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Fellows Corner

Pediatric Anesthesia Fellowship Guidelines

Below is the basic breakdown of the 6 major components of what constitutes an accredited Pediatrics Anesthesia Fellowship. These requirements are explained in exquisite detail further down the pages.

I went to the first site visitors workshop for prospective site visitors in 1997. My basic impression of programs is that all of these requirements are in place, but the fellows are not aware of their existence in such formal detail. The residency directors are usually prepared to have the required documentation of the requirements. Please contact me with any questions

I. Introduction
II. Institutional Organization
III. Faculty Qualifications and Responsibilities
IV. Clinical and Educational Facilities and Resources
V. Educational Program
VI. Evaluation



Definition and Scope of the Specialty

Pediatric Anesthesiology is the subspecialty of anesthesiology devoted to the preoperative,intraoperative, and postoperative anesthetic care of pediatric patients.

Duration and Scope of Education

Subspecialty training in pediatric anesthesiology shall be 12 months in duration, beginning after satisfactory completion of the residency program in anesthesiology as required for entry into the examination system of the American Board of Anesthesiology. Subspecialty training in pediatric anesthesiology is in addition to the minimum requirements described in the Program Requirements for the core program in anesthesiology.

The clinical training in pediatric anesthesiology must be spent in caring for pediatric patients in the operating rooms, in other anesthetizing locations, and in intensive care units. The training will include experience in providing anesthesia both for inpatient and outpatient surgical procedures and for nonoperative procedures outside the operating rooms, as well as preanesthesia preparation and postanesthesia care, pain management, and advanced life support for neonates, infants, children, and adolescents.

Goals and Objectives

The subspecialty program in pediatric anesthesiology must be structured to ensure optimal patient care while providing residents the opportunity to develop skills in clinical care and judgment, teaching, administration, and research. The subspecialist in pediatric anesthesiology should be proficient not only in providing anesthesia care for neonates, infants, children, and adolescents undergoing a wide variety of surgical, diagnostic, and therapeutic procedures, but also in pain management, critical perioperative care, and advanced life support. To meet these goals, the program should provide exposure to the wide variety of clinical problems in pediatric patients, as outlined in V.B., that are necessary for the development of these clinical skills.

Institutional Organization

Relationship to the Core Residency Program

Accreditation of a subspecialty program in pediatric anesthesiology will be granted only when the program is associated with a core residency program in anesthesiology that is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Therefore, subspecialty training in pediatric anesthesiology can occur only in an institution in which there is an ACGME-accredited residency program in anesthesiology or in an institution related to a core program by a formal integration agreement.The director of the core anesthesiology residency program is responsible for the appointment of the director of the pediatric anesthesiology subspecialty program and determines the activities of the appointee and the duration of the appointment.

There must be close cooperation between the core program and the subspecialty training program. The division of responsibilities between residents in the core program and those in the subspecialty program must be clearly delineated.

Institutional Policy

There should be an institutional policy governing the educational resources committed to pediatric anesthesiology programs.

Faculty Qualifications and Responsibilities

Program Director

Qualifications of the Program Director

The program director in pediatric anesthesiology must be an anesthesiologist who is certified by the American Board of Anesthesiology or who has equivalent qualifications. The program director also must be licensed to practice medicine in the state where the institution that sponsors the program is located (certain federal programs are exempted) and have an appointment in good standing to the medical staff of an institution participating in the program. He/she must have training and/or experience in providing anesthesia care for pediatric patients beyond the requirement for completion of a core anesthesiology residency.

The program director in pediatric anesthesiology has responsibility for the training program subject to the approval of the program director of the core residency training program in anesthesiology.He/she must devote sufficient time to provide adequate leadership to the program and supervision for the residents. The clinical director of the pediatric anesthesiology service may be someone other than the program director.

Responsibilities of the Program Director

  • Preparation, periodic review, and, if necessary, revision of a written outline of the educational goals of the program with respect to the knowledge, skills, and other attributes of residents at each level of training and for each major rotation or other program assignment. This statement must be distributed to residents and members of the teaching staff. It should be readily available for review.
  • Selection of residents for appointment to the program in accordance with institutional and departmental policies and procedures.
  • Selection and supervision of the teaching staff and other program personnel.
  • Supervision of residents through explicit written descriptions of supervisory lines of responsibility for the care of patients. Such guidelines must be communicated to all members of the program staff.
  • Residents must be provided with prompt, reliable systems for communication and interaction with supervisory physicians.
  • Implementation of fair procedures, as established by the sponsoring institution, regarding academic discipline and resident complaints or grievances.
  • Preparation of an accurate statistical and narrative description of the program, as requested by the Residency Review Committee (RRC).


Although the number of faculty members involved in teaching residents in pediatric anesthesiology will vary, it is recommended that at least three faculty members be involved, and that these be equal to or greater than two full-time equivalents, including the program director. A ratio of no less than one full-time equivalent faculty member to one subspecialty resident shall be maintained. The RRC understands that full-time means that the faculty member devotes essentially all professional time to the program.

There must be evidence of active participation by qualified physicians with training and/or expertise in pediatric anesthesiology beyond the requirement for completion of a core anesthesiology residency. The faculty must possess expertise in the care of pediatric patients and must have a continuous and meaningful role in the subspecialty training program.

The program should include teaching in multidisciplinary conferences by faculty in pediatric and neonatal intensive care, pediatric medicine, and pediatric surgery.

The pediatric anesthesiology program director and faculty responsible for teaching subspecialty residents in pediatric anesthesiology must maintain an active role in scholarly pursuits pertaining to pediatric anesthesiology, as evidenced by participation in continuing medical education as well as by involvement in research as it pertains to the care of pediatric patients.

Clinical and Educational Facilities and Resources

The following resources and facilities are necessary to the program:

  • Intensive care units for both newborns and older children.
  • An emergency department in which children of all ages can be effectively managed 24 hours a day.
  • Operating rooms adequately designed and equipped for the management of pediatric patients.
  • A postanesthesia care area adequately designed and equipped for the management of pediatric patients must be located near the operating room suite.
  • Pediatric surgical patients in sufficient volume and variety to provide a broad educational experience for the program.
  • Surgeons with special pediatric training and/or experience in general surgery, otolaryngology, neurosurgery, GU, ophthalmology, orthopedics, and plastic surgery must be available.
  • Monitoring and advanced life-support equipment representative of current levels of technology.
  • Allied health staff and other support personnel.
  • Facilities that are readily available at all times to provide prompt laboratory measurements pertinent to the care of pediatric patients. These include but are not limited to measurement of blood chemistries, blood gases and pH, oxygen saturation, hematocrit/hemoglobin, and clotting function.
  • Conveniently located library facilities and space for research and teaching conferences in pediatric anesthesiology.


Educational Program

Goals and Objectives

The director and teaching staff must prepare and comply with written goals for the program. All educational components of the program should be related to the program goals. The program design must be approved by the RRC as part of the regular review process. A written statement of the educational objectives must be given to each resident.

Clinical Components

The subspecialty resident in pediatric anesthesiology should gain clinical experience in the following areas of care of neonates, infants, children, and adolescents:

  • Preoperative assessment of children scheduled for surgery
  • Cardiopulmonary resuscitation and advanced life support
  • Management of normal and abnormal airways
  • Mechanical ventilation
  • Temperature regulation
  • Placement of venous and arterial catheters
  • Pharmacologic support of the circulation
  • Management of both normal perioperative fluid therapy and massive fluid and/or blood loss
  • Interpretation of laboratory results
  • Management of children requiring general anesthesia for elective and emergent surgery for a wide variety of surgical conditions including neonatal surgical emergencies, cardiopulmonary bypass, solid organ transplantation, and congenital disorders
  • Techniques for administering regional anesthesia for inpatient and ambulatory surgery in children
  • Sedation or anesthesia for children outside the operating rooms, including those undergoing radiologic studies and treatment and acutely ill and severely injured children in the emergency department
  • Recognition, prevention, and treatment of pain in medical and surgical patients
  • Consultation for medical and surgical patients
  • Recognition and treatment of perioperative vital organ dysfunction
  • Diagnosis and perioperative management of congenital and acquired disorders
  • Participation in the care of critically ill infants and children in a neonatal and/or pediatric intensive care unit
  • Emergency transport of critically ill patients within the hospital and between hospitals
  • Psychological support of patients and their families
  • In preparation for roles as consultants to other specialists, subspecialty residents in pediatric anesthesiology should have the opportunity to provide consultation under the direction of faculty responsible for teaching in the pediatric anesthesiology program. This should include assessment of the appropriateness of a patient's preparation for surgery and recognition of when an institution's personnel, equipment, and/or facilities are not appropriate for management of the patient.

Didactic Components

The didactic curriculum, provided through lectures and reading, should include the following areas, with emphasis on developmental and maturational aspects as they pertain to anesthesia and life support for pediatric patients:

  • Cardiopulmonary resuscitation
  • Pharmacokinetics and pharmacodynamics and mechanisms of drug delivery
  • Cardiovascular, respiratory, renal, hepatic, and central nervous system physiology, pathophysiology, and therapy
  • Metabolic and endocrine effects of surgery and critical illness
  • Infectious disease pathophysiology and therapy
  • Coagulation abnormalities and therapy
  • Normal and abnormal physical and psychological development
  • Trauma, including burn management
  • Congenital anomalies and developmental delay
  • Medical and surgical problems common in children
  • Use and toxicity of local and general anesthetic agents • Airway problems common in children
  • Pain management in pediatric patients of all ages
  • Ethical and legal aspects of care
  • Transport of critically ill patients

Subspecialty conferences, including morbidity and mortality conferences, journal reviews, and research seminars, should be regularly attended. Active participation of the subspecialty resident in pediatric anesthesiology in the planning and production of these conferences is essential. However, the faculty should be the conference leaders in the majority of the sessions. Attendance by residents at multidisciplinary conferences, especially those relevant to pediatric anesthesiology, is encouraged.

Resident Policies

Duty Hours

While the actual number of hours worked by subspecialty residents may vary, residents should have sufficient time off to avoid undue fatigue and stress. It is recommended that residents be allowed to spend, on average, at least 1 full day out of 7 away from the hospital and should be assigned on-call duty in the hospital no more frequently than, on average, every fourth night.

The program director is responsible for monitoring the residents' activities to ensure adherence to this recommendation.

Peer Interaction

Subspecialty residents in pediatric anesthesiology should become experienced in teaching principles of pediatric anesthesiology to other resident physicians, medical students, and other health-care professionals. This experience should correlate basic biomedical knowledge with clinical aspects of pediatric anesthesiology, including the management of patients requiring sedation outside the operating rooms as well as pain management and life support.

Scholarly Activities

The subspecialty training program in pediatric anesthesiology should provide the opportunity for active resident participation in research projects pertinent to pediatric anesthesia.Subspecialty residents should be instructed in the conduct of scholarly activities and the evaluation of investigative methods and interpretation of data, including statistics; they should have the opportunity to develop competence in critical assessment of new therapies and of the medical literature.

Additional Required Components

There should be prompt access to consultation with other disciplines, including pediatric subspecialties of neonatology, cardiology, neurology, pulmonology, radiology, critical care, emergency medicine, and pediatric subspecialties of surgical fields. To provide the necessary breadth of experience, an accredited residency training program in pediatrics is required within the institution. Residency programs or other equivalent clinical expertise in other specialties, particularly pediatric general surgery and pediatric surgical subspecialties, such as otolaryngology, GU, neurosurgery, ophthalmology, and orthopedics, and pediatric radiology are highly desirable.


Faculty responsible for teaching subspecialty residents in pediatric anesthesiology must provide critical evaluations of each resident's progress and competence to the pediatric anesthesiology program director at the end of 6 months and 12 months of training. These evaluations should include attitude, interpersonal relationships, fund of knowledge, manual skills, patient management, decision-making skills, and critical analysis of clinical situations. The program director or designee must inform each resident of the results of evaluations at least every 6 months during training, advise the resident on areas needing improvement, and document the communication. Subspecialty residents in pediatric anesthesiology must obtain overall satisfactory evaluations at completion of 12 months of training to receive credit for training.

There must be a regular opportunity for residents to provide written, confidential evaluation of the faculty and program.

Periodic evaluation of patient care (quality assurance) is mandatory. Subspecialty residents in pediatric anesthesiology should be involved in continuous quality improvement, utilization review, and risk management.

Periodic evaluation of subspecialty training objectives is encouraged.

Valerie Armstead, MD
Thomas Jefferson University, Philadelphia, PA

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