Perceptions of 24/7 In-house Attending Coverage on Fellow Education and Autonomy in a Pediatric Cardiothoracic Intensive Care Unit

Owens, Sonal T.; Owens, Gabe E.; Rajput, Shaili; Charpie, John R.; Kidwell, Kelley M.; Mullan, Patricia B.

doi:10.1111/chd.12261

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…3,5 Separate cardiac ICUs also tend to have increased access to more cardiac-specific subspecialists (e.g., electrophysiology, heart failure, cardiac anaesthesia consultants). 3,5,15 More commonly in separate cardiac ICUs vs. mixed units, at least one attending has additional cardiac training. 3,5,14 A recent survey of paediatric critical care medicine directors indicated that approximately 33% of cardiac ICU staff physicians are double-boarded in paediatric critical care medicine and cardiology, 12.5% underwent paediatric critical care medicine fellowship and a 1-year cardiac ICU fellowship, 30% underwent cardiology fellowship in addition to a 1-year cardiac ICU fellowship, and 21% underwent paediatric critical care medicine fellowship with no additional training (including those who were practising long before the addition of the 1-year cardiac ICU and dual fellowship training pathways became readily available).…”

Section: Discussionmentioning

confidence: 99%

“…1 While paediatric residents commonly staff mixed units, paediatric critical care medicine fellows are predominant learners in cardiac ICUs, perhaps allowing for more fellow practice autonomy. 3,5,15 Unit structural differences create different learning environments for paediatric critical care medicine fellows and likely affect exposure to various CHDs, acuity, surgical procedures, and circulatory support devices. 3 In general, hospitals with dedicated cardiac ICUs have higher surgical volumes and younger patients with higher-risk defects, increasing fellow exposure to higher acuity patients.…”

Section: Discussionmentioning

confidence: 99%

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High variability in cardiac education and experiences during United States paediatric critical care fellowships

et al. 2022

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Background: Paediatric cardiac critical care continues to become more sub-specialised, and many institutions have transitioned to dedicated cardiac ICUs. Literature regarding the effects of these changes on paediatric critical care medicine fellowship training is limited. Objective: To describe the current landscape of cardiac critical care education during paediatric critical care medicine fellowship in the United States and demonstrate its variability. Methods: A review of publicly available information in 2021 was completed. A supplemental REDCap survey focusing on cardiac ICU experiences during paediatric critical care medicine fellowships was e-mailed to all United States Accreditation Council of Graduate Medical Education-accredited paediatric critical care medicine fellowship programme coordinators/directors. Results are reported using inferential statistics. Results: Data from 71 paediatric critical care medicine fellowship programme websites and 41 leadership responses were included. Median fellow complement was 8 (interquartile range: 6, 12). The majority (76%, 31/41) of programmes had a designated cardiac ICU. Median percentage of paediatric critical care medicine attending physicians with cardiac training was 25% (interquartile range: 0%, 69%). Mandatory cardiac ICU time was 16 weeks (interquartile range: 13, 20) with variability in night coverage and number of other learners present. A minority of programmes (29%, 12/41) mandated other cardiac experiences. Median CHD surgical cases per year were 215 (interquartile range: 132, 338). When considering the number of annual cases per fellow, programmes with higher case volume were not always associated with the highest case number per fellow. Conclusions: There is a continued trend toward dedicated cardiac ICUs in the United States, with significant variability in cardiac training during paediatric critical care medicine fellowship. As the trend toward dedicated cardiac ICUs continues and practices become more standardised, so should the education.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

High variability in cardiac education and experiences during United States paediatric critical care fellowships

et al. 2022

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“…7Concerns about fellows' autonomy were also raised in a study done to evaluate their education in Pediatric Cardiac Intensive Care unit. (8) Effects of increased attending physician presence on education of NICU fellows have not been studied. We hypothesized that 24/7 intensivists' coverage in the NICU at academic institutions would cause a perception of decreased autonomy and would not be perceived as being bene cial for their education.…”

Section: Introductionmentioning

confidence: 99%

Effect of 24/7 attending coverage in the Neonatal Intensive Care Unit on fellow education.

Sahni

Mowes

2020

Preprint

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Background There is a current change in type of attending coverage in the Neonatal Intensive Care Unit (NICU) from home calls to 24/7 in House. Effects of this increased attending physician presence on education of NICU fellows has not been studied. The objective of this study is to evaluate the fellows’ perception of in house attending coverage on their education and evaluate its effect on their perceived autonomy.Methods A secure, anonymous, web-based survey was designed using using RedCap. The web-based survey was sent via the section of Neonatal Perinatal Medicine of the American Academy of Pediatrics, to all members of Training & Early Career Neonatologists. Chi-square tests were used to compare groups on dichotomous outcomes, with Fisher Exact tests used when the expected cell frequencies were small.Results One hundred and twenty-three surveys were analyzed, that included responses from 82 fellows & 41 early career neonatologists. 52% reported having 24/7 attending in-house (IH) coverage. 30 of the 123 respondents experienced a change in model of attending coverage during their training. Among these 30, only 26.6% preferred the model of attending IH coverage. The respondents currently working in IH models, when compared to those in non-IH coverage models felt IH attending coverage was beneficial for fellow education (p <0.05) but was less likely to give fellows autonomy for decision making (p=0.02). Conclusion In our survey respondents with in house attending, had a more favorable view of its benefit on fellow education. Institutions practicing or considering IH attending coverage should consider use of adequate measures to balance fellow supervision and education.

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“…(7) Concerns about fellows' autonomy were also raised in a study done to evaluate their education in Pediatric Cardiac Intensive Care unit. (8) Effects of increased attending physician presence on education of NICU fellows have not been studied. We hypothesized that 24/7 intensivists' coverage in the NICU at academic institutions would cause a perception of decreased autonomy and would not be perceived as being bene cial for their education.…”

Section: Introductionmentioning

confidence: 99%

Effect of 24/7 attending coverage in the Neonatal Intensive Care Unit on fellow education.

Sahni

Mowes

2020

Preprint

View full text Add to dashboard Cite

BackgroundThere is a current change in type of attending coverage in the Neonatal Intensive Care Unit (NICU) from home calls to 24/7 in House. Effects of this increased attending physician presence on education of NICU fellows has not been studied. The objective of this study is to evaluate the fellows’ perception of in house attending coverage on their education and evaluate its effect on their perceived autonomy.MethodsA secure, anonymous, web-based survey was designed using using RedCap. The web-based survey was sent via the section of Neonatal Perinatal Medicine of the American Academy of Pediatrics, to all members of Training & Early Career Neonatologists. Chi-square tests were used to compare groups on dichotomous outcomes, with Fisher Exact tests used when the expected cell frequencies were small.ResultsOne hundred and twenty-three surveys were analyzed, that included responses from 82 fellows & 41 early career neonatologists. 52% reported having 24/7 attending in-house (IH) coverage. 30 of the 123 respondents experienced a change in model of attending coverage during their training. Among these 30, only 26.6% preferred the model of attending IH coverage. The respondents currently working in IH models, when compared to those in non-IH coverage models felt IH attending coverage was beneficial for fellow education (p <0.05) but was less likely to give fellows autonomy for decision making (p=0.02).ConclusionIn our survey respondents with in house attending, had a more favorable view of its benefit on fellow education. Institutions practicing or considering IH attending coverage should consider use of adequate measures to balance fellow supervision and education.

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Perceptions of 24/7 In-house Attending Coverage on Fellow Education and Autonomy in a Pediatric Cardiothoracic Intensive Care Unit

Cited by 9 publications

References 11 publications

High variability in cardiac education and experiences during United States paediatric critical care fellowships

High variability in cardiac education and experiences during United States paediatric critical care fellowships

Effect of 24/7 attending coverage in the Neonatal Intensive Care Unit on fellow education.

Effect of 24/7 attending coverage in the Neonatal Intensive Care Unit on fellow education.

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