The Residency Review Committee for Anesthesiology

Lois L. Bready, M.D., Chair
Residency Review Committee for Anesthesiology

he Residency Review Committee (RRC) for Anesthesiology has lots of news! We have a new Executive Director, Missy Fleming, Ph.D. She is terrific, organized and effective, and we are enjoying working with her. While some of the individuals change each year, the mission of the RRC continues — to ensure that our programs are carefully and thoughtfully reviewed and that accreditation decisions are well considered and fair.

Over the past four years, the Anesthesiology RRC has revised the program requirements (PRs) for residency programs, and the new PRs become effective on July 1, 2008. The requirements are posted on the ACGME Web site at www.acgme.org/acWebsite/downloads/RRC_progReq/040pr07012008.pdf.

Several significant changes merit specific comment:

• Program structure — The capability to provide the clinical base year within the same institution is “desirable but not required” for accreditation. The PGY-1 curriculum has been better defined — residents must have six months of inpatient care (internal medicine, surgery, pediatrics, surgical specialties, OB/gyn, neurology, family medicine or a combination); one to two months of emergency medicine and critical care medicine; and may have up to one month of anesthesiology. The CA-1 through CA-3 years require a minimum of two one-month rotations in pediatric, cardiac, neuro and OB anesthesia; four months of critical care — up to two months in PGY-1 (taken in at least one-month intervals); three months of pain medicine — with up to one month allowed in the PGY-1 year (taken in at least one-month intervals); and one month of perioperative medicine (taken in at least one-week intervals). Elective time includes six months, which can be used to finish all required PGY-1 experiences for residents who transferred from other specialties, for research, for advanced anesthesia rotations, and for other activities related broadly to perioperative medicine.

• Program Director (PD) — Responsibilities of the PD have grown, and the work has become more complex. The RRC addresses this (see our FAQs on the RRC Web site); directors of one-year fellowships and smaller anesthesiology programs should have at least one non-clinical day/week to devote to the educational aspects of the program; directors of large anesthesiology programs generally have two non-clinical days/week for these purposes. When a change in PD is contemplated, the institution’s graduate medical education committee must review and approve the appointment prior to the change being submitted to ACGME via ADS, the electronic data collection system.

• Residents-— The maximum resident complement is set by the RRC, and programs must not exceed that number without prior approval. A new requirement is that others sharing in the learning experience, fellows and others, must not interfere with the residents’ education. Residents are surveyed electronically by ACGME, and this issue is specifically queried. If many residents in a program indicate that their clinical experience is diluted by other learners, this could result in a citation for the program and possible reduced length of accreditation cycle.

• Educational Program — Competency-based goals and objectives are expected for each rotation at each educational level, and evaluations should specifically address the objectives of the rotation. There must be delineation of resident responsibilities for patient care, progressive responsibility for patient management and supervision of residents over the continuum of the program. Individual learning plans or portfolios are valuable means by which to track required resident experiences (cases, presentations, evaluations, test scores, etc.) as well as the resident’s self-reflection and goal-setting. This element is not unlike the maintenance of certification process and is a great way to help our residents develop the skills and habits they will need as lifelong learners.

• Quality Improvement in the Program — The PRs specify a number of evaluations (resident, faculty, program), all of which are to be considered annually in a formal, systematic review of the program. This is very much like QI processes that we use in the clinical setting, and programs and our residents are expected to benefit by the application of the “plan-do-study-act” techniques.

Along with the new PRs comes a new program information form and case log — both Web-based — which should assist programs with tracking and documenting essential data. The RRC plans to pilot the new case log beginning July 2008 and to roll out a final product for all programs in July 2009.

Fellowships: the new adult cardiothoracic programs are up and running with 30 programs approved to date. Critical care program requirements are in the process of revision and should be online later this year. There are currently 50 accredited programs in critical care anesthesia. Pain medicine is now multidisciplinary, with new PRs; the first program surveys began in fall 2007 and are being pre-reviewed by a multidisciplinary advisory committee headed by David L. Brown, M.D. After the pre-review step, the RRC for Anesthesiology will review the anesthesiology-sponsored programs. Pediatric anesthesiology (45 programs at present) will have requirements reviewed in the usual cycle, next year.

A high priority for the RRC is communication; thus, the increased emphasis on the RRC Web site with guidance documents, including FAQs, newsletters, presentations and other material. We are presenting updates at several national and regional meetings (ACGME, Association of University Anesthesiologists, ASA, Society of Academic Anesthesiology Chairs/Association of Anesthesiology Program Directors and others) and at specialty society meetings. We look forward to continuing the ACGME initiatives in outcomes-based, improvement-oriented accreditation.

Lois L. Bready, M.D., is Professor and Vice Chair, Department of Anesthesiology, University of Texas Health Science Center at San Antonio, and Associate Dean for Graduate Medical Education and Designated Institutional Official.