What Gaps Exist in the Acquisition of Clinical Competencies During Pediatric Residency Training?

Abstract

Background: The fundamental objective of pediatric residency training education is to provide physicians with the knowledge and skills required for their future practice in Pediatrics. In order to meet this objective, training must encompass the necessary breadth and depth of content, as well as length of training. Objective(s): The purpose of this study was to identify the clinical competencies that are acquired during pediatric residency training to enable graduates to practice as consultant pediatricians in Canada, and to identify gaps in preparedness. Design/Methods: Pediatricians certified by the Royal College of Physicians and Surgeons of Canada (RCPSC) between June 2004 and June 2008 were invited to complete a web-based questionnaire on 92 clinical competencies associated with pediatric practice. The questionnaire was based on the pediatric objectives of training of the RCPSC with a focus on clinical competencies (diagnosis, management and performing tasks/procedures). Pediatricians were asked to rate the importance of the competency and how well prepared they were at the start of their pediatric consultant practice on a Likert scale of 1 to 5. Comparisons were made between the importance and acquisition of the competencies. Result(s): The survey response rate was 43% (187/435). Overall mean scores for all competencies were: importance 3.61; preparedness 3.29; and gap score 6.40%, p 4.0) and with gap scores (between importance and preparedness) of ? 5% included: crisis resource management (18.2%), ethics applicable to provision or withholding clinical care (12.2%), need for urgent consultation and/or transport (10.2%), failure to thrive, growth problems, gastro-esophageal reflux (5.8%) and diagnosing/managing shock (5.0%). Disciplines with defined competencies and/or clinical competencies with gap scores > 10% included: allergy and immunology; behavior and development; cardiopulmonary resuscitation and airway management; cardiology and ECG interpretation; diagnostic imaging interpretation; hearing loss and hearing assessment; hypertension; obtaining intravenous access; mental health; obesity; ophthalmology; quality assurance and practicebased improvement activities; and thoracentesis and chest tube placement. Conclusion(s): Our results indicate that certain competencies need more emphasis during residency training and pediatric programs need to make changes to adequately prepare residents for independent practice.