Report on the International Accreditation Review Task Force
L. Jane Easdown, MD, MHPE, and Valpuri Luoma, MBChB, FRCA
On behalf of the ICPNT Accreditation Task Force
Valpuri Luoma, MBChB, FRCA
The International Council on Perioperative Neuroscience Training (ICPNT) was formed in 2018. An editorial outlining the history of this accrediting body was published in 2019, and the first neuroanesthesiology fellowships programs were accredited the same year.1 When ICPNT was formed, it was unique in being an international accrediting body. Dr. Kofke, the Chair of ICPNT, suggested creating an international task force to study and report on accrediting processes in other countries. They would give valuable information on local organizations that could enrich the current ICPNT process. There are other publications that have compared accrediting bodies from different countries, but this is the first to investigate neuroanesthesia fellowships.2,3
In January 2021, an international group of seven neuroanesthesiology program directors was formed to study the process of accreditation. The members of this task force are:
- Jane Easdown, Vanderbilt University Medical Center, Nashville, USA
- Alana Flexman, St. Paul's Hospital, BC, Canada
- David Highton, Princess Alexandra Hospital, Queensland, Australia
- Nan Lin, Beijing Tiantan Hospital, China
- Valpuri Luoma, University College London, United Kingdom
- Maria Claudia, Nino de Mejia, Bogota, Columbia
- Cris Taveres, Sao Paulo, Brazil
- Ricard Valero, University of Barcelona, Spain
Each program director was tasked with investigating the accrediting organizations in their local areas, answering the following questions:
- In your area, what are the main accreditation organizations in medical education? This might include your own anesthesia residency and fellowship programs but also other medical specialties.
- Tell us about the history and mission of these organizations. Include any literature and website information.
- How do they go about accrediting programs - process, time frame, incentives, citations? How structured is this process?
- How do these organizations assess their processes and improve standards over time?
The program directors forwarded reports and website material and these materials were collected and analyzed.
Each country has a system, private or governmental, for certifying medical students (Undergraduate Medical Education or UME) and residents (Graduate Medical Education or GME) so that they can be promoted within the system and eventually licensed to practice independently. In addition, the hospitals, universities, and other medical centers that perform the education are also evaluated and accredited. However, the process for accrediting fellowship education, GME beyond residency, is much more diverse depending on the country. Here is a summary of systems we have seen:
- USA (Dr. Easdown): Most fellowships are accredited by the Accreditation Council of Graduate Medical Education (ACGME), a private educational organization. In anesthesiology, the ACGME accredits fellowships in critical care, pain management, obstetric anesthesia, regional anesthesia, pediatric and cardiac anesthesia. The accreditation is a longitudinal process with continuous fellow evaluations and annual surveys. Actual visits might only occur at 10 years. The ACGME sets very detailed standards and duty hours.
- United Kingdom (Dr. Luoma): The General Medical Council is the independent regulator for doctors in the UK, formed in 1858. Their role/focus is to protect patients by ensuring good standards of medical education and practice. In the UK, there is no dedicated accreditation process for anesthesia fellowship programs. The majority will occur at institutions approved for postgraduate training in anesthesia. They do this through surveys of learners and teachers and by site visits.
- Canada (Dr. Flexman): Royal College of Physicians and Surgeons of Canada oversees accreditation of all residency training programs (curriculum, accreditation, examinations) and RCPSC, accredited fellowship, Pain Management only. All other fellowships are run at an institutional level and would be approved by the local university or hospital.
- Spain (Dr. Valero): There is no official accreditation for any fellowships in Spain. Supra-specialty education can be obtained through a university master’s program or postgraduate courses, but mainly through clinical practice experience.
- Europe (Dr. Valero): The European Union of Medical Specialties. With a current membership from 40 countries, it is the representative organization of the National Associations of Medical Specialists in the European Union and its associated countries. It sets specialty standards, advocates for specialties, and accredits specialists. Finland has an accredited neuroanesthesiology fellowship with a standardized curriculum and a final exam for the fellows. More information about this fellowship will be obtained.
- China (Dr. Lin): In China, one can be trained in a specific anesthesia area through a continuing medical education (CME) program that is accredited by a specific hospital. Doctors who want to have advanced training need to visit those programs; the training length varies depending on the objective of the study, from three months to one year. Accreditation is a regional process by a governmental agency.
- Australia and New Zealand (Dr. Highton): Anesthesia training includes two years of general hospital clinical work followed by five years of specialty training. The last year of training is called the Provisional Fellowship Training year, where the resident would focus on one specialty area. Accreditation is by the Australian and New Zealand College of Anaesthetists (ANZCA). This organization makes a site visit to the institutions every five years.
- Columbia (Dr. Nino): Through the Ministry of Education, The National Council of Higher Education, in consultation with Higher Education institutions, accredit and offers medical specialization programs.
- Brazil (Dr. Taveres): Regarding fellowship programs, they are recognized by the Ministry of Education and Culture, the Brazilian Society of Anesthesiology and some of them by the Brazilian Medical Association. In anesthesiology only the fellowship of Pain Medicine has these three accreditations.
When the ICPNT was formed, it was necessary to create an accreditation process with flexibility as international training is not a uniform system for training beyond residency. The task force has seen some excellent examples of curriculum, evaluation systems, training surveys, and details about site visits, which it shares with the ICPNT Executive Council. The task force is also working towards a summary it can share through publication.
- Ferrario L, Kofke WA. Standardized Accreditation of Neuroanesthesiology Fellowship Programs Worldwide: The International Council on Perioperative Neuroscience Training (ICPNT). J Neurosurg Anesthesiol 2019;31:267-9.
- Cassie JM, Armbruster JS, Bowmer MI, Leach DC. Accreditation of postgraduate medical education in the United States and Canada: a comparison of two systems. Med Educ 1999;33:493-8.
- Fishbain D, Danon YL, Nissanholz-Gannot R. Accreditation systems for Postgraduate Medical Education: a comparison of five countries. Adv Health Sci Educ Theory Pract 2019;24:503-24.