REPORT FROM THE ICPNT CHAIR

ICPNT Progress Report

W. Andrew Kofke, MD, MBA, FNCS

W. Andrew Kofke, MD, MBA, FNCS
Chair, ICPNT

ICPNT has been rather busy with continuing to improve infrastructure, processes, education, and accreditation activities.  Notably, the application for accreditation has been revamped and we are ready for letters of intent followed by the provision of applications to programs.  ICPNT's overall activities are summarized in this newsletter article.

ICPNT EC Council Members
Newly appointed to the ICPNT EC are Val Luoma and Jane Easdown. The composition of the ICPNT EC Council is now as follows:

Chair:
W. Andrew Kofke, University of Pennsylvania, Philadelphia, PA

Vice-Chair:
Vacant*

Secretary:
Lara Ferrario, University of Texas, Houston, TX

Treasurer (ex-officio):
John Bebawy, Northwestern, Chicago, IL

Members-at-Large:
Maria Bustillo, Weill Cornell Medical College, New York, NY
Jane Easdown, Vanderbilt, Nashville, TN
Alana Flexman, Vancouver, British Columbia, Canada
Leslie Jameson, University of Colorado, Denver, CO
Chanhung Lee, UC, San Francisco, CA
Val Luoma, University College London Hospitals NHS Foundation Trust, UK
Shobana Rajan, West Penn Allegheny Health System, Pittsburgh, PA
Ricard Valero, University of Barcelona, Spain

*Open for election (via SNACC Nominating Committee). The term will start in September 2021.

ICPNT Continues to Evaluate Fellowships Worldwide
Up to this point, ICPNT has reviewed and accredited 22 programs from around the world.  Nonetheless, we discerned a need to improve the process and have taken a brief hiatus to revise the application, evaluation paperwork, and program requirements. This work has been led largely by Leslie Jameson (University of Colorado) with contributions from several other ICPNT EC members.

As a consequence of these efforts, ICPNT is open again for applications. As of the publication of this newsletter, we are reviewing seven new programs, evaluating one for reaccreditation, and developing procedures for annual maintenance of certification of already accredited programs.  Others interested in applying for accreditation in the next round should submit letters of intent as described on the ICPNT web page at https://www.icpnt.net/.

The Neuroanesthesia Network
The ICPNT founders envisioned the development of a worldwide educational network. This network is overseen primarily by the Neuroanesthesia Program Relations Committee, led by Shobana Rajan. Dr. Rajan has submitted prior newsletter articles overviewing the NPR activities. NPR activities include monthly webinars dealing with journal club discussions, peer review, and fellow evaluation procedures. Directors of accredited programs have been invited to contribute to the educational activities. Eventually, weekly international neuroanesthesia grand rounds could be done with faculty and fellows' contributions everywhere. This network's principle and how it is different from other accreditation systems are illustrated in Figures 1a and 1b (originally conceived by Rafi Avitsian).

Other NPR Committee activities include organizing educational seminars at the SNACC meeting. Indeed, the notion of a “Neuroanesthesia Bootcamp” has been discussed wherein fellows from accredited programs could participate in a comprehensive overview of the principles of neuroanesthesia. This forum could also be a format for fellows to be exposed to techniques that are not available in their local hospitals, such as neuromonitoring, awake craniotomy, etc.

ICPNTFigure 1a. The traditional relationship of accreditation agents to programs.  Programs do not work with each other.  ICPNT rejects this approach.

ICPNTFigure 1b. ICPNT will communicate with programs and support the development of an inter-fellowship program network to facilitate quality improvement, education, and research.

Feedback from Program Directors
ICPNT recently sent a survey to program directors of accredited programs. We were seeking feedback with suggestions for improvement of our procedures.

In addition, a virtual retreat was planned and held on Saturday, April 10 under the leadership of Chanhung Lee by which experiences of accredited programs were reviewed and discussed with a forum to provide feedback to ICPNT for quality improvement. 

Updated Application and Program Requirements
We received significant feedback regarding the unreliability of the application for accreditation. With the assistance of Ruggles Service Corp. the application has been revised to be much more straightforward. In many ways, it resembles an NIH grant application focusing on descriptive file uploads with some descriptive demographic fill-ins. 

With this application update, we create a reviewer assessment form that matches the application form and will facilitate improved feedback to application program directors.  Besides, the program requirements have been updated and uploaded to the icpnt.net web page.

IARS/AUA Abstract
Chanhung Lee has led the writing and submission of an abstract to the IARS/AUA meeting.  The title is “Promoting Perioperative Neuroscience Exchange and Excellence: Neuroanesthesia Program Relations Committee for International Council on Perioperative Neuroscience Training (ICPNT)."  The abstract describes the NPR activities, concluding that having an international collaborative platform creates a setting for the different international programs with variable practices to learn from each other’s experiences. The presentation will describe one of the first such innovative international educational efforts in subspecialty education.

Standardization of Neuroanesthesia Education: Need of the Hour and the Way Forward
Look for an article in Anesthesiology Reviews by this title by Drs. Rajan, Bustillo, Lee, and Kofke. The in-press review illustrates the evolution and progress with standardization of education in neuroanesthesiology, providing a framework upon which individual training programs in neuroanesthesiology can base defined educational standards to meet accreditation criteria. Structured training around the three pillars of neuroanesthesiology with concomitant accreditation is expected to lead to higher education standards with better patient care. The SNACC created milestones for neuroanesthesiology training during residency, and the ICPNT can now use this as a foundation for fellowship training. The review discusses the three pillars of neuroanesthesiology originally espoused by George Mashour during his year as SNACC president.

3 Pillars

The Three Pillars of Neuroanesthesiology
Pillar 1 The care of neurosurgical patients This involves the disciplines of neuroanesthesia, neurocritical care, and neuromonitoring.
Pillar 2 The foundational neuroscience of anesthesiology The target of all anesthesia is the nervous system.
Pillar 3 Neurologic outcomes of non-neurosurgical procedures This includes taking care of the neurologically impaired patient undergoing non-neurologic surgery. 

Fees
The ICPNT EC has decided on the fee schedule of $3500 for initial accreditation and then $500 annually for maintenance and reaccreditation when due. Note that none of the ICPNT officers receive payment, and this covers expenses related to administration costs for ICPNT. The debate is ongoing regarding GDP adjustment. Complete financial data are available to any program director upon written request. 

Proposed Goals for the Upcoming Year
Several tasks remain for ICPNT, some of which are as follows:

  • Review of accreditation procedures by other organizations with Jane Easdown as a lead.  We plan to review accreditation processes by other accrediting organizations to compare and contrast with ICPNT procedures.
  • Develop a program tracking SOP. We need to improve our processes for annual updates of accredited programs.
  • Develop a standing fellowship review committee (FRC) within ICPNT. Like the ACGME RRC, the notion is being considered to have a standing FRC to manage the increasing challenge to review, maintain, accredit, and reaccredit fellowship programs. This committee will require the recruitment of additional individuals willing to serve.  Please contact Andrew Kofke (kofkea@pennmedicine.upenn.edu) if interested in participating in the ICPNT FRC.
  • Develop fellow logs for the use of programs as they want. ICPNT needs to develop software to assist program directors in tracking the clinical experience of their fellows.
  • Milestones. As noted above, ICPNT is considering developing a set of milestones for neuroanesthesia fellows, similar to milestones developed for US residency programs.

Bylaws
The SNACC Board of Directors has approved bylaws incorporating ICPNT into the SNACC framework. The bylaw additions are notable for describing the ICPNT EC composition and elections, ICPNT membership, the accreditation review committee, the neuroanesthesia program relations committee, SNACC-wide elections, and the precise relationship of ICPNT to SNACC. These new elements of the bylaws are reproduced from the snacc.org website.
Accepting Applications in Spring 2021  (see icpnt.net to enter a letter of intent)

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