A current render of pediatric otolaryngology in the United States

摘要

Complex pediatric otolaryngology can be generally regarded as a subspecialty within otolaryngology focusing on the care of children with complex diseases of the head and neck and aerodigestive tract, or in some cases more common diseases in this anatomical region in otherwise medically complex children. This concept of the specialty was succinctly articulated by Charles Bluestone in 1995 when he wrote pediatric otolaryngologists treat “special problems or special children, or both”.1 Increasingly, this care is delivered by multi-disciplinary pediatric health care providers working at highly specialized tertiary care centers for children. This review will briefly cover the historical evolution of the specialty's origins, along with its current state of graduate medical education training and sub-certification efforts. The development of pediatric surgical sub-specialties was spawned from the creation of tertiary pediatric hospitals caring for medically complex children in an environment of multi-disciplinary pediatric subspecialty health delivery. In this context, the earliest work in developing complex pediatric otolaryngology as a formal specialty can be traced to pioneer surgeons in the 1950's such as Blair Fearon, Seymore Cohen, and Charles Ferguson working at leading Children's Hospitals.2 Subsequently, formal groups of thought leaders such as the aforementioned Charles Bluestone and Sylvan Stool working under the auspices of the American Academy of Pediatrics (AAP) in the 1970's worked to develop a formal section for pediatric otolaryngology within the AAP.1 In 1985, 56 otolaryngologists from the United States and Canada founded the American Society of Pediatric Otolaryngology (ASPO), creating an organization to help foster and disseminate research, knowledge and scientific interest in pediatric otolaryngology as well as to gather further respect and recognition from the American Academy of Otolaryngology–Head and Neck Surgery.3 To this end, ASPO annual meetings became a part of the formal Combined Otolaryngologic Society Meetings in 1991. Over the years, ASPO has grown from its initial 56 charter members in 1985, to 385 members in 2010, to a current roster of 650 members in 2019— along the way evolving into the principal academic pediatric otolaryngologic society in North America. The current mission of ASPO is to foster excellence in the care of children with otolaryngologic disorders by promoting education and collaborative research, and to share and disseminate advances and innovations in patient care through the Annual Meeting and other venues.4 The first pediatric otolaryngology fellowships were formed at Children's Hospital of Pittsburgh, Cincinnati Children's Hospital, and Boston Children's Hospital in the 1970's. Other pediatric hospitals soon followed suit, with approximately 20 fellowships existing in 1995. Given this broad proliferation of fellowship programs, in many cases offering widely divergent training experiences, efforts were undertaken to standardize the educational curriculum across programs. In 1995, the Accreditation Council for Graduate Medical Education (ACGME) developed criteria for accrediting pediatric otolaryngology fellowships, with guidelines/program requirements first being made public in 1996. Subsequently, the first four programs to garner accreditation from the ACGME were Cincinnati Children's Hospital, Texas Children's Hospital/Baylor Medical College, the University of Iowa, and Children's Hospital of Pittsburgh. Over the years, the ACGME has refined criteria for complex pediatric otolaryngology in terms of training program requirements, didactic curriculum, index surgical cases, and minimum case numbers for successful completion of training (Table 1). In 2005, the ASPO board espoused the goal of a uniform and transparent application process through a fellowship match, with the subsequent goal of universal ACGME accreditation for all fellowship programs, many of which were still offeri