all of these programs to adopt a uniform curriculum. A suggested guideline for the fellowship by Jaffe et al was published in 1985,’ contributing to the establishment of common goals and objectives among the different training programs. The majority of fellowships offered 2 years of training, with approximately 50% of the time spent in the pediatric emergency department, in supervising residents, and in direct patient care obligations. General aspects of the fellowship experience include: ‘* The physician assumes an active role in the management of any acute illness, either due to trauma or nontrauma, with the use of modem technology and the appropriate knowledge of pediatric procedures, medications, and dosages. 2. The physician must develop operative skills in the performance of emergency procedures that are modified for the ages of the patients. 3. The knowledge of growth and development, and the emotional and social implications of severely ill children, is essential. 4. The epidemiologic factors of infectious and other disease should be highlighted during all the training. 5. The physican must understand the priorities of care in the prehospital setting and education of different groups involved as well as the implementation of disaster plans for the hospital and community. 6. The physician should be exposed to and involved in legislation of injury prevention programs that affect children and teenagers. In addition, most of the programs include obligatory rotations in anesthesia, surgery, critical care, statistics, adult emergency, transport, emergency department administration, and certifications in advanced cardiac life support and advanced trauma life support. Elective rotations and obligatory research in the areas that are attractive to the fellow are required in most of the programs. In our opinion, the survey shows the degree of awareness and support of an important group of pediatric educators after more than 7 years of information available on the existence of pediatric emergency medicine fellowships. However, we feel that more information is needed in the medical community about the institution of these fellowships, in view of the fact that increasing awareness and recognition will greatly enhance education and clinical research, which is critical to the continued development of the specialty. FRANCISCOA. MEDINA, MD VIDYA SHARMA, MD JANE F. KNAPP, MD
University of Missouri-Kansas of Medicine Kansas City, Missouri
City School
131
AMERICAN JOURNAL OF EMERGENCY MEDICINE m Volume 7, Number 1 m January 1989
References 1. Directory of Residency Training Programs, 1986-1987. Chicago, American Medical Association, 1985, pp 351-364 2. Bushore M: Pediatric emergency care: Where do we go from here? A pediatrician’s view. Pediatr Emerg Care 1986;2:258-260 3. Wasserman G: Pediatric emergency medicine: Birth, growth, and development. Emerg Med 1986;3-10 (editorial)
132
4. Baker MD: Physician coverage in the pediatric emergency room. A national survey. Am J Dis Child 1986;140:755-757 5. Losek J, Walsh-Kelly C, Glaeser P: Pediatric Emergency Departments. Pediatr Emerg Care 1966;2:215-217 6. lzsak E, Jaffe D, Felter R: Pediatric emergency medicine fellowship programs. Pediatr Emerg Care 1988;4:60-62 7. Jaffe D, Ludwig S, Zierserl E, et al: Fellowship training in pediatric emergency care: A sample curriculum. Pediatr Emerg Care 1986;2:45-53