By Lori Riegger, M.D.
Although we have had a pediatric anesthesiology fellowship program at C.S. Mott Children’s Hospital since 1991, we have recently received accreditation from the American College of Graduate Medical Education (ACGME). The fellowship program will remain largely unchanged, but the ACGME does have certain requirements, which will further strengthen the program, and the professional training our fellows receive. We are one of only 14 approved pediatric fellowship programs nationally.
The pediatric fellowship will become a pediatric anesthesiology residency program, and our fellows will be referred to as pediatric anesthesiology residents, considered as CA-4s (PG-5s). We currently have four pediatric fellows in the department, and under the guidance of Dr. Paul Reynolds, Associate Chair, we have requested up to seven resident spots in the new program.
Clinical experience will continue to be drawn from those cases currently performed at the various pediatric anesthesia locations in C.S. Mott Children’s Hospital. These include the pediatric operating rooms, where all of the major pediatric surgical subspecialists operate (cardiac, thoracic, urology, orthopedic, plastic surgery, general surgery, transplant, dental/oral, ENT, ophthalmology, and neurosurgery), the radiology suites, cardiology suites, radiation oncology, and the medical procedures unit. In addition, there is a two-month concentration in pediatric cardiac anesthesia, and four weeks on the Pediatric Acute Pain Service. The ACGME requires an intensive care rotation and the pediatric anesthesiology residents will have the choice of spending a month in either the neonatal or the pediatric intensive care unit.
Pediatric anesthesiology fellows will be involved in the daily didactics at C.S. Mott Children’s Hospital, first by attending the conferences and learning the material, and then by teaching the general anesthesiology residents and medical students, with the support of the faculty. They will also be responsible for organizing and leading journal club discussions. The fellows will have opportunities to become involved in clinical research with the support of a faculty mentor, and are expected to make a presentation at the Midwest Anesthesiology Resident Conference (MARC).
The strength of the pediatric anesthesiology program at C.S. Mott Children’s Hospital is the range and depth of experience the residents receive. Last year, nearly 8,000 pediatric anesthetics were administered including 700 cardiac cases, 300 airway cases (excluding T&As), 90 neonatal emergencies (including tracheoesophageal fistulas, gastroschisis and omphaloceles), 70 craniotomies, 70 cleft lip/palates, 60 craniofacial surgeries, and 40 transplants. In 1997, the patient population included over 300 neonates, 1,200 infants, 1,000 one-to-two year-olds and 4,000 three-to-11 year-olds. Outpatients received 50 percent of the anesthetics administered; 25 percent of all cases involved ASA III, IV or V patients. The variety of challenging cases and severity of patients’ conditions make the program an outstanding opportunity to gain experience with the most difficult as well as the more “routine” pediatric anesthetics.
Since 1991, there have been 27 graduates of our fellowship program: 16 (59 percent), elected to pursue academic pediatric anesthesia at teaching institutions, and 11 (41 percent) chose private practice. Once accreditation is recognized nationwide there should be an increased demand for pediatric anesthesiologists trained at an accredited program. In fact, in the November 7th issue of US News and World Report pediatric anesthesia was listed as the "hottest specialty in medicine."