BACKGROUND: 

Clinical experiences, quantified by case logs, are an integral part of pediatric anesthesiology fellowship programs. Accreditation of pediatric anesthesiology fellowships by the Accreditation Council of Graduate Medical Education (ACGME) and establishment of case log reporting occurred in 1997 and 2009, respectively. The specialty has evolved since then, but the case log system remains largely unchanged. The Pediatric Anesthesiology Program Directors Association (PAPDA) embarked on the development of an evidence-based case log proposal through the efforts of a case log task force (CLTF). This proposal was part of a larger consensus-building process of the Society for Pediatric Anesthesia (SPA) Task Force for Pediatric Anesthesiology Graduate Medical Education. The primary aim of case log revision was to propose an evidence-based, consensus-driven update to the pediatric anesthesiology case log system.

METHODS: 

This study was executed in 2 phases. The CLTF, composed of 10 program directors representing diverse pediatric anesthesiology fellowship programs across the country, utilized evidence-based literature to develop proposed new categories. After an approval vote by PAPDA membership, this proposal was included in the nationally representative, stakeholder-based Delphi process executed by the SPA Task Force on Graduate Medical Education. Thirty-seven participants engaged in this Delphi process, during which iterative rounds of surveys were used to select elements of the old and newly proposed case logs to create a final revision of categories and minimums for updated case logs. The Delphi methodology was used, with a two-thirds agreement as the threshold for inclusion.

RESULTS: 

Participation in the Delphi process was robust, and consensus was almost completely achieved by round 2 of 3 survey rounds. Participants suggested that total case minimums should increase from 240 to 300 (300–370). Participants agreed (75.86%) that the current case logs targeted the right types of cases, but requirements were too low (82.75%). They also agreed (85.19%) that the case log system and minimums deserved an update, and that this should be used as part of a competency-based assessment in pediatric anesthesia fellowships (96%). Participants supported new categories and provided recommended minimum numbers.

CONCLUSIONS: 

The pediatric anesthesiology case log system continues to have a place in the assessment of fellowship programs, but it requires an update. This Delphi process established broad support for new categories and benchmarked minimums to ensure the robustness of fellowship programs and to better prepare the pediatric anesthesiology workforce of the future for independent clinical practice.

中文翻译：

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研究生医学教育认证委员会病例日志系统的共识驱动修订：小儿麻醉学奖学金教育

背景： 

通过病例日志量化的临床经验是儿科麻醉学奖学金项目的一个组成部分。研究生医学教育认证委员会 (ACGME) 对儿科麻醉学奖学金的认证和病例日志报告的建立分别于 1997 年和 2009 年进行。从那时起，该专业不断发展，但案例日志系统基本保持不变。通过病例日志工作组 (CLTF) 的努力，儿科麻醉学项目主任协会 (PAPDA) 开始制定基于证据的病例日志提案。该提案是儿科麻醉学会 (SPA) 儿科麻醉学研究生医学教育工作组更大的共识构建过程的一部分。病例日志修订的主要目的是对儿科麻醉病例日志系统提出基于证据、共识驱动的更新。

方法： 

这项研究分两个阶段进行。CLTF 由代表全国不同儿科麻醉学研究金项目的 10 名项目主任组成，利用基于证据的文献来开发拟议的新类别。经过 PPDA 成员投票批准后，该提案被纳入由 SPA 研究生医学教育工作组执行的具有全国代表性、基于利益相关者的 Delphi 流程。三十七名参与者参与了这一德尔菲流程，在此过程中，使用迭代轮次调查来选择旧的和新提出的案例日志的元素，以创建更新案例日志的类别和最小值的最终修订。采用德尔菲法，以三分之二的同意作为纳入的门槛。

结果： 

德尔菲流程的参与度很高，三轮调查中的第二轮几乎完全达成了共识。参与者建议病例总数最低限度应从 240 例增加到 300 例 (300-370)。参与者一致认为（75.86%）当前的案例日志针对的是正确的案例类型，但要求太低（82.75%）。他们还同意 (85.19%) 病例日志系统和最低标准值得更新，并且应将其用作儿科麻醉奖学金基于能力的评估的一部分 (96%)。参与者支持新类别并提供建议的最低数量。

结论： 

儿科麻醉病例日志系统继续在研究金计划的评估中占有一席之地，但需要更新。这一德尔菲流程为新类别和最低基准建立了广泛的支持，以确保奖学金计划的稳健性，并为未来的儿科麻醉学队伍更好地进行独立临床实践做好准备。