ICPNT Update

W. Andrew Kofke, MD
Chair, ICPNT                        
University of Pennsylvania

Philadelphia, PA

Shobana Rajan, MD
Allegheny Health Network
Pittsburgh, PA

Dr. Kofke
W. Andrew Kofke, MD
Dr. Rajan
Shobana Rajan, MD

ICPNT continues with global expansion. We now have a growing international network of neuroanesthesia fellowships. Presently 25 programs boast ICPNT accreditation. The pandemic appears to have produced some difficulty getting applications prepared such that several programs have requested delays to the next cycle with seven more with active letters of intent. Overall, we expect about 32 or more by early 2022.

The present distribution of programs is illustrated in (Figure 1). The worldwide growth is apparent and impressive, representing a significant opportunity for accredited fellowships to participate in this new educational network. Notably, one can envision the network also forming the basis for multi-institutional collaborations in education and research. The following activities and accomplishments illustrate the strong rationale for every high-quality neuroanesthesiology fellowship around the world to seek ICPNT accreditation to facilitate participation in the ICPNT network (Figure 2).

 

 

 

 

Fig 2. Facilitation of an inter-program network by the ICPNT

Fig 2-1

Traditional relationship of accreditation councils to programs. The accreditation council works with individual programs, but programs do not work with each other.  This approach is rejected by ICPNT.

Fig 2-2

ICPNT collaborates with programs and the programs collaborate with each other and the ICPNT. Figure adapted from Rajan et al., Anesthesiology Rev, 2021.   
Artwork by Jovany Cruz-Navarro.

Neuroanesthesia Program Relations Committee

The ICPNT Neuroanesthesia Program Relations (NPR) committee, chaired by Shobana Rajan, offers provocative panels, journal clubs, and lectures. 

Recent presentations in 2021:

Educational Webinars

January 2021 ICPNT Case-based Reasoning Webinar
January 2021 Perfecting Peer Review- A Master Class Webinar
February 2021 ICPNT Journal Club Webinar
March 2021 Evaluation Strategies for Neuroanesthesia Fellows - A Milestones Approach Workshop Webinar
April 2021 Pearls in Neuromonitoring During Neurosurgery – From the Experts
May 2021 Basic Conundrums in Neuroscience
August 2021 Panel Discussion- Awake Craniotomy

Future ICPNT Webinars and Educational Offerings
We hope to have engaging presentations and interactive participation by fellows from different programs.

The ICPNT NPR committee will be hosting a boot camp at the SNACC Annual Meeting "Perioperative Brain Function Monitoring" moderated by Drs. Sharma, Luoma, and Rajan.

Moreover, NPR will be conducting a trial with a more efficient webinar platform which will offer several advantages to accredited programs:

  • The recording and storage of the webinars will be very professional for future access.
  • Webinars can be categorized for easy search capabilities.
  • Faculty and fellows can register themselves and reminders will be sent to the participants automatically.
  • We may be able to offer CME credits or international equivalents in the future.

With our new webinar format we can accommodate suitable presentations from accredited programs around the world.  This is an opportunity for fellows and faculty in accredited programs to deliver educational programs to an international audience.  This opportunity would be advantageous to both presenters and fellows/students in the ICPNT network -a so-called win-win!

Question Bank
The NPR committee is also creating a repository of questions collected from the program directors to have a question bank for the future. In addition, a blog where fellows can share and communicate is being created, and more information regarding this will soon be available.

NPR Members

  • Shobana Rajan, MD, Allegheny Health Network
  • Chanhung Lee, MD, PhD, University of California
  • Valpuri Luoma, MBChB, FRCA, FFICM, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust
  • John Bebawy, MD, Northwestern University Feinberg School of Medicine
  • Jeffrey Pasternak, MD, Mayo Clinic
  • Colleen Naglee, MD, Duke University
  • Deepak Sharma, MBBS, MD, DM, University of Washington

The Application Processes
As a developing accrediting organization, we have learned the challenges of creating a user-friendly application form.  Initially, we used form fields to fill in but encountered multiple technical issues. That has been minimized in the revamped application using word-based templates, allowing for more free form composition by the program directors. This will be evaluated, and further quality improvement in our application processes should be anticipated.  We rely on constructive feedback from program directors and reviewers for this process.

The projected timeline for the next cycle:

Application Release: 
October 1, 2021
Formative Application Due Date:
December 1, 2021 (Payment due date)
Initial Review Feedback (by three reviewers with feedback by primary reviewer):
January 5, 2022 (*Application fee payment required before moving to resubmission stage)
Resubmission:
February 5, 2022
Summative Application Review by ICPNT:
April 1, 2022
Decision letter to the program by ~May 15, 2022

Evaluation of Accreditation Procedures
Multiple organizations are involved in the accreditation of educational organizations ranging from universities to medical schools, to residencies, to fellowships and other subspecialty training organizations.   We suggest that ICPNT could learn from others' experiences in this endeavor.  Thus, ICPNT has commissioned a task force, led by Dr. Jane Easdown from Vanderbilt, to evaluate how other accreditation organizations perform and seek to learn about standard operating procedures which ICPNT may adopt to improve our processes further.

ICPNT EC
Current ICPNT Executive committee members and their terms are listed below. The vice chair is elected by SNACC membership with automatic succession to the chair. Internal processes select other ICPNT EC members. Should we have an ICPNT-wide election process, or should it be by appointment based on past willingness and capability to contribute to the ICPNT mission?

ICPNT Executive Committee includes:

  • Andrew Kofke, MD, MBA, FNCS, University of Pennsylvania (term ends 2022)
  • Alana Flexman, MD, FRCPC, University of British Columbia (term ends 2021)
  • Leslie Jameson, MD, University of Colorado (term ends 2022)
  • Lara Ferrario, MD, University of Texas, Houston (term ends 2022)
  • Ricard Valero, MD, PhD, Hospital Clínic de Barcelona. Universitat de Barcelona (term ends 2021)
  • Chanhung Lee, MD, PhD, University of California (term ends 2021)
  • Shobana Rajan, MD, Allegheny Health Network (term ends 2021)
  • Maria Bustillo, MD, Weill Cornell Medical College (term ends 2021)
  • John Bebawy, MD, Northwestern University Feinberg School of Medicine (term ends 2021)
  • Jane Easdown, MD, MHPE, Vanderbilt University Medical Center (term ends 2022)
  • Valpuri Luoma, MBChB, FRCA, FFICM, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust (term ends 2022)

SNACC Bylaws
The full description of the ICPNT EC can be found in Section 6.1.1 of the bylaws at https://snacc.org/about/mission-bylaws/. Excerpt on terms pasted as below:

Terms
The Chair, Past-Chair, Vice-Chair, and four (4) Members-at-Large will serve terms of two (2) years. As an ex-officio position, the SNACC Secretary/Treasurer position will be filled in accordance with the process outlined in Section 4.1.2 (Election of Officers). Every two (2) years, the Vice-Chair will be elected as described by the process below. The Chair and Past-Chair are filled by succession from the Vice-Chair and Chair, respectively. The ICPNT secretary and Members-at-Large will be appointed by the ICPNT Chair via an internal process and are renewable for one successive term. The Chair of the Neuroanesthesia Program Relations (NPR) Committee is an ex-officio position described elsewhere.

Several openings will arise in the ICPNT EC. Those interested in contributing should contact Dr. Andrew Kofke.

ICPNT Research
ICPNT has made numerous educational research contributions in the form of presentations at meetings and peer-reviewed publications. This may represent the beginnings of a neuroanesthesia research network, the infrastructure of which could be our ICPNT network of accredited fellowships. A summary of publications to date follows:

Peer-Reviewed Articles

  • Rajan S, Bebawy J, Avitsian R, Lee CZ, Rath G, Luoma A, Bilotta F, Pierce JT, Kofke WA. 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 2021; 33 (1): 82-86.
  • Ferrario L, Kofke WA.  Standardized accreditation of neuroanesthesiology fellowship programs worldwide: The international council on perioperative neuroscience training (ICPNT). J Neurosurg Anesthesiol 2019; 31 (3):267-269.
  • Rajan S, Bustillo M, Lee C, Kofke WA: Standardization of Neuroanesthesia Education: Need of the Hour and the Way Forward. Anesthesiology Reviews, 2021 (In press).
  • Bapat S, Roked F, Douglas DR, Luoma A. International accreditation of perioperative neuroscience fellowships. The International Council for Perioperative Neuroscience Training. Bulletin Issue 2021; 126:48-49.

 Abstracts and Posters

  • Avitsian R:  Introducing a New Accreditation Process for Neuroanesthesiology Fellowship: ICPNT.  EuroNeuro Meeting, 2018
  • Wilson S, Luoma V, Roked-London F:  ICPNT Update.  NACCSGBI meeting, Leeds   May 2021
  • Luoma V, et al: Two years of ICPNT accreditation: where are we now? SNACC 2021 (accepted)
  • Douglas D, Wilson S, Luoma A. Improving the Neuroanaesthesia Clinical Fellowship Experience: Gaining Accreditation Through ICPNT SNACC September 2020 [SNACC-439] J Neurosurg Anesthesiol 2020;32(4), UCLH NHS Foundation Trust, London, United Kingdom.
  • H. Rehill, L. Misquita, R. John, V. Luoma. Improvement of Fellowships at The National Hospital for Neurology and Neurosurgery, London by Undertaking The International Council on Perioperative Neuroscience Training (ICPNT) Accreditation. RCOA College Tutors meeting June 2021
  • Chanhung Lee, Leslie Jameson, Rafi Avitsian, Lara Ferrario, Shobana Rajan, Alana Flexman, John Bebawy, Maria Bustillo, Ricard Valero, Stewart Hinckley, W Andrew Kofke.  A New Accreditation Process for Neuroanesthesiology Fellowships: International Council for Perioperative Neuroscience Training (ICPNT).   SNACC/ASA 2020.
  • Chanhung Lee, Shobana Rajan, John Bebawy, Val Luoma, W Andrew Kofke Promoting perioperative neuroscience exchange and excellence: Neuroanesthesia Program Relations (NPR) committee for International Council on Perioperative Neuroscience Training (ICPNT). IARS/AUA 2021. 

Non-Peer Review Newsletter Articles and Presentations

  • Rajan S, Kofke WA. Neuroanesthesia Fellowships on the Futuristic Path to a Novel International Accreditation Process August 2021 ASA Monitor 
  • SNACC and AUA newsletter reports summary can be found at
    https://www.icpnt.net/publications/index.iphtml

To-Do
Several things are on the ICPNT list of things that are still needed; a partial listing:

  • Legal Review of procedures
  • Finalize fall cycle dates and assignments
  • Develop an information packet describing procedures for new programs
  • Develop a standing fellowship review committee (FRC) within ICPNT 
  • Develop an in-training exam for use by programs to assess knowledge of fellows
  • Translate web page into multiple languages
  • Develop a protocol for announcing educational activities of accredited programs that are not activities officially affiliated with ICPNT
  • Develop more expansive marketing, PR plans
  • Integrate accreditation committee recs to standard operating procedures (SOP)
  • Update online documents and charter
  • Develop a tracking system to track graduations of fellows

This is a lot of work. Anyone in SNACC interested to contribute, please get in touch with Andrew Kofke at kofkea@pennmedicine.upenn.edu. Overall, the ICPNT is progressing. Our goal will be for neuroanesthesia fellowship accreditation to become an international standard.

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