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History and evolution of regional anesthesiology and acute pain medicine fellowship training
  1. David Michael Shapiro1,
  2. Mary J Hargett2,
  3. Sandra Kopp3,
  4. Joseph M Neal4,
  5. Edward R Mariano5,6 and
  6. Gregory Liguori2
  1. 1Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Medical Center, New York, New York, USA
  2. 2Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  3. 3Department of Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
  4. 4Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
  5. 5Department of Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
  6. 6Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr David Michael Shapiro, Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Medical Center, New York, USA; david.shapiro{at}


Introduction In 2016, individual training programs in regional anesthesiology and acute pain medicine (RA/APM) became eligible for accreditation by the Accreditation Council for Graduate Medical Education (ACGME), thereby culminating a process that began 15 years earlier. Herein, we review the origins of regional anesthesia training in the USA, the events leading up to accreditation and the current state of the fellowship.

Methods We reviewed pertinent literature on the historical aspects of RA/APM in the USA, related subspecialty training and the formation and current state of RA/APM fellowship training programs. Additionally, a survey was distributed to the directors of the 74 RA/APM fellowships that existed as of 1 January 2017 to gather up-to-date, program-specific information.

Results The survey yielded a 76% response rate. Mayo Clinic Rochester and Virginia Mason Medical Center likely had the first structured RA/APM fellowships with formalized curriculums and stated objectives, both starting in 1982. Most programs (86%), including ACGME and non-ACGME fellowships, came into existence after the year 2000. Six responding programs have or previously had RA/APM comingled with another subspecialty. Eight current programs originally offered unofficial or part-time fellowships in RA/APM, with fellows also practicing as attending physicians.

Discussion The history of RA/APM training in the USA is a tortuous one. It began with short ‘apprenticeships’ under the tutelage of the early proponents of regional anesthesia and continues today with 84 official RA/APM programs and a robust fellowship directors’ group. RA/APM programs teach skills essential to the practice and improvement of anesthesiology as a specialty.

  • regional anesthesia
  • acute pain
  • resident education
  • history

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  • Contributors GL conceived the idea for this study. DMS, GL, MJH, JMN and SK contributed to the study design and survey development. MJH distributed the survey and collected data. MJH, GL and DMS performed data analysis. DMS and GL wrote the first draft of the manuscript. JMN, SK, ERM and GL edited and revised the manuscript. MH, JMN, SK and ERM helped to gather historical facts for the manuscript. GL is the principal investigator and supervised all aspects of the study and historical research including approval of the finalized manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Survey data are available by contacting the corresponding author.