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Objectives: Simulation is a commonly used modality to teach paediatric procedural skills, however, it is resource intensive. Which paediatric skills are best taught using simulation is not known. This study aims to examine what skills to simulate, allowing for the best use of resources in ever expanding curricula., Method: We administered a questionnaire to community and hospitalist general paediatricians in Canada asking them to rate the importance of maintaining competency in each paediatric procedural skill and the frequency with which they perform the skill in their practice., Results: Skills that were rated as highly important and also high frequency were: bag-mask ventilation (BMV), lumbar puncture, neonatal cardiopulmonary resuscitation (CPR), specimen procurement for infectious diseases, immunization, and ear curettage. Skills that were rated as highly important but low frequency were: paediatric CPR, intraosseous needle insertion, neonatal intubation, defibrillation, gathering specimens for evidence of child maltreatment, paediatric intubation, cervical spine immobilization, and oral/nasogastric tube placement., Conclusion: Paediatric procedural skills are rated variably in terms of importance and frequency of use in general paediatric practice. Eight skills of high importance are infrequently performed and should be targeted for teaching via simulation., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The field of Paediatric Medicine has grown tremendously over the last two decades. Several niche areas of practice have emerged, and opportunities for focused training in these areas have grown in parallel. The landscape of 'General Paediatric Fellowship' (GPF) Programs in Canada is not well described; this knowledge is needed to promote standardization and high-quality training across Canada. This study explores the structure and components of existing GPFs in Canada and identifies the interest and barriers to providing such programs., Methods: A questionnaire was created to explore the landscape of GPF Programs in Canada. Invitations to participate were sent to leaders of General Paediatric Divisions across Canada, with a request to forward the survey to the most appropriate individual to respond within their local context., Results: A total of 19 responses (95%) representing 17 different Canadian universities were obtained. Eight universities offered a total of 13 GPF Programs in 2019, with one additional university planning to start a program in the coming year. Existing programs were variable in size, structure and curriculum. Most programs identified as Academic Paediatric Programs, with an overlap in content and structure between Academic Paediatrics and Paediatric Hospital Medicine programs. The majority of respondents felt there was a need for GPF Programs in Canada but cited funding as the most common perceived barrier., Conclusion: A growing number of GPF Programs exist in Canada. Current fellowship programs are variable in structure and content. Collaboration between programs is required to advance GPF training in Canada., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The Royal College of Physicians and Surgeons of Canada (RCPSC) sets objectives for residency training, including many skills that may not be commonly performed in practice., Objective: To describe attitudes of residents enrolled in Canadian paediatric residency programs toward procedural skills training, including perception of importance and perceived proficiency of the RCPSC-required procedures., Methods: An anonymous electronic survey was distributed to all senior residents enrolled in Canadian paediatric residencies, using a five-point Likert scale to address procedural importance and corresponding proficiency. Data were analyzed using descriptive statistics, with Pearson correlation coefficients used to describe relationships among variables., Results: A total of 68 residents responded. Fifteen skills had a mean importance ≥4 (very or extremely important) and five skills had a mean rating <3 (somewhat or not important). Residents believed they were extremely or very proficient (mean rating ≥4) for three skills (bag-mask ventilation, lumbar puncture and chest x-ray interpretation). They reported 23 procedures for which they felt somewhat to not proficient (mean <3). The correlation between importance and proficiency was high (Pearson's correlation coefficient = 0.87). However, proficiency was significantly lower than importance (P<0.05) for the majority of procedures (88%). The largest gaps between importance and proficiency were observed for chest tube insertion, gathering evidence of child maltreatment, defibrillation and intraosseous insertion., Conclusion: Many, but not all, RCPSC-required procedures are believed to be important. Residents do not believe that they are adequately proficient in many of these procedures. Skills with the greatest gap between importance and proficiency may be targets for curricular interventions.