Pediatrics |

The Educational Impact of In-House Attending Coverage Models in the Pediatric ICU FREE TO VIEW

Kyle Rehder, MD; Ira Cheifetz, MD; David Turner, MD
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Duke Children's Hospital, Durham, NC

Chest. 2013;144(4_MeetingAbstracts):760A. doi:10.1378/chest.1702319
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SESSION TITLE: Pediatric Asthma Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: In-house intensivist coverage is now commonplace within critical care, but data regarding clinical outcomes related to these models are mixed. Within pediatric critical care, data are especially limited, and no data exist regarding the impact of IHA coverage on trainee education, autonomy, and supervision. We hypothesized that IHA models would decrease pediatric housestaff autonomy and adversely impact education.

METHODS: A national web-based survey was distributed to attending pediatric intensivists, pediatric critical care fellows, and pediatric residents at academic centers. The survey included questions on the demographics and educational effects of IHA models.

RESULTS: There was a 74% center response rate (147/200 centers), including 472 intensivists, 178 fellows, and 632 residents. Intensivist coverage models included an IHA model (53%), a home coverage model (26%), and a mixed model (21%). 96% of respondents felt that the PICU provides a positive educational experience. Respondents working in IHA models were more likely to perceive that IHA models are good for education (84% vs. 59%, p<0.0001) and improve housestaff supervision (89% vs. 71%, p<0.0001) and less likely to report that IHA models limit housestaff autonomy (54% and 69%, p<0.0001). Only 60% of respondents felt that trainees will be prepared to be an independent attending after training in an IHA model, compared to 81% for a home model (p<0.0001). 65% of intensivists trained in home coverage models, compared to 26% of current fellows (p<0.0001). Residents in an IHA model were more likely to state an attending will be at the bedside when help is needed (84% vs. 61%, p<0.0001). Resident procedural experience was more dependent on presence of a fellowship program rather than coverage model.

CONCLUSIONS: While faculty and trainees working in IHA models perceive that education and supervision are enhanced by this coverage, respondents have concerns regarding preparation of trainees in IHA models.

CLINICAL IMPLICATIONS: As 24/7 IHA coverage increases within pediatric critical care, attention should be paid to maintaining adequate autonomy and preparing housestaff for the transition to independent practice.

DISCLOSURE: The following authors have nothing to disclose: Kyle Rehder, Ira Cheifetz, David Turner

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