Fellowship In Neurosurgical Anesthesiology and Perioperative Neuroscience- The Futuristic Role of the ICPNT – Part 1

Shobana Rajan, MD
Vice-Chair, ICPNT

Shobana Rajan, MD

Andrew Kofke, MD
Chair, ICPNT

Neuroanesthesia fellowship accreditation TEAM (Together we achieve more)

This article discusses the futuristic role of the ICPNT in neuroanesthesia fellowship training worldwide. (This is Part 1, and Part 2 will be continued in the next newsletter).

This organization has the mission “to set high-quality neuro-anesthesia educational standards globally and improve patient outcomes”. In order to achieve this mission, the vision of the ICPNT is

Andrew Kofke, MD
  1. To accredit and thereby ensure standardization of neuroanesthesia education with an international spectrum and scope.
  2. To promote collaboration between accredited programs leading to quality education for fellows graduating from these programs.
  3. To contribute to education and research to our specialty through networking and partnerships.

The strategic goals of the ICPNT consist of the following:

  1. To establish a formal yet Novel accreditation process
  2. Global Standardization of Neuroanesthesia Education
  3. Collaboration and Networking
  4. Innovative concepts of Assessment, Evaluation, and Feedback
  5. Development of Learning Modules and Certifications.
  6. Help new hospitals develop a fellowship program if they need the tools for it.

Formal yet Novel accreditation Process

The program requirements are written in such a way that it supports international differences in training, culture and regulations. Figure 1 describes the flow of the application process. Each application has two stages; the first is a formative submission by the program based on which ICPNT reviewers provide feedback, followed by a summative evaluation by which final accreditation is provided. Three reviewers are assigned for each program who are internationally reputed neuroanesthesiologists and educators. They provide feedback as to how to improve the application and program based on the curriculum core competencies in existence. They identify strengths of each program which could be shared by other programs and weaknesses which could be improved upon. Once that is done, and the changes are made, a summative evaluation is done at the review committee meeting. The review committee consists of all reviewers of all programs in the current cycle. The lead reviewer of each program presents the program to the remaining reviewers, and a vote is cast for accreditation.

Categories of accreditation

A1 is five years- Strong Program, criteria are fully met

A2 3 years – Minor deficiencies are expected to be addressed to meet the criteria fully.

A1 1 year – Deficiencies are major and can be met with significant effort.


Figure 1: Flow of the Application Process

Global Standardization of Neuroanesthesia Education

Currently, the situation of neuroanesthesia fellowship training throughout the world is very heterogeneous without proper standardization in terms of the curricula or duration of training and accreditation. The ICPNT was developed to have some sort of standardization to make the training structured. The goal is to ultimately increase the value of neuroanesthesiology as a sub-specialty and achieve the growth that other sub-specialties like cardiac anesthesia, etc, have already achieved.

The curriculum is based on an adaptation of the three pillars as described by visionary Dr.George Mashour. Pillar 1 is foundational neuroscience in anesthesiology; Pillar 2 is anesthesia for neurosurgical procedures, and Pillar 3 is Neurological outcomes in non-neurologic surgery. The recommended curriculum consists of all essential elements of perioperative neuroscience and anesthesiology divided into 4-week modules, including six modules of clinical neuroanesthesia, and one module of each of the following areas: neurocritical care, neuroradiology, neuromonitoring, neuroscience scholarship. The remaining time is allowed for electives, such as transcranial Doppler ultrasonography, pediatric neuroanesthesiology, and additional training in neurocritical care, general anesthesiology, or scholarship. (Figure 2)

These guidelines represent the first step in standardization in fellowship training. Standardization may offer many rewards, such as fostering continuous quality improvement in patient safety and enabling the spread of best practices. While standardization is mandated, this is built with enough flexibility in curriculum to suit the individual program depending upon geographical differences and availability of resources. The ICPNT curriculum allows personalization of curriculum depending on the interest and needs of an individual fellow in a program allowing them to choose a path with multiple learning opportunities while achieving mastery in the field of neuroanesthesiology. (To be continued in the next issue)

Figure 2: Curriculum and Core competencies (Picture contributed by Jovanny Cruz, Baylor College of Medicine)


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