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Giustini AJ, Sivak EL, Nasr VG, Cladis FP, Andropoulos DB, Deutsch N, Lockman JL, Bower B, Corridore M, Muffly MK. Where have all the pediatric anesthesiology fellows gone in the USA? Anesthesiology fellowship trends. Paediatr Anaesth 2024; 34:734-741. [PMID: 38264926 DOI: 10.1111/pan.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Recent consternation over the number of unfilled Pediatric Anesthesiology fellowship positions in the United States compelled us to assess the change in the ratio of Pediatric Anesthesiology fellows to the number of graduating anesthesiology residents over the 14-year period between 2008 and 2022. We also sought to report the total ratio of anesthesiology fellows to graduating residents and trends in the annual number of fellowship applicants relative to the number of Accreditation Council for Graduate Medical Education (ACGME)-accredited anesthesiology fellowship positions by specialty. METHODS We used publicly available resources, including ACGME Data Resource Books, National Resident Matching Program (NRMP) data, San Francisco (SF) Match data, and American Board of Medical Specialties (ABMS) data, to determine the ratio of anesthesiology fellows to graduating anesthesiology residents and to compare the number of fellowship applicants to fellowship positions for Adult Cardiothoracic Anesthesiology, Critical Care Anesthesiology, Obstetric Anesthesiology, Pain Medicine and Pediatric Anesthesiology. RESULTS Since 2008, the ratio of ACGME-accredited anesthesiology fellows to graduating residents increased from 0.36 in 2008 (2007 residency graduates) to 0.59 in 2022 (2021 residency graduates) and the ratio of Pediatric Anesthesiology fellows to graduating residents remained relatively stable from 0.10 to 0.11. The number of unmatched positions in Pediatric Anesthesiology increased from 17 in 2017 to 86 in 2023, and all ACGME-accredited fellowships had more positions available than applicants in 2023. CONCLUSION In the USA, while the ratio of Pediatric Anesthesiology fellowship graduates to anesthesiology residency graduates remained relatively constant from 2008 to 2022, this is likely a lagging indicator that has not yet accounted for the recent decrease in fellowship applicants. These findings refute prior estimates for a surplus in Pediatric Anesthesia supply in the USA and have significant implications for the future.
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Affiliation(s)
- Andrew J Giustini
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Erica L Sivak
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Franklyn P Cladis
- Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Dean B Andropoulos
- Departments of Anesthesiology and Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Nina Deutsch
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bree Bower
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marco Corridore
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Matthew K Muffly
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, California, USA
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2
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Dutton RP, Bryskin RB, Starks M'R, Shukla AS. Pediatric Anesthesia in the Community. Adv Anesth 2023; 41:127-142. [PMID: 38251614 DOI: 10.1016/j.aan.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Pediatric anesthesia is a diverse subspecialty practiced at thousands of hospitals and ambulatory surgery centers across the country. Most unusual and high-risk cases are performed in dedicated children's hospitals. However, the majority of cases and practitioners are based in the community. We present a review of demographics in pediatric anesthesia in the United States across 7 years of data from US Anesthesia Partners, a national anesthesia practice, which covers the full range of hospitals and outpatient facilities.
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Affiliation(s)
- Richard P Dutton
- Department of Anesthesiology, Texas A&M College of Medicine, Baylor University Medical Center, Dallas, TX, USA.
| | | | | | - Aesha S Shukla
- Quality, Analytics & Patient Experience, US Anesthesia Partners
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3
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Ambardekar AP, Furukawa L, Eriksen W, McNaull PP, Greeley WJ, Lockman JL. A Consensus-Driven Revision of the Accreditation Council for Graduate Medical Education Case Log System: Pediatric Anesthesiology Fellowship Education. Anesth Analg 2023; 136:446-454. [PMID: 35773224 DOI: 10.1213/ane.0000000000006129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical experiences, quantified by case logs, are an integral part of pediatric anesthesiology fellowship programs. Accreditation of pediatric anesthesiology fellowships by the Accreditation Council of Graduate Medical Education (ACGME) and establishment of case log reporting occurred in 1997 and 2009, respectively. The specialty has evolved since then, but the case log system remains largely unchanged. The Pediatric Anesthesiology Program Directors Association (PAPDA) embarked on the development of an evidence-based case log proposal through the efforts of a case log task force (CLTF). This proposal was part of a larger consensus-building process of the Society for Pediatric Anesthesia (SPA) Task Force for Pediatric Anesthesiology Graduate Medical Education. The primary aim of case log revision was to propose an evidence-based, consensus-driven update to the pediatric anesthesiology case log system. METHODS This study was executed in 2 phases. The CLTF, composed of 10 program directors representing diverse pediatric anesthesiology fellowship programs across the country, utilized evidence-based literature to develop proposed new categories. After an approval vote by PAPDA membership, this proposal was included in the nationally representative, stakeholder-based Delphi process executed by the SPA Task Force on Graduate Medical Education. Thirty-seven participants engaged in this Delphi process, during which iterative rounds of surveys were used to select elements of the old and newly proposed case logs to create a final revision of categories and minimums for updated case logs. The Delphi methodology was used, with a two-thirds agreement as the threshold for inclusion. RESULTS Participation in the Delphi process was robust, and consensus was almost completely achieved by round 2 of 3 survey rounds. Participants suggested that total case minimums should increase from 240 to 300 (300-370). Participants agreed (75.86%) that the current case logs targeted the right types of cases, but requirements were too low (82.75%). They also agreed (85.19%) that the case log system and minimums deserved an update, and that this should be used as part of a competency-based assessment in pediatric anesthesia fellowships (96%). Participants supported new categories and provided recommended minimum numbers. CONCLUSIONS The pediatric anesthesiology case log system continues to have a place in the assessment of fellowship programs, but it requires an update. This Delphi process established broad support for new categories and benchmarked minimums to ensure the robustness of fellowship programs and to better prepare the pediatric anesthesiology workforce of the future for independent clinical practice.
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Affiliation(s)
- Aditee P Ambardekar
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Louise Furukawa
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Whitney Eriksen
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peggy P McNaull
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - William J Greeley
- Departments of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennyslvania, Philadelphia, Pennsylvania
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4
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Ambardekar AP, Eriksen W, Ferschl MB, McNaull PP, Cohen IT, Greeley WJ, Lockman JL. A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study. Anesth Analg 2023; 136:437-445. [PMID: 35777829 DOI: 10.1213/ane.0000000000006128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric anesthesiology fellowship education has necessarily evolved since Accreditation Council for Graduate Medical Education (ACGME) accreditation in 1997. Advancements in perioperative and surgical practices, emerging roles in leadership, increasing mandates by accreditation and certification bodies, and progression toward competency-based education-among other things-have created pressure to enrich the current pediatric anesthesiology training system. The Society for Pediatric Anesthesia (SPA) formed a Task Force for Pediatric Anesthesiology Graduate Medical Education that included key leaders and subject matter experts from the society. A key element of the Task Force's charge was to identify curricular and evaluative enhancements for the fellowship program of the future. METHODS The Task Force executed a nationally representative, stakeholder-based Delphi process centered around a fundamental theme: "What makes a pediatric anesthesiologist?" to build consensus among a demographically varied and broad group of anesthesiologists within the pediatric anesthesiology community. A total of 37 demographically and geographically varied pediatric anesthesiologists participated in iterative rounds of open- and close-ended survey work between August 2020 and July 2021 to build consensus on the current state, known deficiencies, anticipated needs, and strategies for enhancing national educational offerings and program requirements. RESULTS Participation was robust, and consensus was almost completely achieved by round 2. This work generated a compelling Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis that suggests more strengths and opportunities in the current Pediatric Anesthesiology Graduate Medical Education program than weaknesses or threats. Stakeholders agreed that while fellows matriculate with some clinical knowledge and procedural gaps, a few clinical gaps exist upon graduation. Stakeholders agreed on 8 nonclinical domains and specific fundamental and foundational knowledge or skills that should be taught to all pediatric anesthesiology fellows regardless of career plans. These domains include (1) patient safety, (2) quality improvement, (3) communication skills, (4) supervision skills, (5) leadership, (6) medical education, (7) research basics, and (8) practice management. They also agreed that a new case log system should be created to better reflect modern pediatric anesthesia practice. Stakeholders further identified the need for the development of standardized and validated formative and summative assessment tools as part of a competency-based system. Finally, stakeholders noted that significant departmental, institutional, and national organizational support will be necessary to implement the specific recommendations. CONCLUSIONS A Delphi process achieved robust consensus in assessing current training and recommending future directions for pediatric anesthesiology graduate medical education.
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Affiliation(s)
- Aditee P Ambardekar
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Whitney Eriksen
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marla B Ferschl
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Peggy P McNaull
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Ira T Cohen
- Division of Anesthesiology and Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's National, Washington, DC
| | - William J Greeley
- Departments of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Nasr VG, Staffa SJ, Vener DF, Huang S, Brown ML, Twite M, Miller-Hance WC, DiNardo JA. The Practice of Pediatric Cardiac Anesthesiology in the United States. Anesth Analg 2022; 134:532-539. [PMID: 35180170 DOI: 10.1213/ane.0000000000005859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND With advances in surgical and catheter-based interventions and technologies in patients with congenital heart disease (CHD), the practice of pediatric cardiac anesthesiology has evolved in parallel with pediatric cardiac surgery and pediatric cardiology as a distinct subspecialty over the past 80 years. To date, there has not been an analysis of the distribution of pediatric cardiac anesthesiologists relative to cardiac and noncardiac procedures in the pediatric population. The primary aim is to report the results of a survey and its subsequent analysis to describe the distribution of pediatric cardiac anesthesiologists relative to pediatric cardiac procedures that include surgical interventions, cardiac catheterization procedures, imaging studies (echocardiography, magnetic resonance, computed tomography, positron emission tomography), and noncardiac procedures. METHODS A survey developed in Research Electronic Data Capture (REDcap) was sent to the identifiable division chiefs/cardiac directors of 113 pediatric cardiac anesthesia programs in the United States. Data regarding cardiac surgical patients and procedures were collected from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHD). RESULTS This analysis reveals that only 38% (117 of 307) of pediatric cardiac anesthesiologists caring for patients with CHD pursued additional training in pediatric cardiac anesthesiology, while 44% (136 of 307) have gained experience during their clinical practice. Other providers have pursued different training pathways such as adult cardiac anesthesiology or pediatric critical care. Based on this survey, pediatric cardiac anesthesiologists devote 35% (interquartile range [IQR], 20%-50%) of clinical time to the care of patients in the cardiac operating room, 25% (20%-35%) of time to the care of patients in the cardiac catheterization laboratory, 10% (5%-10%) to patient care in imaging locations, and 15% covering general pediatric, adult, or cardiac patients undergoing noncardiac procedures. Attempts to actively recruit pediatric cardiac anesthesiologists were reported by 49.2% (29 of 59) of the institutions surveyed. Impending retirement of staff was anticipated in 17% (10 of 59) of the institutions, while loss of staff to relocation was anticipated in 3.4% (2 of 59) of institutions. Thirty-seven percent of institutions reported that they anticipated no immediate changes in current staffing levels. CONCLUSIONS The majority of currently practicing pediatric cardiac anesthesiologists have not completed a fellowship training in the subspecialty. There is, and will continue to be, a need for subspecialty training to meet increasing demand for services especially with increase survival of this patient population and to replace retiring members of the workforce.
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Affiliation(s)
- Viviane G Nasr
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven J Staffa
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David F Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - ShengXiang Huang
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan L Brown
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark Twite
- Children's Hospital Colorado & University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wanda C Miller-Hance
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - James A DiNardo
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Templeton TW, Sommerfield D, Hii J, Sommerfield A, Matava CT, von Ungern-Sternberg BS. Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia-Part 2: Anesthesia-related risk and treatment options. Paediatr Anaesth 2022; 32:217-227. [PMID: 34897894 DOI: 10.1111/pan.14376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/17/2022]
Abstract
Perioperative respiratory adverse events are the most common cause of critical events in children undergoing anesthesia and surgery. While many risk factors remain unmodifiable, there are numerous anesthetic management decisions which can impact the incidence and impact of these events, especially in at-risk children. Ongoing research continues to improve our understanding of both the influence of risk factors and the effect of specific interventions. This review discusses anesthesia risk factors and outlines strategies to reduce the rate and impact of perioperative respiratory adverse events with a chronologic based inquiry into anesthetic management decisions through the perioperative period from premedication to postoperative disposition.
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Affiliation(s)
- Thomas Wesley Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Aine Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, Termerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
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7
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Taenzer AH, Baertschiger RM, Cazaban CG, Evans RE, Murphy M, Wasserman J, Goodman DC. Epidemiology of Surgical Procedures, Anesthesia, and Imaging Studies by Gestational Age during the First Year of Life in Medicaid-Insured Infants. J Pediatr 2021; 229:147-153.e1. [PMID: 33098841 DOI: 10.1016/j.jpeds.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the rate of surgical procedures, anesthetic use, and imaging studies by prematurity status for the first year of life we analyzed data for Texas Medicaid-insured newborns. STUDY DESIGN We developed a retrospective population-based live birth cohort of newborn infants insured by Texas Medicaid in 2010-2014 with 4 subcohorts: extremely premature, very premature, moderate/late premature, and term. RESULTS In 1 102 958 infants, surgical procedures per 100 infants were 135.9 for extremely premature, 35.4 for very premature, 15.5 for moderate/late premature, and 6.5 for term. Anesthetic use was 62.0 for extremely premature, 20.8 for very premature, 11.1 for moderate/late premature, and 5.6 for the term subcohort. The most common procedures in the extremely premature were neurosurgery, intubations, and procedures that facilitated caloric intake (gastrostomy tubes and fundoplications). The annual rates for the first year of life for chest radiograph ranged from 15.0 per year for the extremely premature cohort to 0.6 for term infants and for magnetic resonance imaging (MRI) from 0.3 to 0.01. MRI was the most common imaging study with anesthesia support in all maturity levels. MRIs were done in extremely premature without anesthesia in over 90% and in term infants in 57.2%. CONCLUSIONS Surgical procedures, anesthetic use, and imaging studies in infants are common and more frequent with higher a degree of prematurity while the use of anesthesia is lower in more premature newborns. These findings can provide direction for outcome studies of surgery and anesthesia exposure.
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Affiliation(s)
- Andreas H Taenzer
- Children's Hospital at Dartmouth (CHaD), Dartmouth Hitchcock Medical Center, Department of Anesthesiology & Pediatrics, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia Ganduglia Cazaban
- Department of Management, Policy, and Community Health, University of Texas School of Public Health, Dallas, TX
| | - Rebecca E Evans
- Department of Anesthesiology and Pediatrics, Larner College of Medicine, University of Vermont Medical Center, Burlington, VT
| | - Megan Murphy
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Jared Wasserman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; The Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH
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8
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Margolis RD, Strupp KM, Beacham AO, Yaster M, Austin TM, Macrae AW, Diaz-Berenstain L, Janosy NR. The effects of COVID-19 on pediatric anesthesiologists: A survey of the members of the Society for Pediatric Anesthesia. Anesth Analg 2021; 134:348-356. [PMID: 33439606 DOI: 10.1213/ane.0000000000005422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The COVID-19 pandemic has affected the personal and professional lives of all healthcare workers. Anesthesiologists frequently perform virus-aerosolizing procedures, such as intubation and extubation, that place them at increased risk of infection. We sought to determine how the initial COVID-19 outbreak affected members of the Society for Pediatric Anesthesia (SPA) on both personal and professional levels. Specifically, we examined the potential effects of gender and age on personal stress, burnout, sleep deprivation, anxiety, and depression, assessed job satisfaction, and explored financial impact. METHODS After receiving approval from the SPA Committees for Research and Quality and Safety, and the Colorado Multiple Institutional Review Board, we emailed a questionnaire to all 3,245 SPA members. The survey included 22 questions related to well-being and 13 questions related to effects of COVID-19 on current and future practice, finances, retirement planning, academic time and productivity, and clinical and home responsibilities. To address low initial response rates and quantify nonresponse bias, we sent a shortened follow-up survey to a randomly selected subsample (n=100) of SPA members who did not respond to the initial survey. Response differences between the two cohorts were determined. RESULTS A total of 561 (17%) members responded to the initial questionnaire. Because of COVID-19, 21.7% of respondents said they would change their clinical responsibilities and 10.6% would decrease their professional working time. Women were more likely than men to anticipate a future COVID-19-related job change (OR = 1.92, 95% CI = 1.12 to 2.63, P = 0.011), perhaps because of increased home responsibilities (OR = 2.63, 95% CI = 1.74 to 4.00, P <0.001). Additionally, 14.2% of respondents planned to retire early and 11.9% planned to retire later. Women and non-whites had higher likelihoods of burnout on univariate analysis (OR = 1.75, 95% CI = 1.06 to 2.94, P = 0.026 and OR = 1.82, 95% CI = 1.08 to 3.04, P = 0.017, respectively) and 25.1% of all respondents felt socially isolated. In addition, both changes in retirement planning and future occupational planning were strongly associated with total job satisfaction scores (both P<0.001). CONCLUSIONS The COVID-19 pandemic has affected the personal and professional lives of pediatric anesthesiologists, albeit not equally, as women and non-whites have been disproportionately impacted. The pandemic has significantly affected personal finances, home responsibilities, and retirement planning, reduced clinical and academic practice time and responsibilities, and increased feelings of social isolation, stress, burnout, and depression/anxiety.
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Affiliation(s)
- Rebecca D Margolis
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kim M Strupp
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Abbie O Beacham
- Director of Behavioral Science, University of Louisville School of Dentistry, Louisville, KY
| | - Myron Yaster
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Thomas M Austin
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Andrew W Macrae
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Laura Diaz-Berenstain
- Department of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Children's Hospital of Cincinnati, Cincinnati, OH
| | - Norah R Janosy
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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9
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Obara S, Kuratani N. Training in pediatric anesthesia in Japan: how should we come along? J Anesth 2020; 35:471-474. [PMID: 33009926 DOI: 10.1007/s00540-020-02859-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Soichiro Obara
- Department of Anesthesia, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1, Minami-ohtsuka, Toshima-ku, Tokyo, 170-8476, Japan.
- Teikyo University Graduate School of Public Health, Tokyo, Japan.
| | - Norifumi Kuratani
- Teikyo University Graduate School of Public Health, Tokyo, Japan
- Department of Anesthesia, Saitama Children's Medical Center, Saitama, Japan
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10
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Cladis FP, Davis PJ, DiNardo JA. Hospitalization Patterns for Inpatient Pediatric Surgery and Procedures in California: The Ground Is Shifting. Anesth Analg 2020; 131:1066-1069. [PMID: 32925325 DOI: 10.1213/ane.0000000000004764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Franklyn P Cladis
- From the Departments of Anesthesiology, University of Pittsburgh School of Medicine and
| | - Peter J Davis
- Anesthesiology & Pediatrics, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh
| | - James A DiNardo
- Department of Anaesthesia, Harvard Medical School, Boston Children's Hospital
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11
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Abstract
This article discusses modernizing the education of pediatric anesthesiologists in the United States. First, the current education requirements to become an American Board of Anesthesiology certified pediatric anesthesiologist are detailed and then, through a historical lens, the development of the subspecialty is examined. Gaps and challenges in the current training system are identified and interventions for improvement discussed. Additionally, suggestions are made and questions posed on how to move from a time-based model towards a competency-based curriculum.
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Affiliation(s)
- Tanna J Boyer
- Department of Anesthesia, Indiana University School of Medicine, 1130 West Michigan Street, Fesler Hall 204, Indianapolis, IN 46202, USA.
| | - Jian Ye
- Department of Anesthesia, Indiana University School of Medicine, 1130 West Michigan Street, Fesler Hall 204, Indianapolis, IN 46202, USA
| | - Michael Andrew Ford
- Department of Anesthesia, Indiana University School of Medicine, 1130 West Michigan Street, Fesler Hall 204, Indianapolis, IN 46202, USA
| | - Sally A Mitchell
- Department of Anesthesia, Indiana University School of Medicine, 1130 West Michigan Street, Fesler Hall 204, Indianapolis, IN 46202, USA
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12
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Wang KS, Cummings J, Stark A, Houck C, Oldham K, Grant C, Fallat M. Optimizing Resources in Children's Surgical Care: An Update on the American College of Surgeons' Verification Program. Pediatrics 2020; 145:peds.2020-0708. [PMID: 32312909 DOI: 10.1542/peds.2020-0708] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Surgical procedures are performed in the United States in a wide variety of clinical settings and with variation in clinical outcomes. In May 2012, the Task Force for Children's Surgical Care, an ad hoc multidisciplinary group comprising physicians representing specialties relevant to pediatric perioperative care, was convened to generate recommendations to optimize the delivery of children's surgical care. This group generated a white paper detailing the consensus opinions of the involved experts. Following these initial recommendations, the American College of Surgeons (ACS), Children's Hospital Association, and Task Force for Children's Surgical Care, with input from all related perioperative specialties, developed and published specific and detailed resource and quality standards designed to improve children's surgical care (https://www.facs.org/quality-programs/childrens-surgery/childrens-surgery-verification). In 2015, with the endorsement of the American Academy of Pediatrics (https://pediatrics.aappublications.org/content/135/6/e1538), the ACS established a pilot verification program. In January 2017, after completion of the pilot program, the ACS Children's Surgery Verification Quality Improvement Program was officially launched. Verified sites are listed on the program Web site at https://www.facs.org/quality-programs/childrens-surgery/childrens-surgery-verification/centers, and more than 150 are interested in verification. This report provides an update on the ACS Children's Surgery Verification Quality Improvement Program as it continues to evolve.
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Affiliation(s)
- Kasper S Wang
- Division of Pediatric Surgery, Department of Surgery, Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California;
| | | | - Ann Stark
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Constance Houck
- Division of Perioperative Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Keith Oldham
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Mary Fallat
- Department of Surgery, University of Louisville, Louisville, Kentucky
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Cladis FP, Lockman JL, Lupa MC, Chatterjee D, Lim D, Hernandez M, Yanofsky S, Waldrop WB. Pediatric Anesthesiology Fellowship Positions: Is There a Mismatch? Anesth Analg 2019; 129:1784-1786. [PMID: 31743202 DOI: 10.1213/ane.0000000000004431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Franklyn P Cladis
- From the Department of Anesthesiology and Perioperative Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Concetta Lupa
- Department of Anesthesiology, University of North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado/University of Colorado, Aurora, Colorado
| | - Doyle Lim
- Department of Anesthesiology, Thomas Jefferson University, Nemours AI Dupont Children's Hospital, Wilmington, Delaware
| | - Michael Hernandez
- Department of Anesthesiology, Critical Care and Pain Medicine, The Children's Hospital Boston, Boston, Massachusetts
| | - Samuel Yanofsky
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California
| | - William B Waldrop
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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