June 2006 Newsletter
James G. Ramsay, MD
The Subspecialty of Adult Cardiothoracic Anesthesiology
"The SCA, an international organization of physicians, promotes excellence in patient care through education and research in perioperative care for patients undergoing cardiothoracic and vascular procedures." The SCA leadership has promoted this mission by actively promoting the creation of true subspecialty status with the Accreditation Council of Graduate Medical Education (ACGME), which has finally been achieved. In the very near future (perhaps by the time you read this) if you go to the ACGME website and click on "Residency Review Committees," then "Anesthesiology," Adult Cardiothoracic Anesthesiology will be listed in the menu under both Program Information Forms ("PIFs") and under "Program Requirements." Our subspecialty is now on an equal footing with the other anesthesiology subspecialties of Critical Care Medicine, Pain Medicine, and Pediatric Anesthesiology. Training programs will need to apply to the ACGME for certification of their training in our subspecialty, and when their program is reviewed by the ACGME during a site visit, Adult Cardiothoracic Anesthesiology will be reviewed along with the core program and other approved subspecialties. Fellowship directors around the country will soon (within weeks) be able to download the PIF for our subspecialty, and apply for accreditation. The intent is to enable fellows to enter accredited programs beginning in 2007. The acceptance of standardized training requirements with accreditation of training programs will be a major benefit to our trainees, providing them with goals, objectives, and training which can be recognized wherever they practice. The change in status from a non-accredited subspecialty to an accredited one has major administrative implications, both for the training programs and for the fellows who now become PGY 5 (or above) residents, and must be included in the number of residents training at the institution. Similarly, all the regulations regarding issues such as duty hours will now apply to fellows in adult cardiothoracic anesthesiology.
An important issue is the distinction between accreditation of training programs vs certification of individuals. The ACGME considers these as separate issues, and in fact certification of individuals falls under another jurisdiction (ie, the American Board of Medical Specialties, the "umbrella" organization which includes the American Board of Anesthesiology). While certification cannot exist without first having accredited training programs, the two are not linked and subspecialties may be established years before certification of individuals is considered. The SCA leadership has not discussed the issue of certification, and I predict will not do so for some years. The only certification relevant to our subspecialty (ie, after board certification in Anesthesiology) is for Perioperative Transesophageal Echocardiography - conferred by yet another independent group, the National Board of Echocardiography (NBE) which has no relationship with either the ACGME or the ABA. As a Canadian who moved to the USA in 1990, it has only taken me 16 years to figure this all out!
Program requirements for training in Pediatric Cardiothoracic Anesthesiology are still being worked out by the community of Pediatric Anesthesiologists and Pediatric Cardiothoracic Anesthesiologists.
As we achieve success with some aspects of our mission, we are looking to future achievements in other areas. Specifically, your Board has strongly endorsed enhancement of our funding of research, and is developing an exciting new program related to patient safety in the cardiothoracic operating room. Those of you who attended our meeting in San Diego heard me announce the creation of the Society of Cardiovascular Anesthesiologists Foundation. Under the leadership of Nancy Nussmeier and Glenn Gravlee, a committee of prominent members of the society, and our new Director of Development, John Melleky, we are moving ahead with a major program of fund raising to enhance our ability to support research in our field, and to develop standards for safety in the complex environment of the cardiothoracic operating room. Bruce Spiess and Paul Barash have been key players in the latter project. At this time I just want to "whet your appetite" for information about these endeavors, with future messages rolling out our plans in greater detail. Stay tuned!
James G. Ramsay, MD
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