Guidelines for regional anesthesia training
The Regional Anesthesiology and Acute Pain Medicine Fellowship Directors Group
Abstract: Directors for Regional Anesthesiology and Acute Pain Medicine fellowships develop and maintain guidelines for fellowship training in the subspecialty. The first edition of the guidelines was published in 2005 with a revision published in 2010. This set of guidelines updates the 2010 revision. The guidelines address 3 major topics: organization and resources, the educational program, and the evaluation process. (Reg Anesth Pain Med 2015;40: 213-217)
This is a consensus document that is developed and maintained by Regional Anesthesiology and Acute Pain Medicine fellowship directors and their colleagues (The Group). The Group was formed in 2002 as an international collaboration of fellowship directors (Appendix 1, Supplemental Digital Content 1, http://links.lww.com/AAP/A138) and associate directors interested in advanced Regional Anesthesiology and Acute Pain Medicine training. The Group provides a forum for discussion of issues related to fellowship design and development, administration, and common concerns. Participation is open to all interested individuals, with one official member from each institution. The Group meets semiannually—during the American Society of Regional Anesthesia and Pain Medicine spring meeting and during the American Society of Anesthesiologists annual meeting. Members of this group work collaboratively on initiatives to continually improve the fellowship experience and quality of training.
This document was initially created in 2002, approved by The Group in 2003, and published in Regional Anesthesia and Pain Medicine in 2005.1 The Group has agreed that this document will be reviewed every 3 years, being mindful of developments in the science and practice of Regional Anesthesiology and Acute Pain Medicine. This document was reviewed without change in 2006. In 2009, several changes were approved, including reorganization of the document to reflect the Accreditation Council for Graduate Medical Education (ACGME) competencies. The most important changes reflect the adoption of ultrasound guidance as a tool for nerve localization and increased emphasis on knowledge related to complications specific to the subspecialty and stress the intertwinement of acute pain medicine with perioperative anesthetic procedures. Final approval of this document occurred at The Group’s October 2010 meeting.2 This revision was completed with an understanding of the new ACGME milestones, has been reviewed by all participating institutional delegates, and can serve as a guide for future ACGME accreditation of Regional Anesthesiology and Acute Pain Medicine fellowship programs.
Recently, the importance of multimodal acute pain management incorporating regional anesthetic techniques has been recognized as a specialty within Anesthesiology. In addition to the knowledge of acute pain mechanisms and nuances unique to the perioperative setting, regional anesthesia is now considered a specialized technical skill set. In 2014, there are nearly 60 institutions that have listed themselves as having a nonaccredited fellowship program focused on Regional Anesthesiology and Acute Pain Medicine. Therefore, it has become apparent that accreditation of fellowship training in Regional Anesthesiology and Acute Pain Medicine is essential. The Regional Anesthesiology and Acute Pain Medicine fellowship has recently been approved by the ACGME Board of Directors to become the next accredited subspecialty fellowship training program within anesthesiology and is currently in the process of developing program requirements. As such, these guidelines for fellowship training in Regional Anesthesiologyand Acute Pain Medicine represent the consensus of peers and at this time are not intended to be absolute program requirements nor should they be construed to define standard of care. As detailed in its mission statement, The Group acknowledges that individual fellowship programs may vary from these guidelines and yet maintain a high level of proficiency and integrity.
The purpose of this comprehensive set of goals and competency-based objectives is to recommend desired components of subspecialty fellowship training in Regional Anesthesiology and Acute Pain Medicine. Participating fellowship program directors will ensure the ongoing development of Regional Anesthesiology and Acute Pain Medicine as a defined subspecialty. Educational curricula, clinical care, and research activities are emphasized.