By Angela Hays Shapshak and Atul Kalanuria
The past several months have been eventful for those of us involved in neurocritical care education. As I’m sure you are aware, the first ABMS Neurocritical Care examination is scheduled to take place in October 2021; applications will become available in December of this year. As announced at the recent meeting of the AAN CCEN Section, the exam is now being co-sponsored by the American Boards of Internal Medicine and Surgery, in addition to Neurology, Anesthesiology, Emergency Medicine and Neurosurgery. A grandfathering period of six years is anticipated. Criteria for exam eligibility can be found on the ABPN website.
In conjunction with the development of the ABMS certification pathway, the ACGME has convened a Neurocritical Care Working Group, which is in the process of developing program requirements. The ACGME has indicated that the program requirements will be released for public comment prior to finalization; it is anticipated that they will be finalized by July 2021. ACGME personnel indicate that programs may begin submitting applications for accreditation as soon as the program requirements are finalized.
Although the ABMS/ACGME certification pathway should be available within the next academic year, there are no plans to phase out UCNS certification or program accreditation. In fact, 136 applicants received UCNS neurocritical care certification in 2019, and the next exam is scheduled for November 2021. This examination will be open to AOA-certified physicians as well. The UCNS has also implemented their continuous certification pathway for all diplomates, similar to the Maintenance of Certification programs offered by many ABMS boards. Details can be found here. From an accreditation standpoint, the UCNS neurocritical care milestones have completed a one-year pilot phase and will be required for all accredited programs in 2021.
Although the ACGME/ABMS recognition of neurocritical care as a distinct subspecialty represents a notable milestone for the neurocritical care community, the coexistence of multiple credentialing pathways poses challenges. In fact, the American Board or Neurological Surgeons has indicated that they will continue to accredit fellowships through the CAST program; graduates of CAST fellowships will be eligible for ABNS recognition through the Recognition of Focused Practice Program. Under these circumstances, it is possible that there may soon be three different sets of program requirements, milestones and core curricula for neurocritical care trainees. Some NCS members have already taken note of a discrepancy between the ABPN and UCNS requirements for neurosurgical candidates interested in neurocritical care training. In the interest of resolving this disconnect, Drs. David Hwang and Paul Vespa from the Critical Care and Emergency Neurology Section of the AAN have worked with NCS leadership to draft a proposal to bring UCNS requirements into accordance with those of the ABPN. If approved, this proposal would allow neurosurgical trainees to complete in-folded fellowships after their third year of training and divide the 12-month training program into four-month blocks. This proposal has been submitted to UCNS and is awaiting board approval.
Considering the changing landscape of neurocritical care training and credentialing, NCS leadership have recently approved the creation of a new committee, the Neurocritical Care Training Committee (NCTC). It is anticipated that this new group will serve as a liaison to credentialing and certifying organizations. In keeping with the multidisciplinary nature of NCS, this committee will advocate for the needs of neurocritical care educators and trainees from various backgrounds and at every level. It is anticipated that the NCTC will work closely with existing NCS committees and sections, including the Educational Products Committee, the Fellowship Directors’ and Trainees’ Sections, and the Annual Meeting Committee to further the NCS goal of standardizing neurocritical care training and fostering leadership in education. We hope to be able to share more on this new initiative in the near future.
The Fellowship Directors and Trainees sections have jointly developed a survey that will aim to reduce the discrepancy between programmatic information that is available through the UCNS and the NCS websites. This annual survey focuses on gathering information that is specifically designed to help applicants who are in the process of choosing neurocritical care as their career. Given the wide variation between individual fellowship training programs, this survey will ask programs to enter details ranging from fellowship size, number and accreditation to mentorship, research and curriculum information. Currently, this survey is pending board approval.
To conclude, this has been a challenging year for trainees and programs with many being redeployed to cover patients affected by COVID-19. We extend our thanks to everyone who has played a role in this current pandemic.