Restructuring of
Anesthesiology Residency Training
Maneesh Sharma, M.D.
Recent discussions at the national ASA Resident Governing
Council meeting and the Anesthesiology Resident Review
Committee (RRC) have focused on ways to improve residency
training. Under consideration is a proposal to eliminate
the transitional year and to incorporate the PGY-1
year into a four-year anesthesiology residency.
The goal is to standardize the first year so that
residents have a more equal and positive experience
and so that residents enter the CA-1 year with a common
base of experience relevant to anesthesiology. Transitional
year programs cater not only to anesthesiology but
also to ophthalmology, radiology, nuclear medicine,
etc. Obviously, preliminary medicine and surgery residencies
cater to their own parent fields. Including the first
year into the anesthesiology residency would ensure
that internship rotations would have more value in
our training as anesthesiologists.
The exact curriculum of this first year is still being
discussed and formulated but would likely emphasize
medicine, intensive care, pulmonary medicine, cardiology,
pediatrics and surgery. By ensuring a more concentrated
internship, the class would have a head start on mastering
the skills, knowledge and judgment required of a consultant
in anesthesiology. This accelerated training model
may create the potential for the PGY-4 year to have
structured time in specialty tracks such as research,
critical care, pediatrics and pain medicine.
Small, private internships may still exist but will
have to be accredited by the Accreditation Council
for Graduate Medical Education (ACGME) and be formally
affiliated with an anesthesiology residency. Once
the RRC has constructed the standardized curriculum
for the internship year, programs would be formally
evaluated to ensure that they cover this curriculum.
Anesthesiology program directors will be able to evaluate
and create affiliations with internship programs within
their own institution and elsewhere. This would ensure
both local control and national uniformity in quality.
A few caveats: First, the changes being discussed,
if implemented, will occur over a gradual phase-in
process that will not affect any current anesthesiology
resident in training. Second, internship will continue
to consist of rotations in medicine and surgery services;
however, the first year’s curriculum will be
more formally tied to the parent anesthesiology residency
program. Third, discussions are currently under way
to determine whether residents who switch from other
fields will be required to repeat the PGY-1 year or
to show that their prior experience meets the curricular
goals of the anesthesiology internships.
The drawbacks for the restructuring include the many
logistical problems in initiating such changes. Programs
would be required to obtain intern positions in medicine,
surgery and other departments for the PGY-1 year.
If the resources are not available at the parent institution,
an affiliation with another hospital will need to
be established in order to ensure a complete PGY-1
experience. This is a daunting task to many program
directors across the country.
And let us not forget the residents. Common sentiments
I have heard from fellow residents include: “It
would require us to relocate one year earlier”
and “It would remove the ability to get experience
in fields of medicine I will never be able to get
again.” For osteopathic residents, the anesthesiology
internship might not satisfy their current school
requirement for an internship and would effectively
add a fifth year of training. Finally, why change
something that works?
The ACGME-RRC will decide, with feedback from program
directors, faculty and residents across the country,
exactly what needs to be changed and how it should
be done. The committee consists of members who have
exceptional devotion to our training and our future
as a specialty. As the resident member of the ACGME-RRC,
I can voice your opinions to this group. Our opinions
do matter, and we can make a difference. If you feel
passionately about this issue and have a view you
would like to express, please contact me at <masharma@jhmi.edu>.
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Maneesh
Sharma, M.D., is a fellow in Pain Medicine,
Department of Anesthesiology and Critical Care
Medicine, Johns Hopkins Hospital, Baltimore,
Maryland. |
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