Development of a pediatric anesthesia fellowship curriculum in Australasia by the Society for Pediatric Anesthesia of New Zealand and Australia (SPANZA) education sub committee
March 2023 by Dr Shona Chung
This perspective article outlines the development of a paediatric fellowship curriculum from the initial thought in 2012 to the publication of the final document on the SPANZA website in 2020. The process involved 4 years of work by the SPANZA education committee. This commenced with Delphi rounds and progressed to the development of a curriculum structured around EPA’s (Entrustable Professional Activities). After the curriculum based around EPA’s was completed it was then sent to the Heads of Departments of tertiary paediatric hospitals and mixed adult and paediatric hospitals to seek feedback. The final stage of the development was the Phase 2 evaluation stage in which the document was available on the SPANZA website for a year in draft form to allow members to provide feedback.
Finally, the paediatric fellowship curriculum was published on the SPANZA website and can be found here: https://d311i5pe49swog.cloudfront.net/web-ass
The salient features of the curriculum described in this perspective article is that it is based on Entrustable Professional Activities (EPAs) - which are “an actual unit of work or expected task for the competent professional and is made up of multiple sub competencies” - and that it is a flexible curriculum in which the trainer and trainee can choose the important EPAs for their fellowship time and their planned future workplace. This enables the curriculum to cater for those planning to work in tertiary paediatric hospitals as well as those who intend to work in more rural and remote areas. There are no formal assessments, however the authors suggest using the graduated supervision levels described by Ten Cate; these range from Level 1 (no permission to act) to Level 5 (permission to provide supervision to junior trainees). The perspective article indicates that SPANZA is an incorporated society and does not have the power to enforce the implementation or the assessment of the curriculum.
This perspective article was the subject of an editorial entitled “To bend but not to break: rethinking fellowship training in pediatric anesthesiology” in which the authors applauded the work by Kaur and Taylor but also questioned some of its aspects. This editorial compared the “standardized, highly regulated model” of training in place in the United States to the nimbler curriculum established by SPANZA. It questioned the lack of structured feedback mechanisms in the SPANZA curriculum and whether there is too much flexibility in the EPA structure; suggesting that this may lead to paediatric anaesthesiologists with significantly varying skillsets. Other concerns that were raised in this editorial included – relative novices setting their own curriculum and therefore potentially missing important skills all paediatric anaesthesiologists should have; and having a curriculum based on assumed knowledge of their future workplace – when this is not necessarily always known and subject to change.