P2.Q333: Current Educational State of Academic Pediatric Acute Care Fellowships

Background: Pediatric acute care/urgent care fellowships are a relatively new training opportunity for pediatricians to gain additional experience in urgent care medicine. Most recently, one of the established programs has obtained Academic Pediatric Association (APA) certification, marking a significant step towards national recognition of this field. As the field is expanding and new programs are being created, the Pediatric Acute Care Fellowship Leaders Committee (PAC-FLC) sought to appraise the current educational state of the current roster of established and developing fellowship programs.

Methods: A 37-item Qualtrics instrument was developed as a cross-sectional survey of the current national leaders who are members of the PAC-FLC. The membership includes current pediatric acute care/urgent fellowship program directors, associate program directors, and future program directors from across the country. Domains of the instrument included: general program details, fellowship organization, education, and barriers.

Results: Out of 19 PAC-FLC members, 14 (74%) responded to the survey. The majority of respondents (10/14, 71%) were program directors from the following programs (table). Half of the respondents were leaders from established programs (7 leaders from 6 established programs) and the other half were leaders of developing programs (7 leaders from 6 developing programs). Physician leadership, residency graduate procedural inexperience, and emergency department overutilization were the top 3 reasons for creating fellowship programs. Half of established programs (3n, 50%) have graduated between 6-8 fellows, with the most common type of role that graduates take on being division faculty members. None went on to establish an urgent care in either a rural or urban setting. Leadership potential was the most important component for applicant selection (14n, 100%) with teaching experience being the next most common reason (6/14, 43%). Word-of-mouth recruitment and institution advertisement were the most common methods of recruitment of established programs, no applicants were recruited from conference advertisements. Only two programs listed the option of an academic track or focus for fellows. The most common tracks offered were clinical research, medical education, and quality improvement. Advocacy and healthcare administration training was only offered in a minority (2/6, 33%) of established programs. Quality improvement projects were noted by all established programs to be conducted by fellows. Fellows are educated in the following procedures (fig.) with only two respondents stating their fellows are credentialed for soft tissue-related point-of-care ultrasound scans.
Lack of financial support and national recognition were seen as the biggest barriers to national fellowship growth. Challenges recruiting (8/14 57%) was the most common problem identified.

Conclusion: While challenges of recruitment, financial support, and national recognition remain, pediatric urgent care fellowships are expanding. Areas of fellowship growth may include increased focus on advocacy training, academic tracks, telehealth, and POCUS as well as expansion into the rural and urban settings outside of academic institutions.