P2.Q325: A National Assessment of Pediatric Surgical Critical Care Fellowship Structure: Defining the Training Experience

Background: Pediatric Surgical Critical Care (PSCC) is a unique specialty incorporating fundamental principles of surgical, neonatal, and pediatric critical care. Pediatric surgical intensivists train through ACGME surgical critical care fellowships and are certified though the American Board of Surgery (ABS), though formal assessments of PSCC training program objectives, curricula, and infrastructure have not been performed. This study aims to characterize the current landscape of PSCC training to identify opportunities for standardization and educational improvement.

Methods: Following institutional review board exemption, an anonymous electronic survey-based assessment was distributed to the program directors (PDs) of all United States current ACGME-accredited PSCC fellowships (n=14). The survey investigated two main program domains: administrative (program size, accreditation, recruitment strategies) and educational (curricula components, learning resources, rotation schedule). Graduate outcomes (estimated board passage rates, pediatric surgery match entry) were also assessed. Survey items consisted of multiple choice, multiselect and free-text formats. Responses were reported using descriptive statistics using number of observations and/or proportions.

Results: The survey response rate was 100%. The majority of primary administrative ACGME accreditation responsibilities are managed either by the pediatric surgery section/department (79%) or the adult surgery department (21%). Programs utilize multiple fellow recruitment methods including post-pediatric surgery match referrals (93%), word of mouth (93%), direct application (86%), and the American Pediatric Surgical Association website (86%). Most programs (71%) recruit a combination of both post-residency graduates and in-training residents, while less frequently, programs recruit only residency graduates (21%) or only in-training residents (8%). NRMP match was not utilized by PSCC programs. Approximately 80% of PSCC programs matriculate 1 fellow per academic year; two-fellow (7%) and three-fellow (14%) programs are less common. Only 29% of PDs use a pediatric specific structured curriculum that details specific benchmarks for medical and procedural knowledge. Formalized reading lists and standardized resources are utilized by 64%. All programs offer recurrent educational lectures to fellows by a variety of faculty (Table 1). There is marked heterogeneity across programs related to time spent in core and elective rotations (Table 2). Nearly half (43%) of PDs estimate their fellows to spend < 60% of the academic year as the ‘primary’ critical care provider. Most PSCC programs (86%) expect their fellows to cover pediatric surgery call, commonly between 5-8 calls per month (67%). ABS SCC certifying board passage rates were reported as >90% in all programs. The majority (86%) of PD report that >80% of matriculating PSCC fellows enter the pediatric surgery fellowship match.

Conclusion: PSCC fellowships have great heterogeneity in curriculum and content. These results support the need for structured multidisciplinary efforts to more clearly standardize fellowship experience to equip the pediatric surgical field with a better understanding of these uniquely qualified surgeons.