Neuroanesthesia Milestones for Residency Education

L. Jane Easdown, MD, FRCP(C)
Professor of Anesthesiology
Vanderbilt University

L. Jane Easdown, MD, FRCP(C)
L. Jane Easdown, MD, FRCP(C)

This article is to alert SNACC members to the recent publication of the residency milestones for rotations in neuroanesthesiology.1 This resource was created by the work of a SNACC appointed seven-member task force and advisory team. The project has been completed and the resulting manuscript, along with the milestones has been published in Journal of Neurosurgical Anesthesiology. This article will outline the process and results of this effort and how these milestones may be used for residency programs.  

In 2009, the ACGME introduced the concept of competency-based milestones to replace the time-based global assessment system to evaluate the progress of trainees. Each specialty was charged with developing milestones to assess the progress in knowledge, skills and behaviors necessary for independent practice. The anesthesiology milestones workgroup published the 25 milestones in 2014.2 However, the anesthesiology milestones are not subspecialty-specific. Several members of the Society for Neuroscience in Anesthesiology & Critical Care (SNACC) expressed an interest in investigating the need for rotation specific milestones. As a result, SNACC appointed a task force to adapt the existing ACGME anesthesia milestones for use in neuroanesthesiology rotations. The task force would develop these milestones, create opportunities for programs to trial them and then provide recommendations for implementation. 

The process began with the task force members compiling the goals and objectives of existing neuroanesthesiology rotations used by various residency programs in the United States. Over 20 programs volunteered curriculum. Following review and discussion, a final curriculum with clearly defined goals and objectives was drafted for both the basic and advanced rotations. Next, the task force developed the neuroanesthesiology milestones based on the 25 existing ACGME anesthesia milestones. This was an iterative process replacing the nonspecific language of the anesthesia milestones guided by the goals and objectives in the newly drafted neuroanesthesia curriculum. The consensus was that milestones should be comprehensive, but not exhaustive. After incorporating the suggestions from the advisory committee, the milestones were sent to all members of the task force, advisory committee and SNACC leadership to pilot and evaluate for three months in their respective programs. Feedback was elicited from faculty as well as residents. The task force reviewed all the feedback and finally recommended 12 neuroanesthesiology-specific milestones in five major ACGME domains that were identified as most pertinent to this subspecialty rotation. The final product was approved by SNACC leadership and the ACGME gave permission to adapt and publish the neuroanesthesiology milestones. 

Feedback from programs piloting the milestones showed that they were used in a variety of ways.  They were used as both formative and summative assessments. The faculty used them for the end of day debrief or end of rotation assessment. Residents found them very useful as a pre and post self-assessment of their progression in the rotation. The major strength of these milestones is the rigorous process of their development. This included piloting by a large number of faculty and residents in anesthesiology departments representing the diversity of training programs in the United States, as well as inputs from the SNACC membership representing content expertise. Moreover, the milestones were abridged after the pilot phase to make them more succinct and easier to use.

In summary, SNACC has provided the first set of milestones to evaluate resident training in neuroanesthesiology. These milestones are available to be used by programs to assess residents in a variety of ways and also to assess the curriculum of the programs themselves. It is hoped that residency programs actively incorporate these milestones to give a better assessment of skills, knowledge and behaviors in neuroanesthesiology rotations. The task force invites the readers of newsletter to review these milestones in Journal of Neurosurgical Anesthesiology and implement them in their training program. We look forward to your feedback.

Dr. Deepak Sharma 2.	Dr. Letitia J. Easdown
Dr. Deepark Sharma Dr. Letitia J. Easdown
3.	Dr. Arpad Zolyyomi 4.	Dr. Eugenia Ayrian
Dr. Arpad Zolyyomi Dr. Eugenia Ayrian
5.	Dr. Guy Edelman 6.	Dr. Peggy Wheeler
Dr. Guy Edelman Dr. Peggy Wheeler
  7.	Dr. Michael Mahla
  Dr. Michael Mahla

Neuroanesthesiology Milestones Task Force Members:

  • Dr. Deepark Sharma, Department of Anesthesiology & Pain Medicine, Division of Neuroanesthesiology & Perioperative Neurosciences, University of Washington, Seattle, WA
  • Dr. Letitia J. Easdown, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
  • Dr. Arpad Zolyyomi, Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM
  • Dr. Eugenia Ayrian, Department of Anesthesiology, Keck School of Medicine of University of Southern California, Los Angeles, CA
  • Dr. Guy Edelman, Department of Anesthesiology, University of Illinois, Chicago, IL
  • Dr. Peggy Wheeler, Department of Anesthesiology, University of Illinois, Chicago, IL
  • Dr. Michael Mahla, Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA


  1. Sharma D, Easdown LJ, Zolyomi A et al. Society for Neuroscience in Anesthesiology & Critical Care (SNACC) neuroanesthesiology education milestones for resident education J Neurosurg Anesthesiol 2019 (ahead of print).
  2. Schartel SA, Kuhn C, Culley DJ et al. Development of the anesthesiology educational milestones J Grad Med Educ. 2014;6:12-14.

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