BackgroundAlthough Entrustable Professional Activities (EPAs) regarding pediatric training in care for children with medical complexity (CMC) exist, it is unknown what US pediatric training programs provide for education related to care of CMC and whether educators perceive that pediatric residents are prepared to care for CMC upon graduation.MethodsFrom June, 2021 through March 2022, we surveyed US pediatric residency program delegates about practice settings, current educational offerings, perception of resident preparedness regarding care of CMC, and likelihood to implement CMC education in the future.ResultsResponse rate was 29% (56 /195). A third of responding programs (34%,n= 19) provide a specific educational CMC offering including combinations of traditional didactics (84%,n= 16), asynchronous modules/reading (63%,n= 12), experiential learning (58%,n= 11), and simulation-based didactics (26%,n= 5). The majority (93%,n= 52) of respondents agreed residents should be competent in providing primary care for CMC upon graduation and CMC should receive primary care from a resident (84%,n= 47). A total of 49% (n= 27) of respondents reported their residents are very or extremely well prepared to care for CMC after graduation. A total of 33% (n= 18) of programs reported CMC receive primary care from residents. Respondent average perception of resident preparedness was significantly higher in programs with educational offerings in five of eleven EPAs (nutrition and weight, transitions, feeding tubes, advocacy, and care coordination). The majority (78%,n= 29) of programs without educational offerings are at least somewhat likely to implement CMC curricula in the next three years.ConclusionPediatric residency programs report residents should be competent in care for CMC upon graduation. Pediatric residents are exposed to a wide variety of clinical care models for CMC. The minority of responding programs have intentional CMC educational offerings. Of those programs that provide CMC education, the offerings are variable and are associated with a perception of improved preparedness to care for CMC upon graduation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-023-04324-y.