|
Introduction
Definition and Scope of the Specialty
Pediatric Anesthesiology is the subspecialty of anesthesiology
devoted to the preoperative,intraoperative, and postoperative anesthetic
care of pediatric patients.
Duration and Scope of Education
Subspecialty training in pediatric anesthesiology shall
be 12 months in duration, beginning after satisfactory completion of the
residency program in anesthesiology as required for entry into the examination
system of the American Board of Anesthesiology. Subspecialty training
in pediatric anesthesiology is in addition to the minimum requirements
described in the Program Requirements for the core program in anesthesiology.
The clinical training in pediatric anesthesiology must
be spent in caring for pediatric patients in the operating rooms, in other
anesthetizing locations, and in intensive care units. The training will
include experience in providing anesthesia both for inpatient and outpatient
surgical procedures and for nonoperative procedures outside the operating
rooms, as well as preanesthesia preparation and postanesthesia care, pain
management, and advanced life support for neonates, infants, children,
and adolescents.
Goals and Objectives
The subspecialty program in pediatric anesthesiology must
be structured to ensure optimal patient care while providing residents
the opportunity to develop skills in clinical care and judgment, teaching,
administration, and research. The subspecialist in pediatric anesthesiology
should be proficient not only in providing anesthesia care for neonates,
infants, children, and adolescents undergoing a wide variety of surgical,
diagnostic, and therapeutic procedures, but also in pain management, critical
perioperative care, and advanced life support. To meet these goals, the
program should provide exposure to the wide variety of clinical problems
in pediatric patients, as outlined in V.B., that are necessary for the
development of these clinical skills.
Institutional Organization
Relationship to the Core Residency Program
Accreditation of a subspecialty program in pediatric anesthesiology
will be granted only when the program is associated with a core residency
program in anesthesiology that is accredited by the Accreditation Council
for Graduate Medical Education (ACGME). Therefore, subspecialty training
in pediatric anesthesiology can occur only in an institution in which
there is an ACGME-accredited residency program in anesthesiology or in
an institution related to a core program by a formal integration agreement.The
director of the core anesthesiology residency program is responsible for
the appointment of the director of the pediatric anesthesiology subspecialty
program and determines the activities of the appointee and the duration
of the appointment.
There must be close cooperation between the core program
and the subspecialty training program. The division of responsibilities
between residents in the core program and those in the subspecialty program
must be clearly delineated.
Institutional Policy
There should be an institutional policy governing the
educational resources committed to pediatric anesthesiology programs.
Faculty Qualifications and
Responsibilities
Program Director
Qualifications of the Program Director
The program director in pediatric anesthesiology must
be an anesthesiologist who is certified by the American Board of Anesthesiology
or who has equivalent qualifications. The program director also must be
licensed to practice medicine in the state where the institution that
sponsors the program is located (certain federal programs are exempted)
and have an appointment in good standing to the medical staff of an institution
participating in the program. He/she must have training and/or experience
in providing anesthesia care for pediatric patients beyond the requirement
for completion of a core anesthesiology residency.
The program director in pediatric anesthesiology has responsibility
for the training program subject to the approval of the program director
of the core residency training program in anesthesiology.He/she must devote
sufficient time to provide adequate leadership to the program and supervision
for the residents. The clinical director of the pediatric anesthesiology
service may be someone other than the program director.
Responsibilities of the Program Director
- Preparation, periodic review, and, if necessary, revision
of a written outline of the educational goals of the program with respect
to the knowledge, skills, and other attributes of residents at each
level of training and for each major rotation or other program assignment.
This statement must be distributed to residents and members of the teaching
staff. It should be readily available for review.
- Selection of residents for appointment to the program
in accordance with institutional and departmental policies and procedures.
- Selection and supervision of the teaching staff and
other program personnel.
- Supervision of residents through explicit written
descriptions of supervisory lines of responsibility for the care of
patients. Such guidelines must be communicated to all members of the
program staff.
- Residents must be provided with prompt, reliable systems
for communication and interaction with supervisory physicians.
- Implementation of fair procedures, as established
by the sponsoring institution, regarding academic discipline and resident
complaints or grievances.
- Preparation of an accurate statistical and narrative
description of the program, as requested by the Residency Review Committee
(RRC).
Faculty
Although the number of faculty members involved in teaching
residents in pediatric anesthesiology will vary, it is recommended that
at least three faculty members be involved, and that these be equal to
or greater than two full-time equivalents, including the program director.
A ratio of no less than one full-time equivalent faculty member to one
subspecialty resident shall be maintained. The RRC understands that full-time
means that the faculty member devotes essentially all professional time
to the program.
There must be evidence of active participation by qualified
physicians with training and/or expertise in pediatric anesthesiology
beyond the requirement for completion of a core anesthesiology residency.
The faculty must possess expertise in the care of pediatric patients and
must have a continuous and meaningful role in the subspecialty training
program.
The program should include teaching in multidisciplinary
conferences by faculty in pediatric and neonatal intensive care, pediatric
medicine, and pediatric surgery.
The pediatric anesthesiology program director and faculty
responsible for teaching subspecialty residents in pediatric anesthesiology
must maintain an active role in scholarly pursuits pertaining to pediatric
anesthesiology, as evidenced by participation in continuing medical education
as well as by involvement in research as it pertains to the care of pediatric
patients.
Clinical and Educational Facilities
and Resources
The following resources and facilities are necessary
to the program:
- Intensive care units for both newborns and older children.
- An emergency department in which children of all ages
can be effectively managed 24 hours a day.
- Operating rooms adequately designed and equipped for
the management of pediatric patients.
- A postanesthesia care area adequately designed and
equipped for the management of pediatric patients must be located near
the operating room suite.
- Pediatric surgical patients in sufficient volume and
variety to provide a broad educational experience for the program.
- Surgeons with special pediatric training and/or experience
in general surgery, otolaryngology, neurosurgery, GU, ophthalmology,
orthopedics, and plastic surgery must be available.
- Monitoring and advanced life-support equipment representative
of current levels of technology.
- Allied health staff and other support personnel.
- Facilities that are readily available at all times
to provide prompt laboratory measurements pertinent to the care of pediatric
patients. These include but are not limited to measurement of blood
chemistries, blood gases and pH, oxygen saturation, hematocrit/hemoglobin,
and clotting function.
- Conveniently located library facilities and space
for research and teaching conferences in pediatric anesthesiology.
|
Educational Program
Goals and Objectives
The director and teaching staff must prepare and comply
with written goals for the program. All educational components of the
program should be related to the program goals. The program design must
be approved by the RRC as part of the regular review process. A written
statement of the educational objectives must be given to each resident.
Clinical Components
The subspecialty resident in pediatric anesthesiology
should gain clinical experience in the following areas of care of neonates,
infants, children, and adolescents:
- Preoperative assessment of children scheduled for
surgery
- Cardiopulmonary resuscitation and advanced life support
- Management of normal and abnormal airways
- Mechanical ventilation
- Temperature regulation
- Placement of venous and arterial catheters
- Pharmacologic support of the circulation
- Management of both normal perioperative fluid therapy
and massive fluid and/or blood loss
- Interpretation of laboratory results
- Management of children requiring general anesthesia
for elective and emergent surgery for a wide variety of surgical conditions
including neonatal surgical emergencies, cardiopulmonary bypass, solid
organ transplantation, and congenital disorders
- Techniques for administering regional anesthesia for
inpatient and ambulatory surgery in children
- Sedation or anesthesia for children outside the operating
rooms, including those undergoing radiologic studies and treatment and
acutely ill and severely injured children in the emergency department
- Recognition, prevention, and treatment of pain in
medical and surgical patients
- Consultation for medical and surgical patients
- Recognition and treatment of perioperative vital organ
dysfunction
- Diagnosis and perioperative management of congenital
and acquired disorders
- Participation in the care of critically ill infants
and children in a neonatal and/or pediatric intensive care unit
- Emergency transport of critically ill patients within
the hospital and between hospitals
- Psychological support of patients and their families
- In preparation for roles as consultants to other specialists,
subspecialty residents in pediatric anesthesiology should have the opportunity
to provide consultation under the direction of faculty responsible for
teaching in the pediatric anesthesiology program. This should include
assessment of the appropriateness of a patient's preparation for surgery
and recognition of when an institution's personnel, equipment, and/or
facilities are not appropriate for management of the patient.
Didactic Components
The didactic curriculum, provided through lectures and
reading, should include the following areas, with emphasis on developmental
and maturational aspects as they pertain to anesthesia and life support
for pediatric patients:
- Cardiopulmonary resuscitation
- Pharmacokinetics and pharmacodynamics and mechanisms
of drug delivery
- Cardiovascular, respiratory, renal, hepatic, and central
nervous system physiology, pathophysiology, and therapy
- Metabolic and endocrine effects of surgery and critical
illness
- Infectious disease pathophysiology and therapy
- Coagulation abnormalities and therapy
- Normal and abnormal physical and psychological development
- Trauma, including burn management
- Congenital anomalies and developmental delay
- Medical and surgical problems common in children
- Use and toxicity of local and general anesthetic agents
• Airway problems common in children
- Pain management in pediatric patients of all ages
- Ethical and legal aspects of care
- Transport of critically ill patients
Subspecialty conferences, including morbidity and mortality
conferences, journal reviews, and research seminars, should be regularly
attended. Active participation of the subspecialty resident in pediatric
anesthesiology in the planning and production of these conferences is
essential. However, the faculty should be the conference leaders in the
majority of the sessions. Attendance by residents at multidisciplinary
conferences, especially those relevant to pediatric anesthesiology, is
encouraged.
Resident Policies
Duty Hours
While the actual number of hours worked by subspecialty
residents may vary, residents should have sufficient time off to avoid
undue fatigue and stress. It is recommended that residents be allowed
to spend, on average, at least 1 full day out of 7 away from the hospital
and should be assigned on-call duty in the hospital no more frequently
than, on average, every fourth night.
The program director is responsible for monitoring the
residents' activities to ensure adherence to this recommendation.
Peer Interaction
Subspecialty residents in pediatric anesthesiology should
become experienced in teaching principles of pediatric anesthesiology
to other resident physicians, medical students, and other health-care
professionals. This experience should correlate basic biomedical knowledge
with clinical aspects of pediatric anesthesiology, including the management
of patients requiring sedation outside the operating rooms as well as
pain management and life support.
Scholarly Activities
The subspecialty training program in pediatric anesthesiology
should provide the opportunity for active resident participation in research
projects pertinent to pediatric anesthesia.Subspecialty residents should
be instructed in the conduct of scholarly activities and the evaluation
of investigative methods and interpretation of data, including statistics;
they should have the opportunity to develop competence in critical assessment
of new therapies and of the medical literature.
Additional Required Components
There should be prompt access to consultation with other
disciplines, including pediatric subspecialties of neonatology, cardiology,
neurology, pulmonology, radiology, critical care, emergency medicine,
and pediatric subspecialties of surgical fields. To provide the necessary
breadth of experience, an accredited residency training program in pediatrics
is required within the institution. Residency programs or other equivalent
clinical expertise in other specialties, particularly pediatric general
surgery and pediatric surgical subspecialties, such as otolaryngology,
GU, neurosurgery, ophthalmology, and orthopedics, and pediatric radiology
are highly desirable.
Evaluation
Faculty responsible for teaching subspecialty residents
in pediatric anesthesiology must provide critical evaluations of each
resident's progress and competence to the pediatric anesthesiology program
director at the end of 6 months and 12 months of training. These evaluations
should include attitude, interpersonal relationships, fund of knowledge,
manual skills, patient management, decision-making skills, and critical
analysis of clinical situations. The program director or designee must
inform each resident of the results of evaluations at least every 6 months
during training, advise the resident on areas needing improvement, and
document the communication. Subspecialty residents in pediatric anesthesiology
must obtain overall satisfactory evaluations at completion of 12 months
of training to receive credit for training.
There must be a regular opportunity for residents to
provide written, confidential evaluation of the faculty and program.
Periodic evaluation of patient care (quality assurance)
is mandatory. Subspecialty residents in pediatric anesthesiology should
be involved in continuous quality improvement, utilization review, and
risk management.
Periodic evaluation of subspecialty training objectives
is encouraged.
Valerie Armstead, MD
Thomas Jefferson University, Philadelphia, PA
|
