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Fellowship training is essential to the advancement of any subspecialty. Graduates of fellowship programs are likely to become the future custodians of clinical, educational, administrative, and research efforts in that specialty. The role of basic residency training in any medical specialty is to obtain a degree of comfort and proficiency in that particular field. Proficiency, defined as the “advancement in knowledge” or skill in a field of medicine,1 should be the minimum goal of any postgraduate training program. Indeed, the Program Requirements for Residency Education in Anesthesiology states that residency programs must “promote the acquisition of the knowledge, skills, clinical judgment, and attitudes essential to the practice of anesthesiology”.2

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Subspecialization can be defined as the process by which each generation is able to provide better patient care and to conduct research and educational missions more effectively than the previous generation.3 The Program Requirements for Residency Training in the Subspecialties of Anesthesiology define “advanced training” as an educational experience of at least 1 year, designed to develop advanced knowledge and skills in a specific clinical area.4 This expertise, or special skill and knowledge representing mastery of a particular subject, is the goal of every fellowship program.

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In 19955 the American Society of Anesthesiologists (ASA) newsletter reported the findings of the ASA Committee on Anesthesia Subspecialties. This committee was formed in response to a growing trend of subspecialization within the field. Currently, several areas of subspecialty training are available in the field of anesthesiology (Table 82–1).

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Table 82-1. Recognized Subspecialties of Anesthesia
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Of these, only pain management, critical care, and pediatric anesthesia are officially accredited by the American College of Graduate Medical Education (ACGME). In addition, critical care and pain management offer graduates certification via an examination process. Graduates of other subspecialty programs are presented with a certificate of completion; however, these programs receive no specific recognition from the American Board of Anesthesiology (ABA). Although proficiency in each of these subspecialty fields is often gained during the course of an anesthesia residency, by and large, true expertise can only be accomplished with fellowship training in that given specialty.

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The extent to which the fundamentals of regional anesthesia are taught during residency varies widely among training programs. In many cases, the level of training may well be inadequate.6,7 Fellowship training should ideally be concerned with the development of expertise in the practice and theory of regional anesthesiology. It is interesting to note, that although the medical and surgical applications of regional anesthesia began over a century ago, and the formalization of the subspecialty by the modern-day American Society of Regional Anesthesia (ASRA) began over three decades ago, fellowship training in regional anesthesia is ...

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