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Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP)

1060 www.anesthesia-analgesia.org September 2017 • Volume 125 • Number 3 DOI: 10.1213/ANE.0000000000002330 Management of acutely injured trauma patients is one of the most advanced clinical competencies required by a trauma care team physician. In the United States, the majority of multispecialty trauma care training of anesthesiology residents occurs at level 1 trauma centers. These are primarily academic teaching hospitals with a high trauma case volume, that admits severely injured patients, and who provides 24-hour in-house coverage of anesthesiology services. The anesthesiology service plays an integral role in the management of severely injured patients.1 In contrast to the training, according to the National Anesthesia Clinical Outcome Registry (NACOR) from the Anesthesia Quality Institute (AQI), most trauma and emergency patients are cared for at nonacademic, medium-sized community hospitals.2 All anesthesiologists should acquire the basics of resuscitation for a patient after traumatic injury because even those clinicians who do not practice at level 1 trauma centers may still care for patients with traumatic injuries after residency.2 Trauma anesthesiology (TA) education during residency has been under-recognized and underemphasized. Currently, anesthesiology residency programs offer rotations in a variety of anesthesia subspecialties including ambulatory, transplant, neurosurgery, cardiothoracic, vascular, pediatric, regional, pain management, critical care, and even bariatric surgery. However, a trauma rotation is typically not offered. The Residency Review Committee (RRC) of the American Board of Anesthesiology (ABA) has established that residents must achieve competence in the delivery of anesthetic care for a minimum 20 patients “undergoing procedures for complex, immediate life-threatening pathology,” which may include trauma. The RRC, however, does not specify a minimum number of trauma cases nor the trauma knowledge or skills to be acquired. The mission statement of the ABA declares: “Because of the nature of anesthesiology, the ABA diplomate must be able to manage emergent life-threatening situations in an independent and timely fashion.”3 Nevertheless, the content outline of the (ABA/American Society of Anesthesiologists [ASA]) Joint Council on In-Training Examinations does not offer guidance on a trauma curriculum for anesthesiology training programs to be followed. As a result, many anesthesiology residents graduate with a lack of experience, confidence, and the ability to resuscitate patients with lifethreatening or multiorgan trauma. Given the high number of graduating residents who may provide care for trauma patients in the private and community practice, adequate trauma and acute care education should be offered to equip them with the skills and knowledge to care for polytrauma patients. Committee on Trauma and Emergency Preparedness (COTEP) believes that there is an insufficient emphasis on trauma training in anesthesiology residency programs and that the knowledge and skills of graduating residents Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP)