W. Joshua Frazier, MD
Assistant Professor of Critical Care Medicine
Ohio State University Children's Hospital, United States
Disclosure information not submitted.
Rohali Keesari, MPH, PharmD
Biostatistician-I, Biostatistics Resource
Nationwide Children's Hopsital, United States
Disclosure information not submitted.
Richard Mink, MD, MACM,FCCM
Director, Pediatric Critical Care Fellowship
Harbor UCLA Medical Center, United States
Disclosure information not submitted.
Donald Boyer, MD, MSEd
Associate Professor of Clinical Anesthesiology and Critical Care
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Angela Czaja, MD, MS
Associate Professor
University of Colorado At The Children's Hospital, United States
Disclosure information not submitted.
Bradley Robinson, MD
Program Director, Pediatric Cardiology Fellowship Program
n/a, United States
Disclosure information not submitted.
Shubhika Srivastava, MD
Division Chief, Cardiology
Nemours Cardiac Center, United States
Disclosure information not submitted.
Christiane Dammann, MD
Professor of Pediatrics, Neonatology
Tufts Medical Center, United States
Disclosure information not submitted.
Patricia Chess, MD, MS
Professor of Pediatrics, Neonatology
University of Rochester, United States
Disclosure information not submitted.
Title: A Characterization of ECLS Training Practices in Pediatric Fellowships: Are We Doing Enough?
Introduction/Hypothesis: Extracorporeal life support (ECLS) is a potentially life-saving modality for critically ill patients, but its high-risk, low-volume nature increases the risk of deployment. Studies have found high variability and lack of standardization in approaches to training in adult programs but there are no similar published studies in pediatrics. The objective of this study is to characterize current training practices across institutions and subspecialties that train pediatric fellows in ECLS. We hypothesize that training practices of pediatric fellows will vary widely and that many programs will not have standardized guidelines by which to determine competency. In addition, we hypothesize that simulation-based medical education use will be incorporated variably but with increasing frequency.
Methods: This is a 21-question survey of Pediatric Critical Care Medicine (PCCM), Neonatology, and Pediatric Cardiology Program Directors (PD). Responses are summarized as frequencies and percentages and compared using chi-squared or Mann-Whitney tests.
Results: Of the 75 responses (31% response rate), 45% represented NICU, 43% PCCM and 12% Pediatric Cardiology. Fellows were described as an observer in nearly 30% of programs, most commonly in pediatric cardiology and NICU subspecialties. More than 20% of PD’s felt that fellows were not able to independently manage ECLS at the time of graduation and 55% felt there were gaps in the ECLS education provided. The most common barriers to education were few patients canulated, fellow time constraints, and lack of simulation capabilities/experience. Didactics, simulation, and “bootcamps” were the most common teaching modalities with simulation use 62-75% of respondents. Thirty-five percent of programs had no specific criteria to determine competency in ECLS prior to matriculation (47% of NICU, 33% of cardiology and 22% of PCCM programs). Methods of competency determination most frequently cited were attendance of didactic lectures, attendance of simulation exercises, and ECLS specialist recommendation of advancement.
Conclusion: Wide variability exists in fellow role, frequency of training, PD confidence in independent management, and competence determination. Standardization of ECLS training approaches through a longitudinal curriculum could improve fellow education.