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SPA Newsletter.
Non-ACGME Approved Fellowship Training Programs for Pediatric AnesthesiaAs of November 2003, the ACGME lists 43 approved training programs in pediatric anesthesia (www.acgme.org). Some programs are composites of multiple previous training sites and many are stand alone Children's Hospitals affiliated with a parent training program in Anesthesiology. One of the shared goals of the SPA, AAP and ACGME is to enhance the educational opportunities for physicians. Development of approved training programs in pediatric anesthesia (without subspecialty certification) certainly is consistent with this goal. However, some other training programs also offer non-approved training in pediatric anesthesia.Non-approved training programs are not necessarily programs that applied for approval and were denied. Some of these sites are just entering into the pediatric training program arena without having submitted their site for evaluation. In general hospitals, pediatric patients may not be cohorted to dedicated pediatric operating rooms, or faculty may be covering adult patients in an adjacent room. Some centers may believe that they would not qualify due to a lack of faculty academic productivity or research opportunities directly related to pediatric anesthesia. It could be said that these centers may fall below the threshold where we would like to train new specialists. I would argue that is not necessarily the case. We have seen the difficulty created by the AAP in requiring subspecialty training programs to show evidence of scholarship by all finishing fellows. It is clear that the standard did not work and has been reconsidered. Although I am an academic physician, I recognize that not all specialists who would like to train in pediatric anesthesia are interested in anything other than providing excellence in clinical care to children for their careers. Some programs see great residents finishing who would like to spend more training time in pediatric anesthesia and the resident does not wish to relocate to an approved program for one year only to return to the general area of their residency. With more two professional couples, this dual training also causes temporal and distance difficulties. Therefore, some programs consider offering a clinical fellowship with appropriate educational materials and clinical experience for a select person. We believe there is a special nature to administering anesthesia to children, as do our colleagues with special training in cardiovascular anesthesia and neuroanesthesia. Neither cardiovascular anesthesia nor neuroanesthesia have ACGME certified fellowship programs. Did we not all learn from accomplished mentors in each of these fields during our training -either during a primary residency or subspecialty training to follow? And what of those who trained prior to ACGME approval? Were these leaders in the field not the consultants regarding the attributes required and later proffered by the ACGME? I do not advocate that any clinical facility open up their doors proclaiming themselves to be an excellent training program in pediatric anesthesia without some question of credentialing. For those of us in institutions where we can make the grade for ACGME approval, we should be starting the application process. As far as I can see, there will never be a sufficient supply of well trained pediatric anesthesiologists. For those institutions which choose not to apply for ACGME approval and recognition, careful consideration must be given to providing a sufficiently stimulating and competent training program. Whether the resident will see all types of pediatric anesthesia required by the ACGME or get sufficient pediatric cardiac or liver transplant experience may be variable. However, with greater numbers of clinicians receiving clinical and academic training, we'll assure educators and leaders for tomorrow. Kudos to the programs that have already passed the ACGME approval format. I know we have more to follow. I'd like to see more clinical and academic physicians in pediatric anesthesia!
Joe Tobin, MD
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