Pediatrics and Anesthesiology Combined Training Requirements (Leading to Dual Certification)

PREAMBLE

This document is intended to provide educational guidance to program directors in pediatrics and anesthesiology as well as to individuals potentially interested in combined training in pediatrics and anesthesiology. All program requirements in both specialties, as described on the ACGME web site (https://www.acgme.org/), apply to combined residencies unless specifically modified in this document. However, this integrated program will require five, not six, years as would be necessary if these two residency programs were completed sequentially. Every program that wishes to offer this combined training must be approved by both the American Board of Pediatrics (ABP) and the American Board of Anesthesiology (ABA) before residents are recruited. In addition, both Boards (and Residency Review Committees, RRCs, when applicable) will review these training requirements periodically.

OBJECTIVES OF COMBINED TRAINING

Combined training in pediatrics and anesthesiology should allow the development of physicians who are fully qualified in both specialties. Physicians completing this training should be competent pediatricians and anesthesiologists capable of professional activity in either discipline. It is anticipated that many trainees will develop careers focused on caring for children with complex medical and surgical conditions who are hospitalized and/or require perioperative/periprocedural management. The strengths of the two residencies should complement each other to provide the optimal educational experience and to develop leaders in the field.

Both boards encourage residents to extend their training for an additional sixth year or more in subspecialty training in 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.

GENERAL REQUIREMENTS

Residency Candidates

Residents should enter a combined training residency at the first postgraduate year level (PGY-1). A resident may enter this combined residency at the PGY-2 level only if the first residency year was served in a categorical residency in pediatrics in the same academic medical center. Transitional year training will provide no credit toward the requirements of either Board. Residents may not enter combined residency training and receive credit beyond the PGY-1 level or transfer to another combined residency without the prospective approval of both Boards. A resident transferring from a combined residency to a categorical pediatric or anesthesiology program should seek specific eligibility information from the appropriate Board.

A resident in the pediatrics and anesthesiology combined program may be absent from training (vacation, PREAMBLE OBJECTIVESOFCOMBINEDTRAINING GENERAL REQUIREMENTS parental, sick, etc.) up to a total of five months during the 60 months of required training. Eight weeks (40 days) additional leave from training (above the five months) will be considered. All absences will be shared equally by both training residencies. Absences in excess of those described above will require lengthening of the total training time to compensate for the additional absences from training. The revised policy is in effect for trainees who graduate in 2022 or later.

Characteristics of Eligible Combined Residencies

The two participating core residency programs must be accredited by the ACGME and be within the same academic medical center. They must be located close enough to facilitate cohesion among the residents, attendance at conferences when scheduled, and faculty exchangesof curriculum,evaluation, administration and related matters. They should both be sponsored by the same ACGME Sponsoring Institution. The one exception is when the pediatric program is sponsored by an independent, freestanding, children’s hospital in which case the Designated Institutional Official (DIO) of the institution that sponsors the pediatric residency program will be the DIO with responsibility for institutional oversight of the combined program.

Training

The training requirements for eligibility for each board’s certification process will be satisfied by the satisfactory completion of 60 months of approved combined training. A reduction of 12 months over that required for the two separate residencies is possible due to the overlap of curriculum and experience inherent in the training of each discipline. The reduction of six months of the standard 36 months of pediatric training is met by 30 months of training in the pediatric component of the combined residency and six months of credit granted for training appropriate to pediatrics obtained during the 30 months of anesthesiology residency. The requirement of 48 months of training in anesthesiology is met by the 12 months of the first year of residency in pediatrics, 30 months of training in the anesthesiology component of the combined residency, and six months of credit for training appropriate to anesthesiology obtained during the remaining 18 months of residency in pediatrics. The working relationships developed among categorical and combined residency trainees will facilitate communication between the two specialties and increase the exposure of categorical residents to the other discipline. Training in each discipline must incorporate graded responsibility throughout the training period.

Training in the PGY-1 must include 12 months of training in pediatrics. During the second year, the resident must have 12 months of training in anesthesiology. In each of the remaining three years, the resident shall have six months of training in pediatrics and six months of training in anesthesiology. Rotations of shorter duration, but not less than three months, are also acceptable. During these last three years, it is important that program directors make certain that in the PGY-3-5, each resident will have 18 months of training in each specialty.

Faculty

The combined residency must have one designated director who will be responsible for all administrative aspects of the program and who can devote substantial time and effort to the educational program. This individual can be the director of either the residency program in pediatrics or anesthesiology; the director of the other categorical residency program will be designated the associate director of this combined program. An exception to this requirement would be a single director who is certified in both specialties and has an academic appointment in each department. If the pediatric training largely occurs in an independent, free-standing children’s hospital, the program director of the combined program should be the director of the pediatric residency program. The director and associate director must document meetings with each other at least quarterly to monitor the success of the residency and the progress of each resident.

Well-established communication must occur between these individuals, particularly in those areas where the basic concepts in both specialties overlap, to assure that the training of residents is well coordinated

The program director is responsible for assuring all aspects of the program requirements are met. This individual, along with the associate program director, should submit the application for the program to both the ABP and ABA and notify both boards should any significant changes occur in either of the associated categorical residency programs. The program director and associate program director are responsible for completing evaluation forms for all trainees in the combined program as required by their respective Boards, and both must verify satisfactory completion of the training program on the resident’s final evaluation form.

As a general principle, the training of residents in pediatrics is the responsibility of the pediatric faculty and the training of residents in anesthesiology is the responsibility of the anesthesiology faculty. There should be an adequate number of faculty members who devote sufficient time to provide leadership to the residency and supervision of the residents. It is recommended that some faculty members have completed combined training in these two specialties. Since each component of the residency must be accredited by its respective discipline, the faculty must meet the requirements for their specialty.

Pediatric faculty must be certified by the American Board of Pediatrics or have acceptable educational qualifications in pediatrics as judged by the ACGME’s RC for Pediatrics. Anesthesiology faculty must be certified by the American Board of Anesthesiology or the American Board of Osteopathic Anesthesiology or have acceptable educational qualifications in anesthesiology, as judged by the ACGME’s RC for Anesthesiology.

Curricular Requirements

A clearly described written curriculum must be available for residents, faculty, and the RCs of both Pediatrics and Anesthesiology. The curricular components must conform to the program requirements for accreditation in pediatrics and anesthesiology. The curriculum must assure a cohesive, planned educational experience and not simply comprise a series of rotations between the two specialties. Duplication of clinical experiences between the two specialties should be avoided. Periodic review of the residency curriculum must be performed by the program director and associate program director in consultation with residents and faculty from both departments. Combined training must not interfere with or compromise the training of the categorical residents in either field

Joint educational conferences involving residents from pediatrics and anesthesiology are desirable and should specifically include the participation of all residents in the combined training residency whenever possible.

REQUIREMENTS FOR PEDIATRICS

The training should be the same as described in the ACGME Program Requirements for Graduate Medical Education for Pediatrics as outlined in this document with the exceptions that follow.

The curriculum should be organized in educational units. An educational unit should be a block (four weeks or one month) or a longitudinal experience. An outpatient educational unit should be a minimum of 32 half-day sessions. An inpatient educational unit should be a minimum of 200 hours. The specific curriculum elements are detailed in the following chart.