ICPNT

A Split-Site UK ICPNT Fellowship – A Fellow’s Experience of ICPNT and Specialist Interest Area Training 

 


R. Helen Rehill
ST7 Anaesthetic Trainee
St George’s University Hospitals NHS Foundation Trust
London, UK 


Valpuri Luoma 
Program Director Neuroanaesthesia Fellowship
National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust
London, UK 


Audrey Tan
Program Director Neuroanaesthesia Fellowship 
St. George’s University Hospitals NHS Foundation Trust
London, UK 

Background

St. George’s Hospital, Tooting, London (SGH) is one of the country’s largest acute trusts and principal teaching hospitals[1]. It has 1300 beds, including four dedicated neurosurgical theatres, an interventional neuro-radiological suite with a 24/7 fully staffed mechanical thrombectomy service, and a dedicated neurocritical care unit. It provides neurosurgery for both adult and pediatric patients for the cranial, spine, and functional procedures. In addition, it is the designated Major Trauma Centre for South West London and Surrey, treating up to 120 trauma patients per month, including 70% of polytrauma patients that suffer from traumatic brain injury[2].

Helicopter-view of St. George’s Hospital, Tooting, London (SGH), UK 

 The National Hospital for Neurology and Neurosurgery, Queen Square, London (NHNN) is the UK’s largest dedicated hospital for the care of adult patients with neurological conditions and those requiring elective and emergency neurosurgery, except for trauma[3]. It has 244 inpatient beds, including a 28-bed specialist neurocritical care, six operating theatres, an interventional radiology suite, and the UK’s first interventional MRI suite. It is also a Comprehensive Stroke Centre with an on-site mechanical thrombectomy service. 

National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London, UK 

Royal College of Anaesthesia (RCoA) Specialist Interest Area Training in Neuroanaesthesia 

SGH and NHNN collaborated in 2018 to provide Specialist Interest Area (SIA) training in Neuroanaesthesia, consisting of a 12-month training program with six months spent at each hospital. Fellowships are still offered at both sites individually, but the addition of this program allows trainees within the RCoA program to stay in-training rather than taking time out of the program. This fellowship, split across two separate highly specialized hospitals, has many advantages allowing the Fellows to gain experience in a broad range of neurosurgical procedures and learn multiple anesthetic techniques with which to undertake these. Importantly, it provides experience in all aspects of neuroanesthesia, which may not otherwise be available if training at one site. 

SIA training is the final preparation for independent practice and can be undertaken by any year 6 or 7 Trainee. The aim is to develop mastery in a specific specialty area along with the non-clinical skills required for a specialist Consultant career [4].  

International Council on Perioperative Neuroscience Training (ICPNT) 

NHNN was accredited by ICPNT in 2019 and SGH in 2021. The accreditation process enabled both institutions to further develop and structure their Fellowship Programs and increase collaboration to strengthen the training of future neuro-anesthetists. Accreditation introduced a requirement for specific case types and numbers, as well as a more structured, methodical approach to gaining clinical experience. 

A split-site, internationally accredited neuroanesthesia training program is a highly attractive prospect to Fellows. The structured approach is something that, in previous feedback, Fellows felt was lacking, but since accreditation, satisfaction levels are higher with the more prescriptive framework. The scope of educational opportunities has widened by introducing MDT and neurophysiology clinic attendance and dedicated tutorials for Fellows. The joint fellowship program has also allowed more intellectual cooperation between Neuroanaesthetists at both institutions. 

Fellow Experience (R Helen Rehill) 

When I began my fellowship year, I was given the opportunity to complete an ICPNT-accredited Fellowship as well as my advanced module (SIA) for the RCoA curriculum. This was a fantastic opportunity to become part of an international community of like-minded clinicians who were focused on improving the perioperative care of neurological patients. I have also been able to attend the ICPNT webinars or watch the recordings and join the international journal clubs, which provide interesting and vigorous discussion across many countries of the world. 

I am currently undertaking the latter half of my fellowship at SGH. As a major trauma center, I have had the opportunity to manage complex polytrauma patients who required spinal or cranial surgery, as well as those who have suffered isolated brain injuries, whilst continuing to gain further experience and increased confidence in managing functional, cranial, and spinal surgeries. The on-call portion of the role has allowed me to become more proficient at managing not only neurosurgical emergency cases but assist in the management of general, trauma, maxillo-facial, and ENT and remote site anesthesia in both the cardiac cath-labs and the interventional radiological suite. This has helped me maintain a well-rounded experience and developed my skillset in managing multi-morbid, higher-risk patients, which is highly transferrable to neuroanesthesia. 

I joined NHNN for the first part of my fellowship during the COVID pandemic. The department’s educational program and journal clubs continued virtually, and the provision of Fellow-specific teaching consisting of expertise shared by neurosurgeons, neuroradiologists, and neuro-anesthetists supported our learning requirements during this time. This helped me gain a wealth of knowledge, leading to a better understanding of many of the procedures I was less familiar with. As well as the neurosurgical aspect of training, I also had the chance to gain experience in interventional MRI, improving my understanding of how the logistics of these cases worked whilst performing surgery within the MRI scanning room.  

I have gained confidence completing my Neurocritical Care Module at two different neurocritical care units. It has provided an interesting look into the complexities of neurological disorders and the management of neurosurgical emergencies, giving me a better understanding of the importance of vigorous neuroprotection. 

The ICPNT program has allowed me to undertake a more structured approach to training in my final year before becoming a consultant. Providing the prescriptive numbers across a wide range of procedures has expanded my knowledge and skills, giving me the confidence and understanding that is required of a Consultant Neuroanaesthetist. 

I have thoroughly enjoyed my fellowship year, and it has cemented my firm belief that specializing in neuroanesthesia is the right career path for me. 

References 

[1] https://www.stgeorges.nhs.uk/service/neuro/neurosurgery/ 

[2] https://www.stgeorges.nhs.uk/service/major-trauma-centre/ 

[3] https://www.uclh.nhs.uk/our-services/our-hospitals/national-hospital-neurology-and-neurosurgery 

[4] https://www.rcoa.ac.uk/sites/default/files/documents/2019-08/TRG-CCT-ANNEXE.pdf 

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