Presentation Details
| Charting New Horizons in Anesthesiology Training: A Narrative Review of Perioperative Medicine Fellowships and the Launch of a Combined Critical Care-Perioperative Pathway Mogahed Ismail Hassan Hussein1, Nazish K Hashmi2, Vijay Krishnamoorthy1, Basma Mohamed3, . 1Divisions of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA.2Divisions of Critical Care and Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA.3 Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA |
Abstract
BACKGROUND: Perioperative medicine (POM) has evolved from isolated institutional programs to a field approaching curricular consensus, yet standalone POM fellowships remain constrained by the absence of ACGME accreditation and board eligibility. The 2024–2025 publication of a standardized POM curriculum by the ASA ad hoc Workgroup establishes core competencies spanning risk stratification, comorbidity optimization, systems-based care, and leadership, but does not resolve the credentialing gap. Recognizing that high-risk surgical patients traverse physiologic states demanding dual fluency in perioperative optimization and critical care rescue, Duke launched an innovative combined pathway embedding POM training within an ACGME-approved Critical Care Medicine (CCM) fellowship.
PURPOSE: We conducted a narrative review synthesizing literature on POM fellowship development from 2014 to present, identifying five foundational studies that chart the field's evolution. We analyzed the alignment between Duke's combined pathway and the standardized curriculum, examining whether nine months of CCM training with three months dedicated to POM provides adequate preparation.
RESULTS: The review reveals profound historical heterogeneity in POM training and persistent lack of formal recognition. Duke's 12-month combined CCM–POM pathway addresses this gap by providing board eligibility in CCM and TEE while delivering comprehensive perioperative competencies through longitudinal clinical continuity, integrated leadership projects, and institutional systems exposure. Analysis suggests nine months of focused CCM training represents not merely sufficiency but an optimized structure, given nationwide heterogeneity in CCM curricula even among elite programs.
CONCLUSIONS: Duke's combined pathway offers a timely, evidence-supported innovation that aligns with national standardization efforts while solving the credentialing dilemma. This model serves as a framework for future empirical investigation, including defining the ideal nine-month CCM structure, and positions graduates for emerging POM credentialing frameworks while cultivating physician-leaders fluent across the surgical care continuum.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: We conducted a narrative review synthesizing literature on POM fellowship development from 2014 to present, identifying five foundational studies that chart the field's evolution. We analyzed the alignment between Duke's combined pathway and the standardized curriculum, examining whether nine months of CCM training with three months dedicated to POM provides adequate preparation.
RESULTS: The review reveals profound historical heterogeneity in POM training and persistent lack of formal recognition. Duke's 12-month combined CCM–POM pathway addresses this gap by providing board eligibility in CCM and TEE while delivering comprehensive perioperative competencies through longitudinal clinical continuity, integrated leadership projects, and institutional systems exposure. Analysis suggests nine months of focused CCM training represents not merely sufficiency but an optimized structure, given nationwide heterogeneity in CCM curricula even among elite programs.
CONCLUSIONS: Duke's combined pathway offers a timely, evidence-supported innovation that aligns with national standardization efforts while solving the credentialing dilemma. This model serves as a framework for future empirical investigation, including defining the ideal nine-month CCM structure, and positions graduates for emerging POM credentialing frameworks while cultivating physician-leaders fluent across the surgical care continuum.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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