The development of formal anesthesia training in Canada, the United States of America and the United Kingdom

Abstract

Introduction: At the beginning of the 20th century, most anesthetics were administered by medical students and surgical residents in hospitals, or by general practitioners in private clinics or homes. The few specialist anesthetists who existed were usually self-trained and poorly respected by practitioners in other fields. The development of formal anesthesia training was a driving force for anesthesia gaining acceptance as a specialty. Methods: We reviewed published histories of the three countries' national anesthesia associations and examining bodies, biographies of key individuals, and searched medline and the internet. Results and Discussion: In 1935, the Association of Anaesthetists of Great Britain and Ireland, through the Royal College of Surgeons, introduced the Diploma in Anaesthetics (DA), setting a training standard to establish the specialist nature of anesthesia in the UK. Across the Atlantic, the New York Society of Anesthetists (later re-named the American Society of Anesthesiologists) successfully lobbied for national qualification in anesthesia three years later. Influenced by the events in the UK and the USA, the Royal College of Physicians and Surgeons of Canada approved anesthesia as a specialty in 1942, and introduced the Certificate in Anaesthesia. The Canadian Anaesthetists' Society was formed in response and helped organise programs to prepare candidates for examination. World War II demonstrated the need for properly trained physician-anesthetists. Short courses were offered at the University of Wisconsin, Madison in the USA; at McGill University, Montreal in Canada; and at the Nuffield Department, Oxford in the United Kingdom. Demobilisation resulted in the return of anesthetists at various levels of competence, led to the expansion of existing departments, and necessitated more stringent testing. Certification by the Canadian Royal College could only be obtained through examinations as of 1947, and the British DA was expanded to two parts in 1948. Early residencies in all three countries lasted 1 year, but were gradually superseded by multiple-year training to secure equal respect to other specialties and adequate remuneration. The USA granted Board Certification first, in 1938, followed by Royal College Fellowship in Canada in 1951, and Fellowship in the Faculty of Anaesthetists in the UK in 1953. Current standards for specialist qualification in the three countries are alike, though not identical. Conclusions: The motivation and means by which anesthesia training programs came into existence were largely similar. The national anesthesia societies were critical to establishing initial standards, while World War II and a desire for equal respect to other specialties were catalysts for the expansion of existing training.