title: Exposure to prenatal consultation during pediatric surgery residency: Implications for training.
abstract: OBJECTIVE
  Prenatal consultation is an important skill that should be learned during pediatric surgery training, but there are no formal guidelines for fellowship programs at this time. We sought to characterize the fellowship experience of recent pediatric surgery graduates and assess preparedness for providing prenatal consultation.
  
  
  METHODS
  An anonymous online survey of pediatric surgery fellows graduating in 2012 and 2013 was performed. We asked respondents to describe participation in prenatal consultation and preparedness to perform consultation. We measured demographics and fellowship characteristics and tested associations between these variables and preparedness to perform prenatal consultation.
  
  
  RESULTS
  A total of 49 out of 80 fellows responded to the survey (61% response rate). Most respondents (55%) saw five or fewer prenatal consults during fellowship, and 20% had not seen any prenatal consults. 47% said that fellowship could have better prepared them to perform prenatal consults. Fellows who saw more than 5 prenatal consults during fellowship (33% vs 77%, p=0.002) or described their fellowship as being structured to facilitate participation in prenatal consults (83% vs 27%, p<0.0001) were more likely to feel prepared. Stepwise logistic regression revealed that after adjusting for covariates, fellows graduating from programs that were 1) structured to facilitate participation in prenatal consults (OR 18, 95% CI 3.7-86.7), or 2) did NOT have an established fetal program (OR 5.5, 95% CI 1.1-27.8) were more likely to feel prepared.
  
  
  CONCLUSIONS
  Exposure to prenatal consultation varies greatly across pediatric surgery fellowships, and many recent graduates do not feel prepared to perform prenatal consultation. The presence of an established fetal program did not necessarily translate into improved fellow training. Efforts should be made to standardize the approach to fellow education in this area and ensure that adequate guidance and resources are available to recently graduated pediatric surgeons.
authors.affiliation: Nemours-A.I. DuPont Hospital for Children, Dept of Surgery, 1600 Rockland Rd., Wilmington, DE 19803. Electronic address: lorenberman1@gmail.com.
authors.forename: Loren
authors.initials: L
authors.lastname: Berman
authors.affiliation: Ann and Robert H. Lurie Children's Hospital, Department of Surgery, Chicago IL.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kabre
authors.affiliation: Nemours-AI DuPont Hospital for Children, Center for Healthcare Delivery Science, Wilmington DE.
authors.forename: Anne
authors.initials: A
authors.lastname: Kazak
authors.affiliation: Nemours-A.I. DuPont Hospital for Children, Department of Surgery, Wilmington DE.
authors.forename: Barry
authors.initials: B
authors.lastname: Hicks
authors.affiliation: Hasbro Children's Hospital, Department of Surgery, Providence RI.
authors.forename: Francois
authors.initials: F
authors.lastname: Luks
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005257:Fellowships and Scholarships / Q000592:standards*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D010372:Pediatrics / Q000193:education*; D011296:Prenatal Diagnosis; D012017:Referral and Consultation; D013043:Specialties, Surgical / Q000193:education*; D011795:Surveys and Questionnaires
keywords: Competency; Education; Fellowship training; Pediatric surgery; Prenatal consultation