Hooper, MC, Kamat, PP, Couloures, KG
Pediatric Critical Care Medicine 2018, p. 1., doi:10.1097/pcc.0000000000001809
Within the past 10 years, the need for non-anesthesia providers outside of the operating room has continued to increase. Many of these sedation providers are trained in pediatric critical care medicine (PCCM). Although PCCM physicians are expected to be proficient in pediatric procedural sedation (PPS) for sedation practice both inside and outside of the pediatric intensive care unit (PICU), there do not appear to be standard requirements for cognitive or psychomotor domains for fellows in training. The Accreditation Council for Graduate Medical Education (ACGME) specifies that PCCM fellows should become proficient in sedations, but they offer no guidelines or direction as to exactly how these skills are to be obtained.
Hooper et al sought to study and discuss the current state of sedation training for PCCM fellows via a survey of current PCCM fellowship directors, fellows and recent graduates. The objective of this study was to understand the variability of sedation training within PCCM fellowships as well as to determine if fellows felt that their training adequately prepared them for post-fellowship positions. A 21-question online survey was sent to PCCM fellowship directors active within the ACGME in September 2017, and they were asked to forward the survey to their senior fellows and recent graduates. Responses were tracked in RedCap software.
A total of 65% of fellowship programs responded. Incomplete survey answers were excluded. Most participants (62%) stated that their program did not offer an organized PPS rotation and 7% reported offering PPS as an elective. The programs that did offer PPS as formal rotation reported a length of ~4 weeks. Use of sedation simulation as a teaching tool was uncommon (9.4%). Despite this, 61% of responding fellows and recent PCCM graduates stated that their PPS training was adequate. Still, 30% reported that they required additional training or preceptorship as attending physicians in order to sedate and/or to receive sedation credentials.
The American Society of Anesthesiologists (ASA) does state that physicians providing deep sedation outside of the operating room should have some formalized training in PPS skills. However, the ACGME does not specify how these skills are to be obtained and maintained. Hollman et al describe the design of an educational course for all sedation providers (the SPS Sedation Provider Course®). They describe a successful effort at creating a national curriculum and in-person sedation course, given the lack of uniform standards in education, training and credentialing for sedation providers. They describe a focus on several core sedation competencies, including performing a sedation pre-assessment, understanding sedation medications and their antagonists, performance of moderate vs deep sedation, monitoring of the deeply sedated patient, recognition and management of the deeply sedated patient, and recovery and discharge of the sedated patient. Ninety-four percent of sedation providers who participated in this formal sedation course, with live instructors, clear objectives and direct feedback, stated that this type of format was effective. Participants with fewer than five years of sedation experience stated that they found simulation to be the most valuable educational tool utilized within the course.
Similar surveys have been performed with pediatric emergency medicine (PEM) fellows and have shown comparable variability in provision of formal procedural sedation training. Although pediatric hospital medicine (PHM) physicians are somewhat less likely to provide procedural sedation services on a frequent basis, some do – and most hospitalists are called upon to meet the anxiolysis and analgesia needs of their patients who require procedures and tests. Given the clinical demand for these services and the expectation that PCCM, PEM, and PHM physicians will be competent in providing them, studies such as this one from Hooper et al clearly demonstrate the opportunity that exists within pediatric fellowship programs to provide formal, standardized procedural sedation training to better meet these needs.
The article abstract can be found via the link on our blog:
- Hooper, MC, Kamat, PP, Couloures, KG. “Evaluating the Need for Pediatric Procedural Sedation Training in Pediatric Critical Care Medicine Fellowship.” Pediatric Critical Care Medicine 2018, p. 1., doi:10.1097/pcc.0000000000001809.
- Hollman, GA, Banks, DM, Berkenbosch, JW et al. “Development, Implementation, and Initial Participant Feedback of a Pediatric Sedation Provider Course.” Teaching and Learning in Medicine, vol. 25, no. 3, 2013, pp. 249–257., doi:10.1080/10401334.2013.797352.
Carmen D. Sulton, MD
Assistant Professor of Pediatrics and Emergency Medicine
Emory University School of Medicine
Patricia Scherrer, MD
Sedation Services, Children’s Healthcare of Atlanta at Egleston