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SPA Newsletter

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Volume 17 Number 2
Spring 2004 Newsletter
spa@societyhq.com

Fellow's Corner

This segment presents topics of interest to anesthesiology trainees in pediatric anesthesia and is not endorsed or necessarily representative of the views of the Society for Pediatric Anesthesia. In this issue, Dr. Valerie Armstead will focus on ACGME approved fellowship training programs for pediatric anesthesia. This topic is relevant in light of both the high demand for pediatric anesthesiologists and the increase in residents seeking post-anesthesiology residency training positions. This position is the counterpiece to Dr. Joe Tobin's presentation in the last issue on unaccredited Fellowship programs. As always, please e-mail any commentary you have and I will be happy to add it to the next newsletter.

Fellows corner is an excellent opportunity for future pediatric anesthesiologist to present their viewpoint or ask question about articles, current controversies in anesthesia, or fellowship training. Additionally, it allows trainees an early exposure to the SPA. Questions, commentary or reviews can be sent to jeffrey.galinkin@uchsc.edu. Include your name and hospital affiliation and whether you want these included if printed.

Jeffrey Galinkin, MD
UCHSC/ The Children's Hospital, Denver

Choosing a Career in Academic Pediatric Anesthesia

In response to Dr. Joe Tobin's Fellows' Corner article in the winter 2004 edition of the SPA Newsletter, Non-ACGME Approved Fellowship Training Programs for Pediatric Anesthesia, I whole-heartedly agree with his final words. I too would like to see more clinical and academic physicians in pediatric anesthesia. Moreover, we should SEED more physicians for academic anesthesia. To this end, I would like to briefly discuss why more residents and fellows in pediatric anesthesia should consider a career in academic anesthesiology.

I have the opportunity to serve as a sub specialty site visitor for the ACGME (Accreditation Council for Graduate Medical Education) residency review committee and from time to time am requested to evaluate anesthesia and anesthesia fellowship programs in consideration for approval by the ACGME. I am always impressed at what effort must go into establishing an approved fellowship program. Anyone who is considering a career in academic pediatric anesthesia should choose an approved fellowship program that can prepare them for this type of practice.

The objectives in finding a suitable program for training a pediatric anesthesia fellow for academic practice should include four main goals:

Clinical service

  • A program must be able to sustain itself financially, and provision of an active, successful clinical service is the bedrock which does the following:
  • Emphasizes the anesthesiologist as a physician and one who provides comprehensive perioperative care.
  • Takes a pro-active role in coordinating the team approach to patient care in the operating rooms and peri-operative areas
  • Provides state of the art, cutting edge clinical care.
  • Leads in innovation in the practice of the specialty.
  • Redefines and expands the breadth of anesthesiology services.
  • The department maintains or develops nationally and internationally recognized leaders in each of the major areas of clinical anesthesiology.
  • Maintains excellence and national visibility in Critical Care and Pain Management as these areas come under increasing financial pressures.

Education

  • A program should have an educational program that will train fellows and residents who have competency in knowledge and clinical skills that will provide:
  • Graduates of the program who will be sought after by top departments for faculty positions and by practice groups as their top recruits.
  • Evidence based education
  • A focus on continuous quality improvement in education and a vision for the future.
  • Development and implementation of innovative educational methods, including computer and multimedia approaches
  • Expansion and improvement of the Department's role in medical student education.

Research

  • Personnel shortages make excellence in research a challenge; however the goals should be ones that do the following:
  • Create and apply new knowledge in basic and clinical research programs
  • Move the specialty of Anesthesiology and of medicine forward
  • Ideally are in the mainstream of medical science.
  • Develop or continue research programs that integrate well with areas of research excellence
  • Fosters collaboration and takes advantage of critical mass.
  • Develop and promote clinical research programs
  • Include focus on evidence based medicine and translational research.
  • Establish and maintain fellowship programs in clinical and health services investigation.
  • The operating room and ICU are research laboratories for outcomes and health services research
  • Its process and management must be evaluated and measured through critique and innovation.
  • Studies and improves resource utilization, quality and safety.

Leadership

  • Programs with effective leaders produce leaders in kind. Some of our senior leaders trained at a time when there was no such thing as a fellowship in pediatric anesthesia, yet they had the foresight to help establish ACGME-approved programs. A focused, inspirational head of a pediatric anesthesia program does the following:
  • Emphasizes, empowers, and encourages each member of the faculty to develop her/his professional careers and goals to the fullest.
  • Develops leaders within the department, the medical school, the national anesthesiology community and the broader community of medicine.

Academic Anesthesia Practice Pros and Cons

The rewards of academic pediatric practice can be gratifying. I have tried to do an objective inventory of the pros and cons of a career in academic anesthesia and propose two short lists (see Table 1).

When medical students ask me what influenced my choice of medical specialty and subspecialty I include all those things that made the choosing easy for me. I also mention the fact that anesthesiology is chameleon-like in that a lot of the parameters such as intensity, patient contact, time commitment, practice management, can be ramped up or down throughout one's career. I give similar advice to fellows in pediatric anesthesia. It is possible to move in and out of pediatric academic or private practice. Like many aspects of life, the choices may not be easy but the results often depend ultimately on one's individual attitude and resourcefulness.

The final piece of advice I would like to give to anyone considering a career in academic anesthesia is to establish a mentor relationship with a successful person who has your best interest in mind as they help guide you through the process.


Table 1: Pros and cons of a career in pediatric academic anesthesia

Pros

  • Teaching
  • Potentially rewarding and satisfying
  • Collegiality
  • Academic advancement
  • Non-clinical time
  • Benefit package
  • Constant learning
  • CME
  • Meetings
  • Literature
  • Travel
  • Life style

Cons

  • Teaching
  • Potentially frustrating and irritating
  • Lower earning potential
  • Professional expenses
  • Liability
  • Time consuming
  • Life style
  • Tied to effort and compensation

Table 2: Milestones necessary for establishment of a career in academic research.

Valerie E. Armstead, MD
Associate Professor of Anesthesiology
Thomas Jefferson University/Jefferson Medical College
Philadelphia, PA
valerie.armstead@jefferson.edu

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