ASA August 2003 Newsletter

Pain medicine subspecialty training is currently undergoing expansion and challenges similar in many ways to critical care medicine subspecialty training during the 1970s. The breadth of knowledge within pain medicine is growing rapidly, and while training programs have grown significantly in overall number, most continue primarily with an apprenticeship model of training. Additionally, the field of pain medicine intrigues and attracts other specialty physicians in part due to the often unmet need for control of acute, chronic and cancer pain.

Currently there are more than 100 anesthesiology-based pain medicine fellowship programs, all of which are accredited by the Accreditation Council for Graduate Medical Education (ACGME) via the Anesthesiology Residency Review Committee (RRC). This accreditation oversight via RRC allows its members to have unique vantage points from which to view subspecialty pain medicine training and the educational continuum. For emphasis, ACGME is a private, nonprofit council that evaluates and accredits medical residency programs in the United States and whose primary mission is to promote the quality of residency education for the next generation of physicians and to contribute to safe and effective patient care. The members of the Anesthesiology RRC are practicing anesthesiologists with original nomination through the American Board of Anesthesiology, American Medical Association and ASA.

One of the considerations used by RRC when evaluating pain medicine training is whether the curriculum and length of training continuum is of sufficient duration to cover the breadth of knowledge required by pain medicine subspecialists to care effectively for patients. At present, many voice their opinion that the training continuum needs to be lengthened to allow for the expanding knowledge of pain medicine patient care to be covered effectively. There is a developing sense that an additional six months of training and education will help to cover the growing information about this area of medicine. This lengthening of the training continuum to produce more comprehensively trained physicians may be less problematic than many believe. Instituting a creative use of six months of elective time during the last year of a resident’s core residency program for pain medicine training expansion may be the answer. It will produce no additional time to the overall residency-fellowship training cycle, and it will take advantage of already allocated elective time during the CA-3 year. Other specialties have been successful in using similar models, and we hold out hope that this may work for both our core residencies and pain medicine fellowship programs.

An additional need for our pain medicine fellowship training programs is to continue to nurture a truly academic focus with the creation of new knowledge through research and innovation. It is our belief that any specialty or subspecialty needs this creation of new knowledge as an integral part of the training environment to assure the long-term health of the discipline. There are likely many ways the specialty of anesthesiology can help in developing this subspecialty, and the most important is to have our core residents and pain medicine fellows recognize that pain medicine faculty are succeeding in academic careers. Individual faculty carrying out research, education and clinical care, all the while enjoying the experience, will measure the success of the academic model. This seems most possible in a setting where an individual training program is of sufficient depth and breadth to allow a sufficient number of faculty to collaborate in academic work.

The goal of the Anesthesiology RRC is to create the very best pain medicine physicians by encouraging development of and accrediting training programs that have a comprehensive approach to pain medicine.

James F. Arens, M.D., is Professor and Chair, Department of Anesthesiology, M.D. Anderson Cancer Center, Houston, Texas. He was ASA President in 1989, and is the Outgoing Chair of the ACGME RRC for Anesthesiology.

David L. Brown, M.D., is Professor and Head, Department of Anesthesiology, University of Iowa Health Care, Iowa City, Iowa. He is the Incoming Chair of the ACGME RRC for Anesthesiology.

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