P2.E084: Pediatric Emergency Medicine Fellowship Advocacy Curriculum Needs Assessment

Background: The Accreditation Council for Graduate Medical Education (ACGME) first outlined requirements for a child health advocacy curriculum for pediatric residency training in 1996 after physician experts in child health advocacy identified key advocacy topics and objectives through a series of needs assessments. The 2023 Pediatric Emergency Medicine (PEM) Fellowship guidelines focus on providing culturally competent care in the context of an understanding of the structural and social determinants of health, but advocacy training requirements are not clearly delineated for fellows. This study aimed to develop a consensus on advocacy learning objectives to inform the development of an advocacy curriculum for use in PEM fellowship training.

Methods: A three-round modified Delphi survey technique was distributed to PEM fellowship program directors (PD) and PEM fellows to identify the presence of an existing advocacy curriculum for PEM fellows, stakeholders’ willingness to adopt an advocacy curriculum, and to develop a consensus on the knowledge, skills, and activities considered to be important to include in an advocacy curriculum for PEM fellows. All participants were contacted via e-mail, and the confidential surveys were distributed electronically. The surveys in Round 1 collected demographic data and an initial list of learning objectives. The suggested objectives were grouped into themes by three individual coders (CQ, KG, SY) and disseminated in Round 2 with additional objectives requested. Round 3 surveys asked participants to rank the learning objectives in order of perceived priority. Consensus was based on 55-100% agreement. Responses remained de-identified. All survey results were securely stored in REDCap housed at Baylor College of Medicine in Houston, Texas.

Results: A total of 70 respondents [N=27 (39%) PD and N=43 (61%) fellows] participated in this study. A majority of PEM fellowship programs do not currently offer a longitudinal advocacy curriculum [N=26 (81%)] to fellowship trainees, and a majority [N=26 (65%)] were “likely” or “extremely likely” to utilize an advocacy curriculum if one was available. The study identified themes related to PEM fellows’ advocacy knowledge [N=188], skills [N=145], and activities [N=88] that stakeholders deemed important. Knowledge topics identified included a general understanding of health equity (19%), legislative advocacy (17%), and PEM advocacy basics including avenues for advocacy initiatives, scholarship, and ongoing education. Skills identified included effective communication techniques (22%), advocacy resource engagement and utilization (13%), and engaging with legislative officials (11%). Important advocacy activities identified for fellow participation included legislative advocacy events (26%), injury prevention initiatives (17%), and involvement in media advocacy (13%).

Conclusion: PEM fellowship program directors and fellows recognize the importance of the development and implementation of a child health advocacy curriculum. The themes identified in this study can help inform the design of a PEM-specific advocacy curriculum for these trainees