Perceptions and Barriers Among Japanese Emergency Physicians in Managing Acutely Ill Pediatric Patients: A Mixed-Methods Multicenter Study

Pediatric emergency medicine is not an established subspecialty in Japan, and persistent pediatric workforce shortages have increased reliance on emergency physicians to manage acutely ill children with limited training. This study aimed to characterize emergency physicians’ self-perceived confidence in managing acutely ill pediatric patients and to identify educational and system-level barriers.

We conducted a mixed-methods study from March to July 2024 across 14 emergency departments in Japan Emergency Medicine Network. Board-certified emergency physicians completed an anonymous survey assessing confidence using a five-point Likert scale. Acutely ill pediatric patients were defined as children aged 0–6 years with Japan Triage and Acuity Scale levels 1–2. Physicians reporting neutral or lower confidence were invited to semi-structured Zoom interviews. Mixed-effects ordinal regression examined associations between confidence and years in practice, gender, and pediatric cardiopulmonary resuscitation (CPR) experience, with emergency department as a random effect. Interview data underwent inductive thematic analysis.

Fifty-four physicians completed the survey. No participants reported being very confident; 11% were confident, 39% neutral, 39% not confident, and 11% not confident at all. Higher confidence was associated with greater years in practice (adjusted odds ratio [aOR] 1.09 per year; p=0.05) and male gender (aOR 8.17; p=0.004), but not with pediatric CPR experience. Fifteen interviews identified three themes: limited exposure to critically ill pediatric patients and procedures, challenges leading multidisciplinary pediatric resuscitations due to unclear roles, and emotional distress related to delivering bad news and supporting bereaved families. No participating sites reported pediatric termination-of-resuscitation or bereavement protocols.

Half of emergency physicians reported low confidence in managing acutely ill pediatric patients, underscoring gaps in training and system support. Education-focused interventions, including simulation-based pediatric resuscitation training, protocol development with clearer role delineation, and structured communication and debriefing curricula, may improve physician confidence and pediatric emergency care quality.