Objectives: The purpose of this study is to describe the clinical and educational experience provided to the pediatric emergency medicine (PEM) fellows in procedural sedation/analgesia during their course of training.
Methods: A nonanonymous survey was completed by the program director of each Accreditation Council for Graduate Medical Education (ACGME)-accredited PEM fellowship program listed in the 2001 to 2002 Graduate Medical Education Directory. Information relating to program demographics, agents available for use in the emergency department (ED), and the educational opportunities offered to trainees was sought.
Results: Each of the 32 ACGME-accredited programs completed the survey. Thirty programs report using procedural sedation and analgesia (PSA) to facilitate the completion of nonpainful and 32 programs to facilitate the completion of painful procedures in the ED. Twenty-nine programs (92%) permit their fellows to provide PSA independently after meeting credentialing criteria at their institution. Formal didactic sessions, direct supervision of procedures, and dedicated journal clubs were the 3 most frequently cited educational methods reported. The educational method chosen was not predicted by the ED type, the size of the training program, or by the volume of patients evaluated in the ED. Twelve program directors report their belief that a minimum number of procedures should be completed prior to completion of the training program.
Conclusion: There is wide variation in the educational methods used by PEM fellowship training programs in procedural sedation/analgesia.
Competence with procedural sedation and analgesia (PSA) is an important aspect of pediatric emergency care. With the focus on reducing pain and anxiety in a safe and effective manner, the use of PSA in pediatrics has led to improved outcomes as well as improved parental satisfaction with procedural interventions. 1-3 The Joint Commission on Accreditation of Healthcare Organizations has issued guidelines for the management and monitoring of patients undergoing PSA and requirements for the use of sedation in nonoperative settings by nonanesthesiologists. 4-8 Most emergency departments (EDs) have established sedation protocols that specify the qualifications required for personnel performing PSA, as well as guidelines for documentation and monitoring of such procedures performed in the emergency department (ED). There is variation between institutions regarding the medications that are typically chosen to facilitate painful and nonpainful procedures and what medications are available for use by nonanesthesiologists. While most emergency medicine residency and fellowship programs provide training in PSA, there is no published curriculum or standard for graduate training in this area.
The purpose of this study is to describe the clinical and educational experience of pediatric emergency medicine (PEM) fellows in Accreditation Council for Graduate Medical Education (ACGME)-accredited PEM training programs in the area of procedural sedation/analgesia. We hypothesize that there is variability in the curricular content and in the teaching methods applied.