also includes 4 months in the reciprocal specialty from which the resident enters the training program. For example, pediatric graduates must spend 4 months in adult care rotations. The core content of the curriculum must include training in EMS, administration, ethics, legal issues, research, and procedures. Certification is limited according to the physician’s primary board—7 years for the American Board of Pediatrics, 10 years for the American Board of Emergency Medicine (ACGME, 2004).
EM resident physicians are required to receive training in pediatric emergency care. In the early 1980s, there was considerable concern about the level and quality of pediatric emergency care training provided in these programs. Pediatric emergency care training accounted for approximately 16 percent of training time for EM residents, even though pediatric patients represented about 25 percent of all ED visits (Ludwig et al., 1982). In a survey, 42 percent of residency program directors expressed dissatisfaction with the pediatric training component of the EM residency (Ludwig et al., 1982; Christopher, 2000). Since that time, there has been increased involvement of pediatric emergency medicine physicians in EM residencies. Additionally, more EM residencies include specific training experience in pediatric emergency care, and more EM residency programs are affiliated with pediatric centers (AAP, 2000; Tamariz et al., 2000; Christopher, 2000).
Nonetheless, a more recent assessment of pediatrics in emergency medicine residency programs indicates that progress has been mixed. Pediatric training in EM residency programs continues to represent a relatively small percentage of training time. Today, approximately 13 percent of training time is spent on pediatric electives (Tamariz et al., 2000). EM residents may see children during nonpediatric rotations and certainly during their 18-plus months of supervised training on ED rotations, but the amount of pediatric contact time on these rotations is difficult to determine. At the same time, the confidence of residency directors in their pediatric curriculum has improved. The majority of directors indicated that they were either very or somewhat confident in the areas of trauma, intensive care, airway management, and urgent care. This confidence likely reflects the relatively large exposure of emergency residents to pediatric patients in EDs, pediatric EDs, pediatric intensive care units, and urgent care or fast-track clinics. In the area of neonatal resuscitation, most residency directors were somewhat confident or not very confident, suggesting that emphasis on this skill should be increased in the curriculum (Tamariz et al., 2000).
To be board certified in EM, a physician must pass an exam in that specialty. Approximately 8 percent of the EM board exam focuses on pediatric topics (ABEM, 2004). However, an individual need answer only 75 percent of the total questions correctly to pass. Therefore, an individual can answer all of the pediatric questions incorrectly and still receive a passing score on the exam.