The essay “Pediatrics-Anesthesiology Combined Training: An Applicant’s Perspective” in this issue of Anesthesia & Analgesia provides a thoughtful description of Dr. Ethan Sanford’s decision as a medical student to pursue graduate training in the newly established American Board of Anesthesiology, American Board of Pediatrics (ABA-ABP)–approved combined anesthesiology and pediatrics residency program.1 His story is of particular interest to us as we implement a combined anesthesiology–pediatric residency program at the University of Pittsburgh Medical Center, joining the Children’s Hospital of Boston, Johns Hopkins, Stanford University School of Medicine, the University of California-Irvine Medical Center, and the University of North Carolina-Chapel Hill in offering this training.
The combined anesthesiology–pediatric residency program produces fully qualified and board-eligible pediatrician anesthesiologists in 5 years, following on 30 months of anesthesiology training and 30 months of pediatric training. This curriculum is 1 year shorter than if the trainee completed each categorical residency sequentially.2 Combined residents begin their training with 1 full year of pediatrics, followed by 1 full year of anesthesiology. The remaining 3 years of training alternate every 3 to 6 months between both specialties.
Institutions with ABA- and ABP-certified combined training programs offer a cohesive, complementary curriculum. Combined residents intermingle with pediatric and anesthesiology residents, increasing the exposure of each discipline to the other. Furthermore, there is a significant overlap of clinical rotations—critical care being a prime example—as residents move from one specialty to the other. This cross-training justifies the reduction of 12 months of training. On graduation, “[b]oth Boards encourage residents to extend their training for an additional sixth year or more in [either] pediatrics or anesthesiology and/or investigative, administrative or academic pursuits in order to prepare graduates of this combined training program for careers in research, teaching, or departmental administration and to become leaders in their fields.”2
When considering the design of the combined anesthesiology–pediatric program at the University of Pittsburgh Medical Center, we drew on our personal experiences. We are board-certified in both specialties, having completed our training via the traditional route: 3 years of categorical pediatrics, 3 years of categorical anesthesiology, followed by a 1-year pediatric anesthesiology fellowship. As practicing pediatric anesthesiologists, we are handy with a laryngoscope, but haven’t used an otoscope in a very long time. Developmental milestones and anticipatory guidance are useful in raising our own children, but rarely apply in the perioperative environment. Despite different foci (primary care versus tertiary medical care), our pediatric training complemented our anesthesiology training by helping us understand the natural course of disease in children and the effects that our interventions have on a pediatric patient’s recovery. We became attuned to the effect that disease and therapy have on both the patient and his or her family. In addition, as pediatricians, we know the difficulty and uncertainty that comes with establishing a diagnosis and instituting therapy in children. Indeed, our pediatric training opened our eyes to what we wouldn’t have known with only anesthesiology training. Graduate medical education is particularly adept at this: teaching young physicians to know what they DO NOT know—the proverbial “rabbit hole” of patient care.
If the ultimate goal of residency programs is to produce a competent and caring physician, then combined training in anesthesiology and pediatrics is likely more complete in serving this purpose than the categorical programs alone. The rabbit hole that is the perioperative/surgical environment is not well understood by the majority of our general pediatric colleagues. Similarly, the rabbit hole of the primary care clinic or the pediatric inpatient ward is not well understood by the majority of our anesthesiology colleagues. A pediatric patient may repeatedly traverse the rabbit hole over the course of a hospital admission, a journey wrought with dangers of airway mishaps, respiratory and/or cardiac arrests, increased infection rates, hemorrhage, and the profound anxiety and stress experienced by the young patient and his or her family.
Anesthesiologists are competent and caring physicians, as dedicated to patient care as our primary care colleagues. In the case of pediatric anesthesiologists, the combined expertise of a primary care pediatrician and a critical care anesthesiologist furthers our professional goal of being complete perioperative physicians. Graduates from combined anesthesiology–pediatric residency programs could effectively integrate their pediatric medical knowledge with their perioperative expertise, thus elevating the field of anesthesiology and raising the bar for patient care. All boats rise with the incoming tide. Combining pediatric and anesthesiology residencies is a welcome educational and professional opportunity in our specialty.
Name: Neal F. Campbell, MD.
Contribution: This author helped write the manuscript.
Attestation: Neal Campbell approved the final manuscript. Neal Campbell attests to the integrity of the original data and the analysis reported in this manuscript.
Name: Peter J. Davis, MD.
Contribution: This author helped write the manuscript.
Attestation: Peter Davis approved the final manuscript.
Recuse Note: Dr. Peter J. Davis is the Section Editor for Pediatric Anesthesiology for Anesthesia & Analgesia. This manuscript was handled by Dr. Steven L. Shafer, Editor-in-Chief, and Dr. Davis was not involved in any way with the editorial process or decision.