Training in obstetric anesthesia in the United States

Abstract

The current state of obstetric anesthesia training in the United States has been surveyed by means of records of residents' anesthesia training supplied by the American Board of Anesthesiology and by answers to a questionnaire sent to chairmen of anesthesia residency training programs in the United States.It was found that 40 per cent of the residents in anesthesiology administer fewer than 50 anesthetics for vaginal delivery during a 2 year training program. Almost 50 per cent of the residents administer fewer than 20 anesthetics for cesarean section. In only 28 per cent of hospitals are the majority of anesthetics for vaginal delivery in nonprivate patients administered by resident anesthesiologists. Resident anesthesiologists are assigned specifically for 24 hours per day, 7 days a week obstetric anesthesia care in 17 per cent of the hospitals.Twenty-four per cent of the departments of anesthesiology assign a staff anesthesiologist to teach obstetric anesthesia with this as his sole responsibility. In almost 10 per cent of the residencies no instruction in this field is given at all.Residents in obstetrics administer most of the anesthesia for vaginal delivery in 26 per cent of the hospitals. In almost two thirds of these departments the obstetric resident obtains no instruction from the anesthesia department either in anesthetic technique or management of complications.Either the obstetrician or pediatrician is responsible, solely or in part, for infant resuscitation in approximately one third of the hospitals. However, in the majority of these hospitals, neither specialist receives instruction in this field from the anesthesiologist.This report corroborates the general impression that obstetric anesthesia training in the United States leaves much to be desired. It is urged that renewed efforts be made to improve this neglected field of medicine and thereby reduce maternal and fetal morbidity and mortality.