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June 1996
Volume 60 |
Number 6
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RESIDENTS' REVIEW
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| Anesthesia Fellowships
on the Rise -- New Wave or Dinosaur That Won't Die? |
Zarina Memon, M.D.
Due to the current changing trends in the anesthesiology job
market, many residents are opting to continue their training on
a fellowship track and delay their job search. The focus of this
article will be to present information on fellowship opportunities
in anesthesiology critical care medicine and pain management.
Prior to completing their residency in a specialty program, residents
should take time to decide whether training in a fellowship program
would be a benefit to their career. Even if one chooses a fellowship
and receives training in a subspecialty that is not recognized
by the Accreditation Council for Graduate Medical Education, additional
skills and knowledge in a specialized area of anesthesia can be
acquired. This additional training may be helpful in obtaining
a position in an anesthesia group practice or at an academic center.
Currently, there are a variety of anesthesia fellowships available,
but only two -- critical care medicine and pain management --
are recognized by the American Board of Anesthesiology (ABA) with
a certificate of special qualifications in those two subspecialties.
Other fellowship programs (cardiothoracic, vascular, neurosurgical,
obstetrics and pediatric anesthesia) are not recognized by the
ABA but instead usually offer a certificate of completion as proof
of training. Most fellowships require 12 months of training; however,
some are longer. Regardless of the fellowship, most programs require
satisfactory completion of anesthesiology residency training that
meets the requirements of the ABA.
Critical care anesthesia is devoted to the acute and long-term
care of critically ill patients with multiple organ derangements.
There are other intensive care unit (ICU) training programs directed
solely by surgical and medical teams, but the ABA does not recognize
these for anesthesia accreditation. There are 40 anesthesiology
critical care medicine programs offering approximately 107 positions
throughout the United States (according to a 1995 survey of anesthesiology
residency programs and children's hospitals).
A critical care medicine fellowship requires a minimum of 12 months
of training after the completion of an anesthesiology residency,
and the majority of the 12 months is spent in the medical treatment
of critically ill patients in the ICU. The remaining months are
structured to provide additional resources necessary to develop
skills in teaching, administration and research. Exposure in the
ICU should be broad and should include caring for both adult and
pediatric patients.
Pain fellowships are currently popular and, thus, very competitive.
There are several reasons for this. First, pain fellowship training
positions around the country are limited in number. Second, it
is one of the few areas in which new graduates are in demand because
of their specialized training. There are currently 49 programs
in the United States, most of which accept candidates only from
their own residency programs. A number of these fellowship programs
last for one year; however, some are two-year fellowships. There
is a trend to increase pain fellowship training time from a 12-month
period to a 24-month period in order to separate those who are
truly interested in pain management from those who may be motivated
only by future financial promises.
Good sources of information regarding anesthesiology fellowships
include the Graduate Medical Education Directory, the ASA Executive
Office and the Accreditation Council for Graduate Medical Education.
Zarina Memon, M.D., is a CA-2 anesthesiology
resident at the University of Massachusetts Medical Center, Worcester,
Massachusetts.
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