Advanced second year fellowship training in pediatric anesthesiology in the United States.

April 2014 • Volume 118 • Number 4 Copyright © 2013 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000089 Pediatric anesthesiology as a subspecialty in the United States traces its origins to the post–World War II era when Dr. Robert M. Smith joined the faculty at Harvard Medical School and Boston Children’s Hospital and devoted his career exclusively to this new subspecialty including the creation of a fellowship. Other anesthesiologists soon followed to specialize in pediatric anesthesiology and create pediatric anesthesiology fellowships during the 1950s and 1960s, such as Drs. Margot van Deming and Jack Downes at the Children’s Hospital of Philadelphia and Dr. George Gregory at the University of California, San Francisco.1–3 Pediatric anesthesiology fellowships spread to many institutions during the 1980s and varied somewhat among programs, consisting of 6 to 12 months clinical training in pediatric anesthesiology and often critical care medicine and pain medicine after completing an anesthesiology residency. This mirrored the dramatic growth of pediatric anesthesiology in U.S. academic programs and freestanding children’s hospitals. In 1987, the Society for Pediatric Anesthesia was formed to foster quality of anesthesia and perioperative care and to alleviate pain in children through development of clinical care models, research, and education focused on pediatric anesthesiology and critical care medicine. By 2013, this society had 2814 U.S. members.a In 1997, pediatric anesthesiology met the criteria for recognition as a subspecialty by the Accreditation Council for Graduate Medical Education (ACGME) in the United States, and the Anesthesiology Residency Review Committee developed program requirements for a 12-month subspecialty fellowship training program.4 The Pediatric Anesthesiology Program Directors Association (PAPDA) was formed in 2007 and is a component of the Association of Anesthesiology Subspecialty Program Directors.b In 2011, the first pediatric anesthesiology fellowship matching program was administered through the National Resident Matching Program,c with 75% of positions nationwide being offered within the fellowship match. In 2013, there are 51 accredited pediatric anesthesiology fellowship programs, with 215 available positions.d In October 2013, the first pediatric anesthesiology subspecialty examination was offered by the American Board of Anesthesiology, with >1500 candidates sitting for the examination.e The significant growth and development of pediatric anesthesiology and need for a forum to identify strategies to further its growth and development led to the formation of the Pediatric Anesthesia Leadership Council (PALC) in 2008, a group of chairs and chiefs of pediatric anesthesiology departments or divisions primarily within children’s hospitals and academic anesthesiology departments in the United States. PALC arrived at a consensus that a strategy was required to develop the skills of the workforce to advance pediatric anesthesiology to serve patients better and to align with the health care system of the future. In particular, pediatric anesthesiology fellowships should not only be assessed for clinical skill mastery but also for preparing graduates for roles in leadership, research, education, quality improvement, and pediatric anesthesia subspecialties. In November 2010, PALC joined forces with PAPDA and formed a Pediatric Anesthesia Fellowship Task Force, with the charter to formally evaluate the strengths and weaknesses of the current fellowship training, to elucidate the opportunities and threats as compelling reasons for change, to make specific recommendations for improving the fellowship education of the next generation of leaders and academicians in pediatric anesthesiology, and to communicate these recommendations to stakeholders within and outside the subspecialty. The purpose of this article is to present the work of this task force and the recommendations for an optional Second Year Advanced Pediatric Anesthesiology Fellowship. This Advanced Second Year Fellowship Training in Pediatric Anesthesiology in the United States