Mark A. Warner, M.D., Chair
Residency Review Committee for Anesthesiology
Accreditation Council for Graduate Medical Education

here currently are 131 accredited residency programs, plus 89 pain medicine, 49 critical care medicine, 45 pediatric anesthesiology and 30 adult cardiothoracic anesthesiology subspecialty programs. What is happening with the Residency Review Committee for Anesthesiology (RRC)? Here are a few important questions.

“De-linking” of Subspecialty Fellowships and Residency Accreditation?
The RRC has decided to de-link accreditation lengths between residency and subspecialty programs at the same institution. Previously a less-than-optimal accreditation decision on the residency program would lead to a short accreditation cycle for a subspecialty fellowship that was performing well. It seems unfair to penalize good subspecialty fellowship programs based solely on an underperforming residency program. Thus length of accreditation decisions for all residency and subspecialty programs are now made independently. For example, a residency program may receive accreditation for three years while the anesthesiology critical care program at that same institution may receive a five-year accreditation decision.

For institutions that have residency and subspecialty fellowship accreditation periods of varying lengths, this “de-linking” will lead to multiple surveyor site visits and program information form submissions. The good news: There is no additional cost for multiple site visits since most institutions have many different accredited programs in various specialties, and site surveyors regularly come and go. The bad news: Some institutions may have a variety of anesthesiology and fellowship program reviews occurring intermittently.

What’s Happened With Pain Medicine?
As of July 1, 2007, all pain medicine programs must be multidisciplinary, with qualified faculty actively involved in the training program from at least three of the four specialties of anesthesiology, psychiatry, physical medicine and rehabilitation, and neurology. While this requirement would allow a program to be developed without anesthesiologist involvement, at this time, all 89 accredited programs have anesthesiologists as faculty members. Nearly all of these programs currently are based in anesthesiology departments and will therefore be accredited by the RRC. An advisory review committee chaired by anesthesiologist David Brown, M.D., former chair of the RRC, will initially review all programs and make recommendations to the appropriate RRC. The RRCs in which the programs are based will then make the final accreditation decisions.

Why Assign Maximum Number of Trainees for All Programs?
As pediatric anesthesiology and critical care medicine fellowship programs undergo their next site surveys, those currently without assigned maximum numbers of trainees will be given these for their programs. Maximum numbers already are assigned for pain medicine and adult cardiothoracic fellowship programs. Thus within the next several years, all subspecialty programs will have assigned maximum fellow numbers. Why? The RRC received a number of requests from a broad constituency of residency and subspecialty program directors, along with designated institutional officials (DIOs), to have assigned numbers for all of its programs. The primary concern was the inconsistency of the RRC and its practice of assigning maximum numbers for the residency, pain medicine and cardiothoracic anesthesiology programs but not for pediatric anesthesiology and critical care medicine programs.

What’s With the New Emphasis on FAQs?
The RRC wishes to make as much information about its ideas, interpretations and practices available as possible. An expanded, updated section of frequently asked questions (FAQs) seems to be a reasonable way to help our program directors understand how the RRC addresses and interprets issues. For example, who needs to be notified if a resident wishes to train outside of the country during a rotation? What constitutes a “major” change in a program that needs to be reported to the RRC? Fifty interesting or complex questions are addressed in these FAQs. They can be accessed at the anesthesiology RRC page of the Accreditation Council for Graduate Medical Education (ACGME) Web site www.acgme.org.

Who Has Replaced Judith S. Armbruster, Ph.D.?
After two decades of service to ACGME and leadership on the RRC as its executive director, Dr. Armbruster retired during the past year. Missy Fleming, M.Ed., Ph.D., was appointed earlier this year to the executive director position. Dr. Fleming comes to the RRC after leading child and adolescent health programs for the American Medical Association. She will team with Linda Thorsen, our executive director for anesthesiology subspecialty programs.

Time and Support for Program Directors?
In general the RRC expects that program directors have dedicated nonclinical time and program coordinator support to administer their programs. One-year fellowship program directors of successful programs typically have one nonclinical day each week to develop curricula, develop competency expectations and implement fellow assessments, among other program requirements. Program directors for moderate and large residency programs typically have two nonclinical days each week. The RRC encourages residency programs to consider appointing associate program directors to assist with the management of the programs and to ensure continuity in program leadership.

Thank You to the RRC Members
I have been fortunate enough to have served in a variety of American Board of Anesthesiology, ASA, ACGME and other roles. I can attest that few of these roles take as much effort and time as membership on the RRC. Your RRC members are volunteers who dedicate literally weeks of effort to review programs, prepare for meetings, and lead or serve the various workgroups and committees that develop, interpret and implement program requirements. Why do they do it? They wish to make a difference, and they choose to do so by giving their valuable time and expertise to the specialty by serving on the RRC.

Please thank these folks if you happen to meet any of them at meetings, work or elsewhere. They are terrific people:

It is an honor to serve with such fine people and for such a good purpose.

Mark A. Warner, M.D., is Professor of Anesthesiology, Mayo Clinic College of Medicine, and Dean, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota.