Carolyn F. Bannister, M.D., Chair
Committee on Pediatric Anesthesia

In 1997, the Accreditation Council for Graduate Medical Education (ACGME) began establishing criteria for accreditation of pediatric anesthesiology training programs. At that time, training programs were required to submit to ACGME detailed documentation of volume, breadth and acuity of pediatric anesthesiology cases as well as detailed information on available resources regarding faculty, facilities and funding committed to education. After thorough review, 41 pediatric anesthesiology fellowship programs were accredited by ACGME in 1998 and 1999. Site visits were conducted in the year 2000 to ensure that all 41 programs met minimum requirements to maintain ACGME accreditation.

The impetus for formal ACGME accreditation of pediatric anesthesiology was a joint application for accreditation from the Study Group on Pediatric Anesthesia, the Society for Pediatric Anesthesia (SPA), the ASA Committee on Pediatric Anesthesia and the American Academy of Pediatrics (AAP) Section on Anesthesiology. The Study Group on Pediatric Anesthesia was formed in 1992 by directors of pediatric divisions of anesthesiology residency programs, anesthesiology directors in community and academic children’s institutions and the leadership of SPA, the AAP Section on Anesthesiology and the ASA Committee on Pediatric Anesthesia. The members of this group were interested in structuring quality pediatric anesthesiology fellowship programs to promote excellence in the delivery of pediatric anesthesia.

In addition to the goal of defining the specialty of pediatric anesthesiology and assisting with the scope of education of pediatric anesthesiologists, the group also developed guidelines for the pediatric perioperative environment. These guidelines have gained wide acceptance as standards of care for pediatric anesthesiology. The guidelines were carried forward by the Committee on Quality Assurance of the AAP Section on Anesthesiology and were published in 1999.¹

Two pediatric anesthesiology representatives were chosen in 2002 to become members of the Anesthesiology Residency Review Committee (RRC.) Mark A. Rockoff, M.D., and Steven C. Hall, M.D., were instrumental in assisting the RRC with definitions of the specialty, the scope of education and the goals and objectives for pediatric anesthesiology training. Drs. Rockoff and Hall have held meetings with pediatric anesthesiology program directors at the biannual SPA meetings during the SPA/AAP winter educational meeting and the ASA Annual Meeting. Agenda items have varied based on the needs of the program directors but have included discussions on gaining and maintaining accreditation, surviving site visits and communicating with the RRC.

Program directors of pediatric subspecialty programs were invited to meet with RRC representatives and provide input into the continuing evolution of program requirements. One requirement vigorously upheld by the RRC is that faculty must demonstrate significant scholarly activity to provide a strong academic base for teaching in addition to a strong clinical experience. Specific faculty requirements have not yet been delineated.

In a report prepared by Drs. Rockoff and Hall in 2001 to the RRC, pediatric anesthesiology program directors proposed minimum numbers of cases for each fellow in a pediatric anesthesiology fellowship [Table l]. As can be seen from the table, the accepted minimum number of cases in some categories is still under review.

Table 1: Suggested Minimum Number of Cases for Each Fellow in a Pediatric Anesthesiology Fellowship Program Total Number of Cases/Year – 250 Total Number of Patients < 1 month age – 35 Total Number of Patients < 1 year age – 60 Cardiac Cases – 10-15 Craniotomies – 5 Acute and Chronic Pain Experience Experiences Outside the Operating Room Critical Care Experience

In an effort to establish a comparative database with which programs may judge the adequacy of their training experience, program directors now submit annual caseloads for each fellow in training. The aggregated data, without identifying individual fellows or programs, may be used to define the ranges of clinical experiences and demonstrate the average fellow experience.

The current Program Requirements for Residency Education in Pediatric Anesthesiology may be viewed at <www.acgme.org> by clicking on “Program Requirements,” then “Anesthesiology,” then “Pediatrics.”² The definition, scope and duration of specialty training, requirements for academic affiliation and potential sponsorship of education programs are delineated in the program requirements. Recommended clinical and didactic components, as well as educational resources for teaching, research and other scholarly opportunities for trainees, are included. Resident duty hours, including call and any approved moonlighting hours, must comply with the ACGME requirements that were implemented in all ACGME-approved residency programs on July 1, 2003.

In spring 2003, the RRC submitted revisions to the Program Requirements for Residency Education in Pediatric Anesthesiology. Comments on the revisions were solicited from ASA, the American Board of Anesthesiology and the AAP Section on Anesthesiology and Pain Medicine. A justification and impact statement was included with the proposed revisions. Upon review of the solicited comments and any suggested revisions, the RRC will publish the revised Program Requirements for Residency Education in Pediatric Anesthesiology. Stay tuned for updates.

References:

1. Hackel A, Badgwell JM, Binding RR, et al. Guidelines for the pediatric perioperative environment. Pediatrics. 1999; 103(2):512-515.

2. ACGME Program Requirements for Residency Education in Pediatric Anesthesiology. <www.acgme.org>.

Carolyn F. Bannister, M.D., is Assistant Professor of Anesthesiology, Emory University School of Medicine, and is an anesthesiologist at Children’s Healthcare of Atlanta at Egleston, Atlanta, Georgia.