DOI: 10.1097/01.aco.0000191892.21444.1f
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PMID: 16534297
Issn Print: 0952-7907
Publication Date: 2005/12/01
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Excerpt
Perhaps the ACGME-Residency Review Committee (RRC) process for anesthesiology isn't keeping pace with the need for education of graduate physicians caring for the ever expanding numbers of ambulatory patients. Perhaps there is an opportunity to enhance the ambulatory anesthesia curriculum. To validate this query, consider the following.
The fundamental (core) education of anesthesiologists in the USA encompasses a 4-year curriculum set forth by the Anesthesiology RRC. Program requirements for this core education in anesthesiology are comprehensive and very detailed in some areas [3]. Subspecialty education in such areas as obstetric, pediatric, neuro- and cardiothoracic anesthesia is required and represents 30% of the educational activity in the first 2 of the 3 years of clinical education in anesthesiology. Case numbers that define the minimum resident experience for these special areas have been stated [3]. In the final year of clinical anesthesiology graduate education, ‘The program must provide 12 months experience in advanced and complex anesthesia assignments…’ [3] (italics show my emphasis).
The same degree of specificity is not insisted upon for ambulatory anesthesia education. While the RRC defines the specifics of subspecialty education of anesthesiology residents, it calls for the following curriculum in ambulatory anesthesia:
What are the definitions of appropriate and sufficient? The Content Outline of the Joint Council on In-Training Examinations of the American Board of Anesthesiology and American Society of Anesthesiologists, which defines the curricular content of anesthesiology education, demonstrates the ‘sparse emphasis’ placed on ambulatory anesthesia learning [4]. Compare the content outline for education about clinical respiratory anesthesia care with that for ambulatory anesthesia (see Table 1).
This issue of Current Opinion in Anaesthesiology presents some of the important and ongoing dialogue centered on the anesthesia care of patients undergoing surgical, diagnostic and/or therapeutic procedures in the ambulatory setting. Tait (pp. 603–607) reviews the dilemma and morbidity of administering anesthesia to a child with a respiratory tract infection. Aouad and Nasr (pp. 614–619) discuss the problem of emergence delirium in the pediatric population – a population with a majority of ambulatory patients. Lermitte and Chung (pp. 598–602) consider the ‘right’ types of patients of all ages for ambulatory anesthesia. Orhan-Sungur, Apfel and Akça (pp. 620–624) outline the considerations for the use of nitrous oxide in the anesthetic prescription, raising our level of awareness about the potential morbidity associated with such a technique, which is employed in current ambulatory anesthesia practice. Bergendahl, Lönnqvist and Eksborg (pp. 608–613) advocate the use of clonidine in the pediatric setting as a premedication because it is not only effective but it may have fewer side effects than currently utilized sedatives.
All of these authors assist practitioners caring for such patients by providing better understanding of clinically relevant issues about ambulatory anesthesia: anesthesia for a child with a respiratory tract infection, emergence delirium, selection of patients of all ages for ambulatory anesthesia, the use of nitrous oxide in the ambulatory anesthesia setting and safe and effective premedication of pediatric patients. Hopefully these updates will result in change in clinical practice and reduce morbidity and mortality associated with ambulatory anesthesia.
Barbara S.
