Pediatric Cardiac Anesthesia Fellowship Training

Frank McGowan, M.D.,
Children’s Hospital, Boston

Some of the leadership in Adult Congenital Cardiology have expressed concern that the concepts being discussed by the CCAS and the SPA for such training will exclude those anesthesiologists with adult cardiac anesthesia fellowships who desire greater expertise in caring for the adult with congenital heart disease. There are several possible areas of confusion over the way forward for fellowship training in congenital cardiac anesthesia, some arising from the recent ability of adult cardiac anesthesia fellowships to obtain ACGME certification:

Pediatric cardiac anesthesia deliberately took a "pass" on trying to be included in the ACGME process, at least for the time being. This occurred for many reasons --see the CCAS President’s Message for further details.
One of the consequences of the adult process is that there is no requirement to spend any time doing pediatric cardiac anesthesia during the adult cardiac anesthesia fellowship. In addition, because of case (and echo) number requirements and other factors, most adult programs obtaining ACGME certification now have fewer fellows, with the practical consequence of less elective time for anyone who might have wanted to do a month or more of congenital as part of their adult fellowship. Here at Boston Children’s, we have seen our "rotating" adult fellow numbers drop markedly as a result.
The most time any "adult" fellow spent doing pediatric cardiac at Boston Children’s was usually one month, some did 2 months. This would be typical of most places, and it would not be unfair therefore to question how well-equipped such fellows actually are to care for adult congenital patients.
No defined "track" for pediatric cardiac anesthesia has been established. There has been much discussion. One concern relevant to the question from the Adult Congenital Cardiology leadership is that the "typical" adult cardiac anesthesia fellow with "typical" anesthesia and adult cardiac anesthesia training will not be entirely competent to care for the neonates and infants who make up a bulk of the initial cases, nor will they be able to function as useful consultants for non-cardiac pediatric anesthesia cases in these patients, nor will they be suitable for the vast majority of jobs that exist (i.e. ones where they will probably be asked to cover, at least on call, "general" pediatric anesthesia cases).
What has been tentatively (and I emphasize the word) envisioned is 2 pathways for entry into and completion of "pediatric cardiac anesthesia" training. Both would require about 18 months (again, please do not take this as anything more than the overall conversation at this point). If a trainee wanted to enter from pediatric anesthesia, he/she would do combined pediatric anesthesia/cardiac anesthesia fellowships, with some time off of each for electives (e.g. adult, echo, etc.). For someone coming from adult cardiac training, their base and "elective time" would be significantly (say 6-9 months) spent doing many of the components of a pediatric anesthesia fellowship, pediatric echo, etc.
In addition, like it or not, this subspecialty has moved more toward having its foundations in pediatric anesthesia as opposed to cardiac anesthesia. This is not inconsistent with ACC and AHA guidelines on what is necessary for tertiary/quaternary care of the ACHD patient. More important, like anything else, my view of expertise in ACHD is that it is not as much about training requirements as it is about actual interest, involvement, long-term commitment, and compulsiveness.

Pediatric Cardiac Anesthesia Fellowship Training

© 2007 CONGENITAL CARDIAC ANESTHESIA SOCIETY