ICPNT LogoInternational Council on Perioperative Neuroscience Training (ICPNT) Continues to Accredit Fellowships Worldwide

Applications Accepted in the Spring for Fall Accreditation

W. Andrew Kofke, MD, MBA
Chair ICPNT, SNACC Past President
University of Pennsylvania

Rafi Avitsian, MD
ICPNT Member, SNACC Past President
Cleveland Clinic Foundation

Chanhung Lee, MD, PhD
ICPNT Member
University of California San Francisco

W. Andrew Kofke, MD, MBA

We are very much hopeful that SNACC membership is aware of the ICPNT and its activities towards accreditation of neuroanesthesiology fellowship programs worldwide. The International Council on Perioperative Neuroscience Training (ICPNT) is functioning under the regulatory umbrella of SNACC and is committed to developing a SNACC-based international neuroanesthesiology fellowship accreditation service. 

Because of its international and non-ACGME related nature, ICPNT has drawn widespread interest within communities looking for training in perioperative neuroscience. To meet the challenge at its early development stage, ICPNT has conducted three rounds of pilot program reviews and accreditation to strengthen the program requirements, governing procedures, and applications and review process, despite regional variations in different parts of the world.

A writing committee created the foundational documents for this organization based on past publications of SNACC members. The program requirements are written to facilitate international differences in regional training culture and regulations and to allow for different methods of funding while setting an internationally accepted standard for neuroanesthesiology fellowship programs (see icpnt.net for details). ICPNT is also involved in providing the networking between programs, which we believe is key to improve training through use of each other’s experiences.

ICPNT continues its seminal work developing an international accreditation process for neuroanesthesiology fellowships. Two cycles for a total of seven programs were invited to be pilot programs in 2019 and have since been reviewed and granted accreditation. This year the first fellows will be graduating, having the honor of ICPNT accreditation for their program completion. We see this as a great accomplishment and reason to celebrate. Currently eight additional invited pilot programs encompassing North America, Oceania, Europe, Asia, and South America have applications in preparation to be reviewed in April 2020. (Figure 1)

Figure 1

(Figure 1) Initial worldwide interest in neuroanesthesia fellowship accreditation.

As such the ICPNT is pioneering the notion that an international standard for neuroanesthesia fellowships can be created. The goal is to aspire fellowships to adopt high educational standards and apply for ICPNT accreditation. Notably ICPNT is not just a scattershot collection of accredited programs. (Figure 2a) Rather it is our goal to create a coordinated network of neuroanesthesiology programs which can collaborate on endeavors in education, clinical quality improvement, and research. (Figure 2b)

Figure 2

(Figure 2a) Traditional relationship of accreditation agents to programs. Programs do not work with each other. This approach is rejected by ICPNT.

Figure 2b

(Figure 2b) ICPNT will communicate with programs, but also support development of an inter-fellowship program network to facilitate clinical quality improvement, education, research, and evaluation of fellowship training outcomes.

Another novel element of ICPNT’s approach to accreditation is to offer a two-step application process. The first is formative, by which the assigned reviewers offer suggestions to improve the application and/or the program. The second stage is summative whereby a final application is submitted for approval or deferral. Note that every effort is made not to fail any programs but rather, to offer help and guidance towards a path that leads to recognition via accreditation, so the program can be validated in having world class fellowship quality. (Figure 3)

Figure 3

(Figure 3) The accreditation process for an ICPNT application demonstrates a vision of inclusion rather than exclusion, with the emphasis on helping programs to get accredited rather than ‘policing’. Note the two-stage process of formative followed by summative evaluation. The ‘not acceptable’ category includes constructive advice to subsequently resubmit an application which will be acceptable.

Thus overall the novel elements of ICPNT can be summarized with these unique features:

  • A novel inclusive approach is introduced to review the application for ICPNT accreditation. Each application has two stages; the first is a formative submission by which reviewers provide constructive feedback to enable improvement of the applying program, then followed by a summative evaluation by which final accreditation is provided. (Figure 3)
  • Promotion and support of the development of an international network of neuroanesthesiology fellowship programs to enhance education, quality improvement and research. (Figure 2) The Neuroanesthesia Program Relations (NPR) committee has been initiated to foster academic and professional relations and networking among ICPNT accredited programs. 
  • Fellows can be junior faculty eliminating dependence on government funding.
  • Enfolded fellowship during residency is allowed.
  • ICPNT relies on the experience of members in SNACC as well as other perioperative neuroanesthesiology societies worldwide to prepare educational resources for trainees in all accredited programs

Our next steps will be to continue to better organize our webpage and other information technology infrastructure, clarify in the SNACC bylaws the relationship of ICPNT to SNACC, proceed with getting the word out about ICPNT by newsletters, international presentations, social media, and presence at the SNACC Annual Meeting. We intend to provide value to neuroanesthesia fellowship programs, neuroanesthesia fellows, and future patients around the world undergoing neurosurgical and neurointerventional procedures.

We expect to advance beyond our invited pilot program phase and anticipate a general availability for programs to apply for accreditation beginning in the spring. A letter of intent is first required, which can be completed at icpnt.net. This will permit ICPNT to properly plan and allocate resources. Anticipated review and decisions on spring applications will be made in the fall of 2020.


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  3. Journal of Neurosurgical Anesthesiology.  22(3):252-5. 2010.
  4. Journal of Neurosurgical Anesthesiology.  25(1):1-7. 2013.
  5. Rev Esp Anestesiol Reanim. 2012;59 Supl 1:1-2
  6. European Journal of Anaesthesiology. 34(2):51-3. 2017.












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