A Consensus-Driven Revision of the Accreditation Council for Graduate Medical Education Case Log System: Pediatric Anesthesiology Fellowship Education

Abstract

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 evidencebased 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.

A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study

“…Participants agreed (75.9%) that current ACGME requirements broadly target the correct types of cases but that case requirements are currently too low (85.7%). A pediatric anesthesiology fellowship case log system revision is underway; that process and outcomes are discussed in an accompanying article (Ambardekar et al 11 ).…”

“…It is no surprise, however, that most agree the case log system requires recharacterization and revision to evolve with the complexity of our current practice. Specific findings of the Delphi process as they relate to current case log system and proposed changes are discussed in detail in the accompanying article by Ambardekar et al 11…”

“…It is no surprise, however, that most agree the case log system requires recharacterization and revision to evolve with the complexity of our current practice. Specific findings of the Delphi process as they relate to current case log system and proposed changes are discussed in detail in the accompanying article by Ambardekar et al 11 Apprenticeship during clinical experiences alone is not sufficient for programs to succeed in a competencybased education system. CBME necessitates processes for regular, formative feedback and validated summative evaluations, 15 and our stakeholders agree (96.3%) that this is an opportunity for improvement.…”

To bend but not to break: Rethinking fellowship training in pediatric anesthesiology

“…Traditional case requirements attempt to address this by setting a bar for minimum exposure, and adaptations in this system are the subject of rigorous inquiry. 7 Perhaps there is a place for both the incorporation of universal elements with a layer of flexibility to ensure that we are meeting the needs of our patients. Ultimately, the curriculum relies on the agreement of the necessary EPA driven skills between several key stakeholders: hospitals, trainees, and patients.…”

“…Are there some skills and situations that all trainees should be exposed to, regardless of their future practice setting, because these entities are at the core of what a pediatric anesthesiologist should be and know? Traditional case requirements attempt to address this by setting a bar for minimum exposure, and adaptations in this system are the subject of rigorous inquiry 7 . Perhaps there is a place for both the incorporation of universal elements with a layer of flexibility to ensure that we are meeting the needs of our patients.…”