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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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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 ...