Pediatrics-Anesthesia Combined Residency Training

T he residency application process induces excitement and confusion in varying proportions for every medical student. As an applicant to the recently established combined pediatrics-anesthesia residency programs, my apprehension was compounded by several additional challenges. One such challenge was explaining what these programs entail to nearly everyone I met, including many of my interviewers. Programs combining training in pediatrics and anesthesiology are a recent addition to a number of combined residency programs that have emerged over the past 30 years. They are 5-year residencies in which the initial year is spent as a categorical pediatrics intern, the second year as a clinical anesthesia resident, and the final 3 years transitioning between pediatrics and anesthesiol-ogy. The first residents to start the program have recently embarked on the final 3 years of training. The utility of training in pediatrics and anesthesiol-ogy, 2 seemingly unrelated fields, was important to convey before approval of this program by the American Board of Anesthesiology (ABA) and the American Board of Pediatrics. 1,2 This task was initiated by the ABA under the leadership of Dr. Mark Rockoff, a pediatrician and anesthesiologist who trained in both residency programs consecutively. The tenants of pediatrics training include understanding developmental physiology along with congenital problems, managing multiple patients on hospital wards, leading multidisciplinary general and subspecial-ized teams, and working with patients and their families in diverse settings. Anesthesiology training, however, stresses extensive knowledge of clinical pharmacology, independence , efficient communication, technical skills, hands-on learning, the ability to rapidly synthesize knowledge into immediate treatment, and experience in crisis management. Generalizations about the skill sets needed in pediatrics or anesthesiology break down in many clinical circumstances. Nonetheless, several knowledgeable physicians with whom I have spoken have had reservations about pursuing what they see as a very subspecialized residency program applicable to only a narrow set of careers. Graduates of combined programs are likely to find opportunities where the worlds of pediatrics and anesthe-siology directly interact. Nowhere is this clearer than in specialties that share a place in caring for acutely ill children: pediatric anesthesiology and pediatric critical care. Training in pediatric illnesses and developmental anomalies would undoubtedly aid anesthesiologists in caring for children with complex illnesses whether in operating rooms or other procedural settings. Similarly, training in diverse perioperative and periprocedural cases should aid pediatri-cians in managing resuscitation and ventilation situations in intensive care units or sedation/regional anesthesia in any setting. In addition, …