How general pediatricians learn procedures: implications for training and practice

ABSTRACT

The Accreditation Council for Graduate Medical Education (ACGME) requires General Pediatricians (GPeds) to learn thirteen procedures during training. However, GPeds infrequently perform these procedures in practice. We sought to determine:1) how GPeds learned procedures, 2) if GPeds self-reported achieving competence in the required ACGME procedures during training, and 3) if GPeds maintained these skills into practice. We conducted this mixed methods study from 2019–2020. 51 GPeds from central Ohio and the American Board of Pediatrics General Examination Committee were recruited via email or snowball sampling and participated in semi-structured recorded phone interviews probing procedural performance during training and current practice. Participants represented varied geographic regions and clinical settings. We employed Sawyer’s ‘Learn, See, Practice, Prove, Do, Maintain’ mastery learning pedagogical framework as a lens for thematic analysis. Participants did not demonstrate competence in all ACGME required procedures during training, nor sustain procedural skills in practice. Most participants learned procedures through a ‘see one, do one’ apprenticeship model. GPeds reported never being formally assessed on procedural competence during residency. All GPeds referred out at least one procedure. GPeds also believed that skill maintenance was unwarranted for procedures irrelevant to their current practice. GPeds did not sufficiently demonstrate competence in all ACGME required procedures during training, partially suggesting why they infrequently perform some procedures. Alternatively, these required procedures may not be relevant to their practice. Pediatric residency procedures education might consider using mastery learning for practice-specific procedures and surface-level methods (learning without mastery) for other skills.

KEYWORDS:

• Accreditation council for graduate medical education
• pediatrics
• residency
• procedures
• Education
• mastery learning

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclaimer

This content is solely the responsibility of the authors and does not represent the official views of the American Board of Pediatrics or the American Board of Medical Specialties.

Ethical approval

Nationwide Children’s Hospital Institutional Review Board (IRB) determined that project was exempt on March 2, 2019

Additional information

Funding

This work was supported by the American Board of Medical Specialties Research and Education Foundation.

Notes on contributors

Maya S. Iyer

Dr. Iyer was supported by a grant to the American Board of Medical Specialties Research and Education Foundation from the American Board of Medical Specialties. The funder/sponsor did not participate in the work.