Shared Perspectives: ABA offers AEP for International Graduates, and ASA Showcases New Career Pathways

The American Board of Anesthesiology (ABA) is proud to offer the Alternate Entry Pathway (AEP) program, which allows international medical graduates to enter the ABA examination system for initial certification in anesthesiology. Candidates for the AEP program need to be certified by the national anesthesiology organization in the country where they trained and be currently practicing anesthesiology in the United States. This mechanism helps address workforce challenges by increasing the number of board-certified anesthesiologists who are in practice and who trained abroad.

The AEP program (theaba.org/training-programs/alternate-entry-pathway/guidelines/) provides two separate pathways:

• Clinician Educator Pathway: Documented achievement in teaching is required and could include 1) recognition by peers and students as an excellent teacher and 2) participation in faculty development programs with application of principles of education from those programs.

• Research and Fellowship Pathway: The successful candidate should have a preexisting track record of scholarly activity as represented by the scholarship of discovery, dissemination, and application.

Both pathways require the sponsoring program's department chair and program director to submit a four-year mentoring plan for future academic development. As of December 2023, 53 individuals had completed one of the two pathways and were board certified by the ABA. In addition, there are 48 anesthesiologists currently in the AEP program.

Maya Hastie, MD, EdD, is a Professor of Anesthesiology and Vice Chair for Education at Columbia University Medical Center in New York. She graduated from the School of Medicine at the American University of Beirut (AUB) in Lebanon. Dr. Hastie completed her residency in anesthesiology at AUB, as well as a cardiothoracic fellowship and a pediatric fellowship before joining Columbia University as a faculty member. Dr. Hastie describes her AEP experience as seamless, professional, and validating. She says she was promoted to associate professor soon after achieving board certification, largely based on the scholarly work required for the AEP.

“The AEP program is a valuable opportunity for international-trained physicians in our specialty,” says she said. “It is rigorous and demanding, but it is this rigor that makes it valuable to the specialty and the participants.”

In 2023, the ABA's Board of Directors (BOD) approved a fast-track pathway. This new pathway will allow AEP program participants who perform exceptionally well on the In-Training Examination to take the BASIC Exam on an accelerated timeline. Those who pass the BASIC Exam on the first attempt can then move on to take the ADVANCED Exam, followed by the APPLIED Exam. This new structure allows AEP candidates to earn ABA certification as early as two years after beginning the AEP program, as opposed to the traditional four years.

The ABA also has increased the maximum number of allowable AEP slots from four to eight per institution.

The future of anesthesiology is in the hands of today's students, residents, and early-career anesthesiologists. Attracting medical students to the specialty and ensuring residents and early-career anesthesiologists are well supported are just some of the many ways ASA works to alleviate workforce challenges and secure the specialty's future. To advance this objective, ASA creates and shares targeted resources designed to increase engagement, build the pipeline, and ready the workforce.

Too frequently, medical students are not exposed to the specialty early enough to understand the many benefits of a career in anesthesiology. Alternatively, they may be introduced, but their experience with the specialty is too passing or shallow to imprint the true value of the work anesthesiologists do. So, to educate and attract more medical students to anesthesiology, ASA created a series of short videos: the Pathways to Anesthesiology video series (asahq.org/pathways). Episodes, under 10 minutes each, feature young anesthesiologists, “near peers,” talking about the history of the specialty, the patients we serve, subspecialties, diversity, the role of ASA, and more. These 17 videos are featured on ASA's website, promoted through social media, and shared through partnerships with program directors across the country. Through them, students gain a clear and positive picture of the specialty, the anesthesiology community, and the difference we make in the lives of our patients. There is no better way to draw new anesthesiologists to the specialty than by amplifying our truths.

Once young physicians choose anesthesiology, ensuring that they feel heard and supported, and have easy access to valuable and absorbing information, helps the society build loyalty and grow relationships with future leaders. Giving residents a voice to explore and address the issues they care about most, and a channel dedicated exclusively to their concerns, helps ASA connect with residents consistently and meaningfully. The Residents in a Room (asahq.org/podcasts) podcast features residents in conversation around a topic of interest or querying knowledgeable experts about subjects that matter to them. From nontraditional career pathways to exam prep, interview tips, global health, health equity, and more, ASA's resident podcast is published monthly across all podcast platforms. Over 65 episodes have been published to date, featuring hundreds of residents as guests. The series gives young anesthesiologists their own channel to interrogate topics that matter to them, amplify messages they care about, and learn from luminaries in the field. Experts in the specialty have visited the show to educate on topics ranging from how to nail an interview, to managing wellness, to contract negotiations. We invite guests to share their experiences with their networks, drawing new listeners and deepening our impact and engagement.

Moving into the first few years of practice, we know new anesthesiologists face unique demands, new challenges, and fresh opportunities. To help this cohort navigate the unfamiliar terrain, ASA created the Early-Career Membership Program (asahq.org/ecmp). This initiative gives new members three years of membership for one low price and, perhaps more importantly, curates and shares timely and relevant resources, delivering the most pertinent information to new members to help them manage the obstacles frequently faced in these early years. Year-one resources, for example, aim to help with board exams and educate around evidence-based practice guidelines. Year two prioritizes assets that help young anesthesiologists develop subspecialty skills, career-plan, and engage the anesthesiology community through advocacy. The final year of the program shifts the lens, highlighting resources about MOCA, practice management, and professional development. We're giving early-career anesthesiologists real bang for their buck, because we know the investment will pay off for the specialty and the society in the long run.

Finally, to bring it all together, ASA's Roadmap to Become an Anesthesiologist website (asahq.org/roadmap) is a hub for anyone hoping to gain knowledge of the specialty or a deeper understanding of medical school and residency. The site shares success stories as well as information on the trajectory of residency, the diversity of anesthesia careers, and the variety of pathways into anesthesiology. It's a one-stop portal curated by a workgroup of the Committee on Residents and Medical Students and one more opportunity for ASA to nurture the anesthesiologists of the future.

Sharing career pathways and options with medical students, giving voice to residents, and supporting new anesthesiologists with targeted information builds a bridge to a strong, vibrant future. Although workforce challenges remain, the intellect, dedication, and courage of new anesthesiologists instills optimism and hope for the specialty.