SCA: Creating a New Breed of Subspecialists

n October 2005, the Accreditation Council for Graduate Medical Education (ACGME) posted proposals for training program requirements in cardiothoracic anesthesiology on its Web site for comment. This was a momentous achievement for cardiothoracic anesthesiologists nationwide. It was the culmination of many years of effort by SCA and many individuals related to our subspecialty.

SCA’s mission is to promote “excellence in patient care through education and research in perioperative care for patients undergoing cardiothoracic and vascular procedures.” What could be more important or relevant to this mission than ensuring a core program of knowledge, case-type exposure and specific expertise for subspecialist cardiothoracic anesthesiologist trainees? To this end, more than eight years ago, Richard Davis, M.D., then president of SCA, appointed a task force under the leadership of past president Alan Jay Schwartz, M.D., to create a proposal for submission to ACGME. Dr. Schwartz and his task force created the “criteria document,” also found at the ACGME Web site. (Go to <www.ACGME.org>, click on “Program Requirements” then “Adult Cardiothoracic Anesthesiology.”)

This document presents the very persuasive and complete case in favor of establishing subspecialty training requirements. While this document reflects a large component of the work of the task force, Dr. Schwartz and his task force also have expended a major effort to elicit support from leaders in anesthesiology and in other specialties who provide care for the cardiothoracic surgery patient. Once the proposed training requirements have been accepted, this will lead to ACGME accreditation of training programs, placing the subspecialty of cardiothoracic anesthesiology on the same educational foundation as cardiothoracic surgery and cardiology.

The criteria document and the proposed program requirements define what SCA and ACGME believe “make” a cardiothoracic anesthesiologist. These documents indicate the broad range of experience, as well as the type of environment required, for the creation of a subspecialist. A year of training in adult cardiothoracic anesthesiology will be expected to provide, among many other experiences, adequate exposure and training in transesophageal echocardiography (TEE) to enable the fellow to be eligible for certification in perioperative TEE by the National Board of Echocardiography (NBE). This reflects the reality that TEE is an integral part of cardiothoracic anesthesiology practice.

One of the issues surrounding the creation of a new subspecialty is, what happens to the old guys like me? We need to be very clear on this point: Creation of a subspecialty with program requirements and ACGME accreditation of training programs does not mean certification of individuals. The practice of cardiothoracic anesthesiology will continue as in the past, and those individuals currently providing this care should continue to call themselves cardiothoracic anesthesiologists. In addition to staying abreast of new procedures and developments in our field, those of us who trained before the widespread adoption of TEE need to advance our knowledge of this powerful tool to provide the expert care and guidance expected by our surgical colleagues. With recognition of the subspecialty of cardiothoracic anesthesiology and accreditation of training programs, the professional prestige for those of us currently in practice will be enhanced, as we will be recognized as the pioneers and mentors of the new breed of subspecialists.

The process of creating the new subspecialty of cardiothoracic anesthesiology, with ACGME accreditation of training programs, appears to be “on track” to become a reality within the next two years. For more than 10 years, successive presidents and boards of SCA have strongly supported the cause. Thank you and congratulations to Dr. Davis, who had the vision, to Dr. Schwartz and his task force, who have guided the process to date, and to all those within and outside of anesthesiology who have helped in the realization of this important goal.

James G. Ramsay, M.D., is Professor of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.