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A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study
Anesthesia & Analgesia ( IF 5.7 ) Pub Date : 2023-03-01 , DOI: 10.1213/ane.0000000000006128
Aditee P Ambardekar 1 , Whitney Eriksen 2 , Marla B Ferschl 3 , Peggy P McNaull 4 , Ira T Cohen 5 , William J Greeley 6 , Justin L Lockman 7, 8
Affiliation  

BACKGROUND: 

Pediatric anesthesiology fellowship education has necessarily evolved since Accreditation Council for Graduate Medical Education (ACGME) accreditation in 1997. Advancements in perioperative and surgical practices, emerging roles in leadership, increasing mandates by accreditation and certification bodies, and progression toward competency-based education—among other things—have created pressure to enrich the current pediatric anesthesiology training system. The Society for Pediatric Anesthesia (SPA) formed a Task Force for Pediatric Anesthesiology Graduate Medical Education that included key leaders and subject matter experts from the society. A key element of the Task Force’s charge was to identify curricular and evaluative enhancements for the fellowship program of the future.

METHODS: 

The Task Force executed a nationally representative, stakeholder-based Delphi process centered around a fundamental theme: “What makes a pediatric anesthesiologist?” to build consensus among a demographically varied and broad group of anesthesiologists within the pediatric anesthesiology community. A total of 37 demographically and geographically varied pediatric anesthesiologists participated in iterative rounds of open- and close-ended survey work between August 2020 and July 2021 to build consensus on the current state, known deficiencies, anticipated needs, and strategies for enhancing national educational offerings and program requirements.

RESULTS: 

Participation was robust, and consensus was almost completely achieved by round 2. This work generated a compelling Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis that suggests more strengths and opportunities in the current Pediatric Anesthesiology Graduate Medical Education program than weaknesses or threats. Stakeholders agreed that while fellows matriculate with some clinical knowledge and procedural gaps, a few clinical gaps exist upon graduation. Stakeholders agreed on 8 nonclinical domains and specific fundamental and foundational knowledge or skills that should be taught to all pediatric anesthesiology fellows regardless of career plans. These domains include (1) patient safety, (2) quality improvement, (3) communication skills, (4) supervision skills, (5) leadership, (6) medical education, (7) research basics, and (8) practice management. They also agreed that a new case log system should be created to better reflect modern pediatric anesthesia practice. Stakeholders further identified the need for the development of standardized and validated formative and summative assessment tools as part of a competency-based system. Finally, stakeholders noted that significant departmental, institutional, and national organizational support will be necessary to implement the specific recommendations.

CONCLUSIONS: 

A Delphi process achieved robust consensus in assessing current training and recommending future directions for pediatric anesthesiology graduate medical education.



中文翻译:

重新设计研究生医学教育的共识驱动方法:儿科麻醉学德尔菲研究

背景: 

自 1997 年研究生医学教育认证委员会 (ACGME) 认证以来,儿科麻醉学进修教育必然发生发展。围手术期和外科实践的进步、领导角色的新兴、认证和认证机构的任务增加以及向基于能力的教育的进展——其他事情——给丰富当前的儿科麻醉培训体系带来了压力。小儿麻醉学会 (SPA) 成立了小儿麻醉学研究生医学教育工作组,其中包括来自学会的主要领导和主题专家。该工作组负责的一个关键要素是确定未来研究金计划的课程和评估改进。

方法: 

该工作组执行了一个具有全国代表性、基于利益相关者的德尔菲流程,该流程围绕一个基本主题:“是什么造就了儿科麻醉师?” 在儿科麻醉学界内人口多样化且广泛的麻醉师群体中建立共识。2020 年 8 月至 2021 年 7 月期间,共有 37 名不同人口和地域的儿科麻醉师参与了多轮开放式和封闭式调查工作,以就当前状况、已知缺陷、预期需求和加强国家教育服务的战略达成共识和计划要求。

结果: 

参与度很高,第二轮几乎完全达成共识。这项工作产生了令人信服的优势、劣势、机会和威胁 (SWOT) 分析,表明当前儿科麻醉学研究生医学教育计划的优势和机会多于劣势或威胁。利益相关者一致认为,虽然研究员入学时具备一些临床知识和程序差距,但毕业后仍存在一些临床差距。利益相关者就 8 个非临床领域以及具体的基础知识或技能达成一致,无论职业规划如何,都应向所有儿科麻醉学研究员教授这些知识或技能。这些领域包括 (1) 患者安全、(2) 质量改进、(3) 沟通技巧、(4) 监督技巧、(5) 领导力、(6) 医学教育、(7) 研究基础知识和 (8) 实践管理。他们还同意应该创建一个新的病例日志系统,以更好地反映现代儿科麻醉实践。利益相关者进一步确定需要开发标准化和经过验证的形成性和总结性评估工具,作为基于能力的系统的一部分。最后,利益相关者指出,实施具体建议需要重要的部门、机构和国家组织的支持。

结论: 

德尔菲流程在评估儿科麻醉学研究生医学教育当前培训和推荐未来方向方面达成了强有力的共识。

更新日期:2023-02-21
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