ICPNT

ICPNT in Europe – A Short Report from the Neuroanesthesiology Fellowship Program Directors Meeting

 


Valpuri Luoma, MBChB, FRCA, FICM
ICPNT Executive Committee Member

ICPNT Neuroanesthesiology Fellowship accreditation was launched in 2019, and there are currently five accredited programs in Europe: two in the UK and one in Denmark, Germany, and Spain, respectively. The first program to be accredited was the National Hospital for Neurology and Neurosurgery (NHNN), followed closely by Odense University Hospital1 in 2019. All the institutions have individual fellowship programs, but NHNN and St George’s University Hospital in London also have a joint program2 where a fellow will complete a minimum of 6-months of training at each hospital. Duration of fellowships is either 1 or 2 -years; one institution offers a 2-year program, and at others, Fellows may extend their program duration beyond 1 year if preferred, for example, due to less-than-full-time training or personal circumstances e.g. combining with academic interests.

The results of a short survey to provide an overview of the experience of ICPNT accreditation in Europe were presented during the Neuroanesthesiology Fellowship Program Directors meeting at the 50th SNACC Annual Meeting. Program Directors of European ICPNT-accredited programs were asked:

  • How many neuroanesthesiology fellows were currently completing an ICPNT-accredited Fellowship program?
  • How many fellows had graduated, and importantly their career post-fellowship?
  • What the perceived challenges and benefits had been?

There are currently 11 ICPNT Fellows in-training across 4 institutions in Europe, with 16 who have graduated. Twelve graduates are from the UK; this is due to earlier program accreditation as well as a local organization of health services. Following graduation:

  • 7 Fellows have continued with their anesthesiology specialist training (UK)
  • 9 Fellows have been appointed to a faculty position in neuroanesthesiology
    • 4 at their fellowship institution
    • 5 at a different institution; 4 were international medical graduates who have returned to their training institution

Several benefits of ICPNT accreditation were highlighted, broadly divided into 3 categories:

  • Peer network and collaboration: Two institutions shared that they are working with other neuroscience centers to offer an educational and clinical experience not available locally e.g., management of trauma, sitting or awake craniotomy. One center is also developing a local educational network to increase didactic learning opportunities. Accreditation may also promote the importance of neuroanesthesiology as a sub-specialty that requires specific knowledge and skills.
  • Peer review and the accreditation process (including the financial investment) help justify changes to a fellowship that may otherwise be challenging to implement, e.g., moving from service provision to learning-based or the inclusion of additional training modules such as intra-operative neuromonitoring. It also supports continuous development and improvement to ensure that fellowships meet the ICPNT standards. Improvement is supported by Fellow feedback and input, as well as the collaborations and educational networks already mentioned. ICPNT also requires Faculty to be up to date, promoting lifelong learning. The presence of learned Faculty encourages others to do the same.
  • Benefits for Fellows: having a structured fellowship program with defined learning outcomes is appealing. It also allows Faculty to plan learning opportunities / clinical experiences. Fellowship programs can be individualized to each Fellow around the ICPNT structure e.g., choice of OR or new skills where previously there may have been less focus. As already mentioned, collaboration with other neuroscience centers offers further experience as well as a future career network.

As with any process, there are some challenges. Whilst meeting ICPNT standards, there is also a need to meet local post-graduate training requirements. The different curricula can complement each other. The flexibility of the ICPNT curriculum allows it to adapt to local requirements, and it may also add further structure to the learning outcomes. Delivering the ICPNT clinical experience can be challenging; due to local working practices, it may not be possible to deliver modular training requiring local adaptions, and the local case mix may not cover all areas of training, hence the importance of collaborations. There is also an administrative burden due to the need for local assessment, evaluation, and feedback solutions. Finally, the impact of the COVID-19 pandemic3 has been significant. As documented, the incidence of burnout is high. Constant change to hospital structure due to surges has impacted Fellow’s clinical experience through reduced elective workload or re-deployment, which may impact recruitment. A silver lining has been the move to virtual tutorials, which has increased access to educational resources.

This survey has highlighted some of the perceived benefits of ICPNT accreditation in Europe, particularly collaboration and building a peer network, as well as providing an overview of Fellow numbers. Finally, a thank you to the Program Directors of the European ICPNT fellowship programs for collaborating on this survey.

References 

  1. Being an ICPNT Fellow at Odense University Hospital, Denmark by Stine Hebsgaard and Lise Skyttegaard. SNACC Newsletter Fall 2022 https://snacc.org/newsletter/fall-2022
  2. A Split-site UK ICPNT Fellowship – A Fellows Experience of ICPNT and Specialist Interest Area Training by Helen Rehill. SNACC Newsletter Summer 2022 https://snacc.org/newsletter/june-2022-newsletter/?g4-text
  3. Rajan S et al. The Impact of the Global SARS-CoV-2 (COVID-19) Pandemic on Neuroanesthesiology Fellowship Programs Worldwide and the Potential Future Role for ICPNT Accreditation J Neurosurg Anesthesiol 2012;33(1):82-6. PMID: 33075035

Back to top