Inpatient Exposure, Confidence, and Knowledge in Pediatric Hematology/Oncology: Evaluating General Pediatric Residents During 2025 ACGME Curriculum Change

Background General pediatricians often evaluate hematologic and oncologic presentations before subspecialty consultation, yet the 2025 Accreditation Council for Graduate Medical Education (ACGME) pediatric requirements reduce inpatient pediatric hematology/oncology (PHO) time, raising questions about resident readiness. We evaluated whether inpatient PHO exposure was associated with resident confidence and knowledge in faculty‐prioritized topics. Procedure We conducted a single‐center cross‐sectional study. PHO faculty completed a needs assessment to identify generalist‐relevant competencies. Residents completed a 27‐item confidence survey and an 8‐item multiple‐choice question (MCQ) assessment and were compared across cohorts with 0, 288 (one 4‐week block), or 840 inpatient PHO hours using Kruskal–Wallis testing. Spearman correlation related confidence to knowledge overall and within cohorts. Results Fourteen PHO faculty and 44 of 89 residents (49.4%) completed the surveys. Overall confidence differed across cohorts ( p < 0.0001), similar in the 0‐ and 288‐h cohorts but higher in the 840‐h cohort. Total MCQ scores did not differ significantly ( p = 0.1283). Five of eight faculty‐prioritized topics were answered correctly by fewer than half of residents. Higher confidence was associated with higher knowledge overall ( ρ = 0.31, p = 0.04), but this reflected differences between cohorts and was not significant within any cohort. Conclusions Greater inpatient PHO exposure was associated with higher confidence but not higher MCQ performance, and confidence was not a reliable indicator of measured knowledge. Residents approximating the new ACGME exposure threshold were indistinguishable from those with no exposure in either outcome. PHO educators should assess knowledge directly against defined generalist outcomes rather than assuming time on service or confidence reflects the knowledge residents need. This work was presented in part as Poster #202, “Impact of Reduced Pediatric Heme/Onc Exposure on Resident Confidence and Knowledge,” at the 2026 American Society of Pediatric Hematology/Oncology Conference, April 29 to May 2, 2026, Minneapolis, Minnesota, and published in the Pediatric Blood & Cancer 2026 ASPHO Conference Paper and Poster Index. The poster was selected as a top poster at ASPHO that year.