Stoltzfus D P, Watson C B, Ries M C
Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
Anesth Analg. 1995 Sep;81(3):441-5. doi: 10.1097/00000539-199509000-00002.
Anesthesiology critical care medicine (ACCM) fellowship training was accredited in 1989, and a small number of graduating anesthesiology residents pursue this additional training. Considering the flexible program guidelines of the American Board of Anesthesiology (ABA), we hypothesized that ACCM fellowship training programs varied significantly among the 42 institutions accredited to offer this program. This study of ACCM fellowship programs used a six-part, 57-item questionnaire completed by 36 program directors to describe six aspects of the program: institution size, program director, attending staff, fellowship applicants, curriculum, and the role of the American Society of Critical Care Anesthesiologists (ASCCA). Ninety-four percent of ACCM fellowships are in facilities with more than 400 beds; 81% of these institutions have more than 20 intensive care unit (ICU) beds as the basis for fellowship teaching. Eighty-three percent of ACCM program directors have practiced critical care for more than 5 yr. All programs had more than one attending physician, with the majority having a multidisciplinary attending staff. During two academic years (1990-1992), 12 (33%) of 36 programs did not have a fellow, resulting in an average of less than one fellow for each program. ACCM fellow involvement in patient care was characterized as "primary" in medical and pediatric ICUs and "cooperative" in surgical ICUs. Fellowship curricula had varied requirements for research, intraoperative anesthesia, and ICU procedures performed by the fellow. In general, program directors believe that salary and on-call responsibility are not important issues for applicants. Nineteen percent of program directors train ACCM fellows longer than the 12 mo required by the ABA and believe that ACCM training should be lengthened.
麻醉重症医学（ACCM）专科培训于1989年获得认证，少数即将毕业的麻醉科住院医师会接受这一额外培训。考虑到美国麻醉委员会（ABA）灵活的项目指南，我们推测在42家被认可提供该项目的机构中，ACCM专科培训项目存在显著差异。这项关于ACCM专科培训项目的研究使用了一份由36位项目主任填写的包含六个部分、57个条目的问卷，以描述该项目的六个方面：机构规模、项目主任、主治 staff、专科培训申请人、课程设置以及美国重症麻醉医师协会（ASCCA）的作用。94%的ACCM专科培训设在拥有400多张床位的机构；其中81%的机构拥有超过20张重症监护病房（ICU）床位作为专科培训教学的基础。83%的ACCM项目主任从事重症监护工作超过5年。所有项目都有不止一名主治医生，大多数项目拥有多学科的主治 staff。在两个学年（1990 - 1992年）期间，36个项目中有12个（33%）没有专科培训学员，导致每个项目平均不到一名学员。ACCM专科培训学员在医疗和儿科ICU中的患者护理参与程度被描述为“主要”，在外科ICU中为“合作”。专科培训课程对学员进行的研究、术中麻醉和ICU操作有不同要求。总体而言，项目主任认为薪资和值班责任对申请人来说并非重要问题。19%的项目主任培训ACCM专科培训学员的时间超过ABA要求的12个月，并认为ACCM培训应该延长。
