Building Pediatric Competency in the Emergency Department

Pediatric competencies define the essential abilities ED clinicians need to care for children, including:

• Knowing pediatric-specific guidelines and red flags
• Performing technical skills safely (e.g., IV access, airway management)
• Communicating effectively with children, families, and team members
• Working as a coordinated team during routine care and high-risk events

Competencies may be assessed by:

• Embedding pediatric elements into existing competencies (e.g., blood administration that includes pediatric dosing), or
• Dedicated pediatric competency assessments, especially for high-risk or low-frequency skills.

• Competency assessment is part of a broader skill development process:
  Learn → See → Practice → Prove → Do → Maintain

• Competency assessment occurs in the “Prove” phase, when clinicians demonstrate they can perform a skill correctly and reliably before practicing independently.

Not every skill needs the same level of assessment. A needs assessment helps identify:

• High-risk, low-frequency events
• Known gaps in pediatric skills or confidence
• Areas tied to patient safety, quality improvement, or regulatory requirements

Priority pediatric competencies are outlined in the Pediatric Readiness Joint Policy Statement and provide a strong foundation for EDs of all sizes.

Competency assessment should be intentional and structured. Key questions include:

• Who evaluates the skill (educators, preceptors, clinical leaders)
• When assessment occurs (orientation, annual review, just-in-time, remediation)
• Where it takes place (bedside, clinical unit, simulation)
• Why the skill is assessed (learning feedback vs. independent practice)
• How performance is measured (checklists, observation, simulation)

Common assessment methods include:

• Direct observation during patient care
• Simulation for rare or high-risk events
• Skill checklists and rating scales
• Entrustment decisions (level of supervision required)

Assessments may be:

• Formative – focused on coaching and skill development
• Summative – determining competence or readiness for independent practice

Pediatric competencies generally fall into four categories:

• Knowledge: clinical guidelines, algorithms, and pediatric principles
• Skills: technical and procedural abilities
• Affective: professionalism, empathy, family-centered care
• Teamwork & Communication: handoffs, closed-loop communication, team response

Matching the assessment method to the type of competency improves reliability and relevance.

• Use more than one assessment method, especially for high-risk skills
• Use simulation for rare but critical pediatric events
• Use observation for routine clinical behaviors
• Use entrustment to guide increasing independence
• Clearly define assessment frequency (orientation, annual, post-training)
• Document results consistently to support training, compliance, and quality improvement

Well-designed pediatric competency programs support safer care, stronger teams, and improved readiness for children in every ED.