In this needs assessment survey, we found that leaders in the field of pediatric urgent care believe that general pediatric residency graduates need additional training before they can achieve competence in urgent care. The estimated time range for this training varied widely; however, most survey respondents recommended that recent pediatric residency graduates have an additional 6 months to 1 year of training.
The vast majority of survey respondents consider clinical competency the most important skill for a pediatric urgent care provider, followed closely by procedural competency. We believe these aspects of urgent care are best learned in a supervised environment. On the other hand, study participants considered the skills of administration, quality improvement, and teaching as less important. These can be safely acquired on-the-job and, while important, do not directly impact patient care.
Our findings are timely because of the growing demand for urgent care services, due in part to the rising cost of emergency department visits and the shortage of primary care availability [2, 3]. With the expansion of urgent care centers throughout the country, there has also been a concurrent increase in the number of urgent care centers specifically geared toward the care of the pediatric patient. Pediatric residency graduates are the largest portion of the pediatric urgent care center workforce .
To our knowledge, this is the first study evaluating the preparedness of pediatric residency graduates to provide care in a pediatric UCC. This adds to the developing set of literature around providing quality, patient-centered care in UCCs. Our results supplement the findings of another study, which examined the effects of establishing an urgent care curriculum and lecture series for residents in the primary care setting. Overall response to the content was positive, but more importantly, referral percentage to subspecialists decreased from 34% before the intervention to 31% after the intervention . Interestingly, our study, which focused on leaders in the field of urgent care medicine, contradicts the findings of another study, which focused on pediatricians’ self-perception. A survey of residency graduates found that, despite limited access to clinical time in the emergency department, 98% of trainees felt that they were well-prepared to manage pediatric emergencies . The gap between the self-perception of residency graduates’ competence and the perception of emergency medicine and urgent care medicine leadership is an interesting finding in and of itself and warrants further investigation.
Pediatric urgent care centers see a wide range of patient acuity and often provide care that encompasses some services normally administered in the primary care office and some traditionally provided in the emergency department. Pediatric urgent care providers are often expected to be competent in fracture management, wound care, abscess drainage and IV placement. In addition, between 1 and 5% of patients who initially present to an UCC will subsequently require transport to an emergency department ; consequently, an urgent care provider must be competent to provide stabilization of critically ill children prior to the availability of transport to a higher acuity setting. The ACGME requires only 2 months of pediatric emergency training in 3 years of pediatric residency . Therefore, pediatric residency graduates are often underprepared for this work. Consistent with this, none of the survey respondents feel that a recent graduate of a pediatric residency is ready to provide competent care in an UCC without further training.
The majority of survey respondents recommend that recent pediatric residency graduates have an additional 6 months to 1 year of training to competently provide urgent care. The vast majority of survey respondents consider clinical competency the most important skill for a pediatric urgent care provider, followed closely by procedural competency. The majority of survey respondents consider administrative skills, quality improvement skills and teaching skills as less important. Recently, a new crop of pediatric urgent care fellowships has arisen to meet this demand. Further educational needs assessments will help refine these fellowships to more specifically meet the needs of recent pediatric residency graduates planning on working in pediatric UCCs.
These new urgent care fellowships provide a supervised environment for pediatric residency graduates to gain the clinical and procedural competency needed to work in an urgent care setting. In addition, an academic setting can help fellows gain administrative, quality improvement and teaching skills.
First and foremost, our survey completion rate was only 42%; however, this is comparable to the generally accepted 50% response rate in social research surveys and higher than the average 30% response rate to online surveys [9, 10]. The majority of respondents were from academic institutions, were located in a hospital and employed recent pediatric residency graduates. It is unclear if the respondents are overall representative of the larger surveyed population. In addition, in order to reach the most pediatric urgent care center directors possible, we administered the survey to the members of PEMNAC and SPUC, contributing to the limitation of targeting mainly academic urgent care centers and urgent care centers in urban and suburban areas. Another limitation of this study is that the respondents are all in senior leadership positions, which may introduce bias as leaders in urgent care may have self-interest in differentiating their field as a specialty. No recent pediatric residency graduates or trainees were included in this survey. It is possible that recent pediatric residency graduates and trainees would identify different degrees of competency and different knowledge gaps than their supervisors. In addition, in order to maintain anonymity, we did not ask respondents to specify the location of the UCC they direct. It is therefore possible that the majority of our results are from one region in the United States and not representative of pediatric UCCs around the country. Lastly, in an effort to keep the survey short and therefor maximize the likelihood of survey completion, we did not specify particular procedures or clinical competencies. It is possible the results would have varied from one procedure or clinical competency to the next, giving more granularity to the information.