ORIGINAL CONTRIBUTION pediatric emergency medicine
The Role of the Emergency Physician in Providing Pediatric Emergency Care -A Membership Survey A survey of the membership of the American College of Emergency Physicians (ACEP) was undertaken to identify members with special interest or expertise in pediatric emergency medicine. A questionnaire was published in the Augus4 1988 issue of ACEP News, which was distributed to 12,079 members. One'hundred seventy-one responses were returned, revealing a subset of the membership (1.42%) with a special interest or expertise in pediatric emergency care. This group was characterized as to type of residency training, board certification (completed or planned), practice location, and percentage of practice composed of children. Opinions were sought regarding subspeciality certification, continuing medical education needs, and quality and quantity of pediatric emergency medical training in pediatric and emergency medicine residency programs. More than 200 physicians were identified as resources in pediatric emergency medicine for ACER The majority of the respondents favored subspecialty board certification. Continuing education needs are generally being met, but there is a need for better geographical distribution of courses. Minifellowships and more pediatric rotations for emergency medicine residents were suggested. [Eitzen E, Schafermeyer RW, Strange GR: The role of the emergency physician in providing pediatric emergency care - A membership survey. Ann Emerg Med May 1990;19:532-535.]
Edward Eitzen, Jr, MD Robert W Schafermeyer, MD, FACEP Gary R Strange, MD, FACEP Dallas, Texas From the Emergency Medicine Committee, American College of Emergency Physicians, Dallas, Texas. Received for publication July 17, 1989. Revision received October 27, 1989, Accepted for publication November 10, 1989. Address for reprints: Beverly Draper, American College of Emergency Physicians, PO Box 619911, Dallas, Texas 75261-9911.
INTRODUCTION As part of an effort to evaluate the role of emergency physicians in pediatric emergency care and to identify members with special interest or expertise in pediatric emergency medicine, the American College of Emergency Physicians's {ACEP) Pediatric Emergency Medicine Committee developed a questionnaire to survey the general membership, focusing on the need for subspecialty certification and continuing education needs. The information provided was used by the Pediatric Emergency Medicine Comm i t t e e to formulate future goals and identify m e m b e r s available for involvement in this area. ACEP represents more than 13,100 member physicians who have an interest in the practice of emergency medicine. There are an estimated 23,000 practicing emergency physicians, 7,888 of whom are board certified. In comparison, there are an estimated 37,000 practicing pediatricians, approximately 28,000 of w h o m are board certified. The Committee wished to evaluate and define the interrelationship of these groups in the provision of pediatric emergency care. This survey is just one facet of this evaluation and planning process; both ACEP and the American Board of Emergency Medicine (ABEM) are undertaking concurrent activities in pediatric emergency medicine to assist in this process. ABEM has worked with the American Board of Pediatrics (ABP) in developing guidelines for joint training programs. The ACEP Pediatric Emergency Medicine Committee has developed a position paper on the role of the emergency physician in the delivery of pediatric emergency care. The State University of New York at Syracuse is completing an emergency medicine training program survey on pediatric emergency medical care. These activities should facilitate the development of pediatric emergency medicine.
19:5 May 1990
Annals of Emergency Medicine
532/75
PEDIATRIC EMERGENCY MEDICINE Eitzen, Schafermeyer & Strange
METHODS A questionnaire was developed and published in the August 1988 issue of ACEP News. Physicians with interest, training, and/or experience in both pediatrics and emergency medicine were asked to respond. Of the 12,079 questionnaires sent to members, 171 were returned, a response rate of 1.42%. P h y s i c i a n s who r e s p o n d e d provided data regarding their training, specialty board certification status, practice setting, percentage o f practice involving children, and comm e n t s r e g a r d i n g w h e t h e r subspeciality certification in pediatric emergency medicine should be available to physicians who concentrate their practice in this area. Survey respondents' opinions also were solicited as whether their continuing education needs were being met. RESULTS In regard to specialty training, 43% of the respondents had completed a p e d i a t r i c r e s i d e n c y and 26% an emergency medicine residency. Nineteen percent of the respondents were boarded in pediatrics, 38% in emergency medicine, and 24% in both fields (Table 1). Respondents were queried regarding their plans to seek further board certification in either pediatrics or emergency medicine. The largest group (37%) were physicians already boarded in emergency medicine who had no plans to take pediatric boards. The second largest group (24%) were those already boarded in both specialties, followed by 14% already boarded in pediatrics and planning to take emergency medicine boards and 12% not boarded in either specialty but planning to take the emergency medicine boards (Table 2). Only 55 (32%) respondents board prepared in e m e r g e n c y m e d i c i n e were residency trained in emergency medicine. The survey allowed respondents to select more than one practice location; therefore, p e r c e n t a g e s t o t a l m o r e t h a n 100%. O n e h u n d r e d twenty-eight (75%) respondents indicated that they practiced in a general hospital emergency department, whereas 11% practiced in a children's hospital ED. Twenty-five percent of the respondents practiced in a teaching environment (Table 3). The percentage of respondents' 76/533
TABLE 1. Specialty training and certification of 171 ACEP members with an interest in pediatric emergency medicine
Pediatrics Emergency medicine Both Neither
Specialty Training Completed Board Residency (%) Certified (%) 43 19 26 38 6 24 25 19
practice involving children varied widely. N i n e t y respondents (52%) said the percentage of their practice involving children was between 11% and 30%, whereas 22 p h y s i c i a n s (13%) said that more than 90% of their practice involved children. Fifty-eight percent of the respondents favored subspecialty certification in pediatric emergency medicine; 68% of those who completed a pediatric residency and 61% of those who completed an emergency medicine residency favored subspecialty certification. Of the 43 respondents who did not complete a residency in either field, 60% did not favor subspecialty certification. Of those boarded in pediatrics, 81% favored subspecialty certification, whereas those boarded in emergency medicine were evenly split 48% for and 50% against. Of those boarded in both fields, 61% favored subspecialty certification; of those without boards, 50% favored subspecialty certification. Respondents were asked whether they had special expertise or experience in pediatrics or emergency medi c i n e if t h e y w e r e n o t f o r m a l l y trained or boarded in both. Thirtyeight percent of the total respondents replied affirmatively; 42% of that group indicated that they plan to take the specialty board in which they have special expertise. This group represented 21% of the total respondents and correlated well with the 26% to 27% who plan to take the emergency medicine boards. In addition to responding to specific questions, respondents were asked to comment on subspecialty certification, continuing medical education, and any other subject pertinent to the survey. The comments Annals of Emergency Medicine
ranged from very positive to very negative and demonstrated that some of ACEP's and ABEM's activities were not known by some respondents. For the questions Should there be a subspeciality certification in pediatric emergency medicine? And if so, for whom and by whom?, most respondents favored subspecialty certification, particularly for those practicing in teaching programs and large metropolitan and children's hospitals and for those not qualified to take emergency medicine boards by the practice category. A vocal minority of respondents feel that there are already too many " m e r i t badges" required and that subspecialty certification would only add to the confusion. Several respondents believe that pediatric emergency medicine is too limited an area for subspecialty certification. Several remarked that they would rather see efforts put into enhancing pediatric training in emergency medicine residencies. Others stated that having subspecialists available as teachers to facilitate enhanced pediatric education is a good idea. An appropriately trained and certified emergency physician can deliver proper emergency care to a pediatric patient. However, in children's hospital EDs and in emergency medicine and pediatric training programs there is a need for special expertise in pediatric emergency medicine. The need is to provide optimal emergency care to children and to enhance the training of emergency medicine and pedia t r i c r e s i d e n t s . W h o s h o u l d be trained, and who should certify? Survey respondents have different opinions on the question of certification, which is currently being negotiated 19:5 May 1990
TABLE 2. Board certification examination plans of 171 ACEP members with an interest in pediatric emergency medicine Response NO.
%
64
37
41 24 21
24 14 12
Boarded in pediatrics; no plans for emergency medicine Not boarded; no plans to take either Not boardgd; will take both Not boarded; will take pediatrics
8 6
5 4
3 2
2 1
Boarded in emergency medicine; will take pediatrics
2
1
Boarded in emergency medicine; no plans for pediatrics Boarded in both Boarded in pediatrics; will take emergency medicine Not boarded; will take emergency medicine
TABLE 3. Practice settings of 171 ACEP members with an interest in pediatric emergency medicine Responses Practice Setting
NO.
%
General hospital ED
128 24 19 18
75 14 11 11
5 5 4
3 3 2
Emergency medicine teaching program Pediatric teaching program Children's hospital ED Pediatric outpatient clinic or office Minor emergency or urgent care facility Pediatric ED Other
6 Note: The survey allowed respondents to select more than one practice location; therefore, percentages total more than 100%.
between ABP and ABEM. Are there training needs or continuing medica] education needs that are not being met? At present, most of the practitioners of emergency medicine are trained in other specialties. Many request both core and advanced level educational programs and preceptorships, as well as i n f o r m a t i o n regarding appropriate equipment for the ED and prehospital providers. Most respondents felt that their specific continuing medical education needs are being met. They noted a need for advanced life support courses and core topics, particularly in certain geographic areas, and a need for more "cutting edge" meetings. The need for minifellowships and more pediatric rotations for emergency medicine residents was men19:5 May 1990
tioned many times. Skills laboratories were m e n t i o n e d by m a n y respondents, although these are costly and labor intensive. Finally, many of those responding to the survey expressed their desire for enhancement of pediatric emergency training in both emergency medicine and pediatric residencies. Other comments. More than 200 p h y s i c i a n s were i d e n t i f i e d as resources for ACEP. O t h e r surveys were uncovered concerning pediatric and emergency medicine training in the United States. One of these surveys indicated that there are approxi m a t e l y 280 p r a c t i c i n g pediatric emergency medicine specialists in North America.
DISCUSSION Although the results of this survey Annals of Emergency Medicine
3
cannot be considered to be representative of the ACEP membership as a whole, they present a picture of the background and opinions of a small but increasingly vocal segment of ACEP's membership that is interested in the subspecialty area of pediatric emergency medicine. The m a j o r i t y of r e s p o n d e n t s f a v o r e d subspecialty board certification in pediatric emergency medicine. There is a need for better geographic distribution of continuing medical education courses in pediatric emergency medicine as well as more meetings concerned with recent research findings. ACEP has a large resource of expertise in pediatric emergency care from which to draw, and ACEP must provide the practitioner w i t h the continuing education necessary to ensure optimal emergency care to 534/77
PEDIATRIC EMERGENCY MEDICINE Eitzen, Schafermeyer & Strange
children. The Pediatric Emergency Medicine Committee recognizes that these survey results are more representative of
78/535
the opinions of a vocal minority of ACEP's membership rather than the opinions of the majority of members but believes that it is this minority
Annals of Emergency Medicine
who will facilitate the definition and f u r t h e r d e v e l o p m e n t of pediatric emergency medicine within our specialty.
19:5 May 1990
The Role of the Emergency Physician in Providing Pediatric Emergency Care -A Membership Survey A survey of the membership of the American College of Emergency Physicians (ACEP) was undertaken to identify members with special interest or expertise in pediatric emergency medicine. A questionnaire was published in the Augus4 1988 issue of ACEP News, which was distributed to 12,079 members. One'hundred seventy-one responses were returned, revealing a subset of the membership (1.42%) with a special interest or expertise in pediatric emergency care. This group was characterized as to type of residency training, board certification (completed or planned), practice location, and percentage of practice composed of children. Opinions were sought regarding subspeciality certification, continuing medical education needs, and quality and quantity of pediatric emergency medical training in pediatric and emergency medicine residency programs. More than 200 physicians were identified as resources in pediatric emergency medicine for ACER The majority of the respondents favored subspecialty board certification. Continuing education needs are generally being met, but there is a need for better geographical distribution of courses. Minifellowships and more pediatric rotations for emergency medicine residents were suggested. [Eitzen E, Schafermeyer RW, Strange GR: The role of the emergency physician in providing pediatric emergency care - A membership survey. Ann Emerg Med May 1990;19:532-535.]
Edward Eitzen, Jr, MD Robert W Schafermeyer, MD, FACEP Gary R Strange, MD, FACEP Dallas, Texas From the Emergency Medicine Committee, American College of Emergency Physicians, Dallas, Texas. Received for publication July 17, 1989. Revision received October 27, 1989, Accepted for publication November 10, 1989. Address for reprints: Beverly Draper, American College of Emergency Physicians, PO Box 619911, Dallas, Texas 75261-9911.
INTRODUCTION As part of an effort to evaluate the role of emergency physicians in pediatric emergency care and to identify members with special interest or expertise in pediatric emergency medicine, the American College of Emergency Physicians's {ACEP) Pediatric Emergency Medicine Committee developed a questionnaire to survey the general membership, focusing on the need for subspecialty certification and continuing education needs. The information provided was used by the Pediatric Emergency Medicine Comm i t t e e to formulate future goals and identify m e m b e r s available for involvement in this area. ACEP represents more than 13,100 member physicians who have an interest in the practice of emergency medicine. There are an estimated 23,000 practicing emergency physicians, 7,888 of whom are board certified. In comparison, there are an estimated 37,000 practicing pediatricians, approximately 28,000 of w h o m are board certified. The Committee wished to evaluate and define the interrelationship of these groups in the provision of pediatric emergency care. This survey is just one facet of this evaluation and planning process; both ACEP and the American Board of Emergency Medicine (ABEM) are undertaking concurrent activities in pediatric emergency medicine to assist in this process. ABEM has worked with the American Board of Pediatrics (ABP) in developing guidelines for joint training programs. The ACEP Pediatric Emergency Medicine Committee has developed a position paper on the role of the emergency physician in the delivery of pediatric emergency care. The State University of New York at Syracuse is completing an emergency medicine training program survey on pediatric emergency medical care. These activities should facilitate the development of pediatric emergency medicine.
19:5 May 1990
Annals of Emergency Medicine
532/75
PEDIATRIC EMERGENCY MEDICINE Eitzen, Schafermeyer & Strange
METHODS A questionnaire was developed and published in the August 1988 issue of ACEP News. Physicians with interest, training, and/or experience in both pediatrics and emergency medicine were asked to respond. Of the 12,079 questionnaires sent to members, 171 were returned, a response rate of 1.42%. P h y s i c i a n s who r e s p o n d e d provided data regarding their training, specialty board certification status, practice setting, percentage o f practice involving children, and comm e n t s r e g a r d i n g w h e t h e r subspeciality certification in pediatric emergency medicine should be available to physicians who concentrate their practice in this area. Survey respondents' opinions also were solicited as whether their continuing education needs were being met. RESULTS In regard to specialty training, 43% of the respondents had completed a p e d i a t r i c r e s i d e n c y and 26% an emergency medicine residency. Nineteen percent of the respondents were boarded in pediatrics, 38% in emergency medicine, and 24% in both fields (Table 1). Respondents were queried regarding their plans to seek further board certification in either pediatrics or emergency medicine. The largest group (37%) were physicians already boarded in emergency medicine who had no plans to take pediatric boards. The second largest group (24%) were those already boarded in both specialties, followed by 14% already boarded in pediatrics and planning to take emergency medicine boards and 12% not boarded in either specialty but planning to take the emergency medicine boards (Table 2). Only 55 (32%) respondents board prepared in e m e r g e n c y m e d i c i n e were residency trained in emergency medicine. The survey allowed respondents to select more than one practice location; therefore, p e r c e n t a g e s t o t a l m o r e t h a n 100%. O n e h u n d r e d twenty-eight (75%) respondents indicated that they practiced in a general hospital emergency department, whereas 11% practiced in a children's hospital ED. Twenty-five percent of the respondents practiced in a teaching environment (Table 3). The percentage of respondents' 76/533
TABLE 1. Specialty training and certification of 171 ACEP members with an interest in pediatric emergency medicine
Pediatrics Emergency medicine Both Neither
Specialty Training Completed Board Residency (%) Certified (%) 43 19 26 38 6 24 25 19
practice involving children varied widely. N i n e t y respondents (52%) said the percentage of their practice involving children was between 11% and 30%, whereas 22 p h y s i c i a n s (13%) said that more than 90% of their practice involved children. Fifty-eight percent of the respondents favored subspecialty certification in pediatric emergency medicine; 68% of those who completed a pediatric residency and 61% of those who completed an emergency medicine residency favored subspecialty certification. Of the 43 respondents who did not complete a residency in either field, 60% did not favor subspecialty certification. Of those boarded in pediatrics, 81% favored subspecialty certification, whereas those boarded in emergency medicine were evenly split 48% for and 50% against. Of those boarded in both fields, 61% favored subspecialty certification; of those without boards, 50% favored subspecialty certification. Respondents were asked whether they had special expertise or experience in pediatrics or emergency medi c i n e if t h e y w e r e n o t f o r m a l l y trained or boarded in both. Thirtyeight percent of the total respondents replied affirmatively; 42% of that group indicated that they plan to take the specialty board in which they have special expertise. This group represented 21% of the total respondents and correlated well with the 26% to 27% who plan to take the emergency medicine boards. In addition to responding to specific questions, respondents were asked to comment on subspecialty certification, continuing medical education, and any other subject pertinent to the survey. The comments Annals of Emergency Medicine
ranged from very positive to very negative and demonstrated that some of ACEP's and ABEM's activities were not known by some respondents. For the questions Should there be a subspeciality certification in pediatric emergency medicine? And if so, for whom and by whom?, most respondents favored subspecialty certification, particularly for those practicing in teaching programs and large metropolitan and children's hospitals and for those not qualified to take emergency medicine boards by the practice category. A vocal minority of respondents feel that there are already too many " m e r i t badges" required and that subspecialty certification would only add to the confusion. Several respondents believe that pediatric emergency medicine is too limited an area for subspecialty certification. Several remarked that they would rather see efforts put into enhancing pediatric training in emergency medicine residencies. Others stated that having subspecialists available as teachers to facilitate enhanced pediatric education is a good idea. An appropriately trained and certified emergency physician can deliver proper emergency care to a pediatric patient. However, in children's hospital EDs and in emergency medicine and pediatric training programs there is a need for special expertise in pediatric emergency medicine. The need is to provide optimal emergency care to children and to enhance the training of emergency medicine and pedia t r i c r e s i d e n t s . W h o s h o u l d be trained, and who should certify? Survey respondents have different opinions on the question of certification, which is currently being negotiated 19:5 May 1990
TABLE 2. Board certification examination plans of 171 ACEP members with an interest in pediatric emergency medicine Response NO.
%
64
37
41 24 21
24 14 12
Boarded in pediatrics; no plans for emergency medicine Not boarded; no plans to take either Not boardgd; will take both Not boarded; will take pediatrics
8 6
5 4
3 2
2 1
Boarded in emergency medicine; will take pediatrics
2
1
Boarded in emergency medicine; no plans for pediatrics Boarded in both Boarded in pediatrics; will take emergency medicine Not boarded; will take emergency medicine
TABLE 3. Practice settings of 171 ACEP members with an interest in pediatric emergency medicine Responses Practice Setting
NO.
%
General hospital ED
128 24 19 18
75 14 11 11
5 5 4
3 3 2
Emergency medicine teaching program Pediatric teaching program Children's hospital ED Pediatric outpatient clinic or office Minor emergency or urgent care facility Pediatric ED Other
6 Note: The survey allowed respondents to select more than one practice location; therefore, percentages total more than 100%.
between ABP and ABEM. Are there training needs or continuing medica] education needs that are not being met? At present, most of the practitioners of emergency medicine are trained in other specialties. Many request both core and advanced level educational programs and preceptorships, as well as i n f o r m a t i o n regarding appropriate equipment for the ED and prehospital providers. Most respondents felt that their specific continuing medical education needs are being met. They noted a need for advanced life support courses and core topics, particularly in certain geographic areas, and a need for more "cutting edge" meetings. The need for minifellowships and more pediatric rotations for emergency medicine residents was men19:5 May 1990
tioned many times. Skills laboratories were m e n t i o n e d by m a n y respondents, although these are costly and labor intensive. Finally, many of those responding to the survey expressed their desire for enhancement of pediatric emergency training in both emergency medicine and pediatric residencies. Other comments. More than 200 p h y s i c i a n s were i d e n t i f i e d as resources for ACEP. O t h e r surveys were uncovered concerning pediatric and emergency medicine training in the United States. One of these surveys indicated that there are approxi m a t e l y 280 p r a c t i c i n g pediatric emergency medicine specialists in North America.
DISCUSSION Although the results of this survey Annals of Emergency Medicine
3
cannot be considered to be representative of the ACEP membership as a whole, they present a picture of the background and opinions of a small but increasingly vocal segment of ACEP's membership that is interested in the subspecialty area of pediatric emergency medicine. The m a j o r i t y of r e s p o n d e n t s f a v o r e d subspecialty board certification in pediatric emergency medicine. There is a need for better geographic distribution of continuing medical education courses in pediatric emergency medicine as well as more meetings concerned with recent research findings. ACEP has a large resource of expertise in pediatric emergency care from which to draw, and ACEP must provide the practitioner w i t h the continuing education necessary to ensure optimal emergency care to 534/77
PEDIATRIC EMERGENCY MEDICINE Eitzen, Schafermeyer & Strange
children. The Pediatric Emergency Medicine Committee recognizes that these survey results are more representative of
78/535
the opinions of a vocal minority of ACEP's membership rather than the opinions of the majority of members but believes that it is this minority
Annals of Emergency Medicine
who will facilitate the definition and f u r t h e r d e v e l o p m e n t of pediatric emergency medicine within our specialty.
19:5 May 1990
