Preparing Physicians to Lead: A Survey of Pediatric Emergency Medicine Fellows and Program Directors on Operations, Administration, and Leadership Education.

Background: Operations, administrative, and leadership (OAL) skills are critical for emergency physicians who lead multidisciplinary teams and manage operational tasks daily. Although the ACGME requirements outline key administrative competencies, many pediatric emergency medicine (PEM) fellows do not achieve proficiency, and no standardized curriculum exists. Objectives: Our primary aim is to describe existing practices for teaching OAL topics in PEM fellowships. Our secondary aim is to identify content areas for future curricula. Methods: We conducted a cross-sectional survey targeting PEM fellowship program directors (PDs) and fellows. Using the American Academy of Pediatrics Section on Emergency Medicine's PEM PD listserv, we identified 77 programs, including 400 second- and third-year fellows and 400 recent graduates. Surveys assessed the presence of operations curricula and perceived readiness for post-graduation OAL responsibilities. Data were analyzed using descriptive statistics. Results: Respondents included 42/77 PDs (55%) and 75/336 fellows (22%). Most PDs (34/42, 81%) and fellows (48/75, 64%) reported no operations curricula. Among PDs without curricula, 22/34 (65%) expressed interest in adopting one, and 30/31 (97%) of current fellows without curricula were interested in participation. The primary barrier to implementation was lack of time (8/12, 67%). PDs reported limited fellow exposure to faculty engagement/development (30/39, 77%), staffing models (28/39, 72%), finance and billing (24/39, 62%), and patient throughput (24/39, 62%). Fellows also reported low confidence in these areas. PDs (24/39, 62%) and fellows (39/70, 56%) identified healthcare disparities as the most important topic for future curricula. Conclusion: This study highlights significant variability in the presence and content of operations curricula within PEM fellowship programs. Although some programs provide formal training, many fellows report a lack of confidence in OAL skills, underscoring the need for a standardized curriculum to ensure fellows are prepared for post-graduate OAL roles. While focused on PEM, these findings reflect broader opportunities to strengthen OAL education across graduate medical training.