Assessing procedural skills training in pediatric residency programs

OBJECTIVE. The objective of this study was to assess the opinions of pediatric program directors regarding procedural skills training of pediatric residents. METHODS. We developed a survey based on the Residency Review Committee's guidelines for procedural training. It included items about the importance of 29 procedures encountered in pediatric training, estimates of residents' competence in performing them, and the teaching of procedural skills. The survey was sent to members of the Association of Pediatric Program Directors. The primary outcome was the perceived importance for residents to achieve competence in these procedures, rated on a 10-point Likert scale. Secondary outcomes included perception of resident competence to perform procedures and educational methods used by respondents for teaching procedural skills. Associations between demographic characteristics and perceived importance or competence were also assessed. RESULTS. Surveys were sent to 139 programs, and 112 responded. Thirteen procedures were rated 8 or higher by > 75% of program directors. Seven skills that were prioritized by the Residency Review Committee did not achieve this level of consensus. Respondents reported that many residents failed to achieve competence by the end of training in 9 of 13 procedures that they rated as very important, including venipuncture, neonatal intubation, and administering injections. Residents who perform the majority of venipunctures and intravenous catheter placements at their institutions were more likely to be judged competent in performing these skills than residents who do not. CONCLUSIONS. The Residency Review Committee's list of procedures does not necessarily reflect the opinions of pediatric program directors on the most essential skills for trainees. Many residents may not develop competence in several important procedures by the end of residency, most notably vascular access and life-saving skills. A more robust and standardized method is needed for teaching procedural skills and for documenting competence.