A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study

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.

A Consensus-Driven Revision of the Accreditation Council for Graduate Medical Education Case Log System: Pediatric Anesthesiology Fellowship Education

“…Furthermore, converting the totality of these educational experiences into a system of competency-based medical education requires validated assessment tools and regular and constructive feedback. The stakeholder group generated robust consensus during the Delphi process around many of these components, which are reported in the accompanying publication by Ambardekar et al 8…”

“…Furthermore, converting the totality of these educational experiences into a system of competency-based medical education requires validated assessment tools and regular and constructive feedback. The stakeholder group generated robust consensus during the Delphi process around many of these components, which are reported in the accompanying publication by Ambardekar et al 8 Interestingly, the proposed modifications were suggested and agreed upon in the setting of participant [11][12][13][14] 92.31 7.5 (5-13.75) Cardiac patient (unrepaired cyanosis, severe pulmonary hypertension, valvular dysfunction requiring medication, or awaiting heart transplant) for noncardiac surgery [11][12][13]15 80.77 7.5 (5)(6)(7)(8)(9)(10) Out of operating room/remote anesthesia [16][17][18][19] 100.00 20 (12.5-20) Shared airway case 18,20 88.46 10 (7.5-15) Single lung ventilation 92.31 5 (5-10) High volume blood loss or third space losses [21][22][23][24] 84.62 10 (5-15) Vasoactive infusion management 13 84.62 15 (5-20) Neuromonitoring 100.00 10 (5-15)…”

To bend but not to break: Rethinking fellowship training in pediatric anesthesiology

“…Given its long-established nature, US programs have required significant effort to reiteratively refine and adapt curricular standards using rigorous evidence-based methods, with the support of guiding organizations such as the Society for Pediatric Anesthesia. 2 To best evaluate the merits and feasibility of an EPA based curriculum, one must first understand the movement in medical education towards competency-based education utilizing EPAs.…”

“…This is in contrast to the standardized, highly regulated training model in place in some areas of the world, including in the United States of America. Given its long‐established nature, US programs have required significant effort to reiteratively refine and adapt curricular standards using rigorous evidence‐based methods, with the support of guiding organizations such as the Society for Pediatric Anesthesia 2 …”

Creating the Pediatric Anesthesiology Consultant: You Can’t Have Your Cake and Eat It Too (Unless You Change the Recipe)

“…Over the years, much thought and discussion have gone into how to improve pediatric anesthesiology fellowships. The two studies presented in this journal by Ambardekar et al 1,2 ask the question needed to guide the next iteration of pediatric anesthesiology fellowship training: "How should pediatric anesthesiology graduate medical education adapt to adequately prepare trainees for their future? ".…”