The Neuroanesthesiology Fellowship Program at Cleveland Clinic – History, Milestones, and Accreditation

Rafi Avitsian MD, FASA  
Professor of Anesthesiology
Secretary, Medical Staff Office
Department of General Anesthesiology
Cleveland Clinic, Ohio, USA

Dr. Avitsian
Rafi Avitsian MD, FASA

The Department of General Anesthesiology at the Cleveland Clinic has a long history of excellence in training. The neuroanesthesiology fellowship program has delivered many exceptional clinicians and scientists. I am honored to be an alumnus of this program and to serve as the current program director. Many expert predecessors trained me in the field, such as Drs. Zeyd Ebrahim, Armin Schubert, James Munis, and Michelle Lotto. The fellowship itself was launched in 1982 by Drs. Zeyd Ebrahim, Sheila Run and Glen deBoer. Dr. Steve Roth, MD, FARVO, the Michael Reese Endowed Professor of Anesthesiology in the University of Illinois College of Medicine, mentions:

“My experience as the first neuroanesthesia fellow at CCF was outstanding. It also set the stage for my success as a faculty member in anesthesiology. Dr. Zeyd Ebrahim was in charge of the program. He helped me to construct the year so that I achieved maximal benefit. In addition to Zeyd, there were other faculty including Drs. Sheila Run and Glenn deBoer, who provided outstanding mentorship and guidance. As a fellow, I was responsible for handling the most difficult cases, including intracranial aneurysm clipping, AVM resections, and complex craniotomy for tumor and epilepsy, as well as complex spine fusions. I was given the opportunity to supervise residents in the operating room. The program also allowed me to perform research. I did a study on neuromuscular relaxation in epilepsy surgery and another on brain metabolism during intracranial aneurysm clipping, both of which were published in peer-reviewed journals. Dr. Stephen Jones, a Ph.D. with expertise in cerebral blood flow, also was a great mentor. Finally, the fellowship gave me training in EEG and SSEPs with world-class neurologists. Overall, this experience was great for my career. After I left Cleveland Clinic, I took a junior faculty position at the University of Chicago, where I remained for 27 years, becoming the first clinical faculty in that department to achieve tenure, as well as continuous NIH funding for over 21 years, and I also ran the Section of Neuroanesthesia. I am grateful to Zeyd and the other faculty for giving me this opportunity and helping me to launch my career.”

Perioperative neuroscience has a special footprint at the Cleveland Clinic and interest in neuroanesthesiology within the department is deep. In 2010 shortly after becoming the program director, I redesigned the curriculum to fulfill specific requirements common in accredited fellowships. The redesigned program was based on rotation blocks, with specified core competency goals, keeping in mind that fellows should have elective rotations to tailor their experience according to their professional interests.

Program directors in SNACC were advocating for advancing formal training with a mutual interest in standardizing the learning experience. Fortunately, I was included in the group investigating this interest, and later, in the task force that developed a curricular guideline for designing a fellowship program. The Cleveland Clinic program was instrumental for the task force to develop the guidelines, and the input from the task force further improved our curriculum. I was fortunate to be a part of the task force to make accreditation a reality.

Since 2010, more than 20 fellows have been enrolled in the program. All graduates have been a source of pride for the program and its faculty; they have touched many lives with the expertise gained during their training. Some are practicing in prestigious centers in the USA, Canada, and Europe and some have their names on significant publications. Just to mention a few, Dr. Shobana Rajan, a director on SNACC Board, Vice-Chair of ICPNT, and past chair of trainee engagement committee. Dr. Eman Nada, division chief of regional anesthesia and a member of the ICPNT reviewers. Dr. Shilpa Rao a key figure in neuroanesthesiology training at Yale University. Dr. Rao sent me the following:

“My fellowship training has prepared me extremely well in my career. The research block helped me understand the basics of research. I am currently actively involved in a few outcomes research projects at my current institution. In my current practice, I am the "go-to" person for children coming in for neurosurgeries. We were also actively encouraged to attend the SNACC annual conference and present papers/poster. This is one of the best neuroanesthesiology fellowships in the country, which trains and equips its fellows."

In 2019 the Cleveland Clinic neuroanesthesiology program was granted accreditation by ICPNT, a historic success in the close to the forty-year history of this fellowship. It brought a new identity and life to the fellowship, a prestige to the program and the whole department. The program now claims standardization and progressive quality of training not only within the institution and nationally but also globally. The networking between the accredited programs has brought new ideas for each program to improve their curriculum and training for the trainees, making us more competitive, attracting quality applicants.

Dr. Adel Budiansky, a graduate after accreditation, sent the following:

“I feel fortunate to have completed an ICPNT-accredited neuroanesthesia fellowship at Cleveland Clinic. I appreciated having a structured curriculum, which ensured that all aspects of neuroscience and neuroanesthesia were covered. The out-of-OR rotations, including neuromonitoring and NICU, ensured that the training was well-rounded. I very much benefited from the formal, ongoing feedback, which was helpful for honing my clinical skills and ensuring my continual learning. Being part of an ICPNT-accredited fellowship meant being connected to other accredited programs and learners, an excellent experience and career move: through the structured program and mentorship, I not only became a confident neuroanesthesiologist, but also left with official recognition of my training, which proved to be an asset when being hired for my current job. One of my early career goals is to develop a fellowship program at my center that will meet ICPNT accreditation standards.”

Accreditation creates validity and quality training. I receive many requests from different programs with strong neurosurgical to refer graduates. Accreditation creates an opportunity for networking of programs with participation from faculty and trainees. The fellows and young faculty get opportunities to present, giving them experience in public speaking and lecturing, further improving their academic careers. We are eagerly waiting for other programs to join so that we can expand our collaboration and learn from each other to advance this subspecialty further.

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