The Society of Neurological Surgeons (the Senior Society) overwhelmingly approved the creation of a Committee on Accreditation of Subspecialty Training (CAST) at its most recent meeting in Cleveland. This committee will be responsible for accreditation of subspecialty training (fellowships) in neurosurgery. The Senior Society was assigned responsibility for fellowship oversight training following a 1999 summit meeting in New Orleans with representation from neurosurgery’s Residency Review Committee (RRC), Senior Society, ABNS, CNS and AANS. At this meeting the following guidelines were created:
- Certification for supplemental training will be institutional.
- There will be no subspecialty certification by the ABNS.
- The RRC would evaluate fellowships only in regard to their impact on residency training. The training of fellows must not adversely affect the resident core training.
- Flexibility in regard to timing and duration of additional training should be maximized. The concept of enfolding subspecialty training into residency elective time should be preserved.
Background
The following background information is critical to understand the development of CAST:
Accreditation by the RRC is the review of training sites.
Thus the present role of the RRC in regard to supplemental training (i.e. fellowships) is restricted to evaluation of any adverse impact on residency training.
Certification by the ABNS involves an examination of individuals.
In order for a fellowship to have ACGME approval, the following thresholds must be surpassed:
- The content of the fellowship must represent a “new body of knowledge.” This threshold in most circumstances prohibits the creation of an ACGME fellowship in established areas (i.e., spine, peripheral nerve and pediatrics) since these activities do not represent “new body of knowledge.” In contrast, the recently ACGME-approved fellowship in interventional neurosurgery did represent a “new body of knowledge.”
- An ACGME fellowship must be 12 months in duration.
CAST was created under the guidance of a series of Presidents of the Senior Society: Drs. John Van Gilder, Bill Shucart, Buzz Hoff, Howard Eisenberg and Marty Weiss. CAST consists of a Chairman (H. Richard Winn, MD), Secretary/Treasurer (David Piepgras, MD), and three standing committees:
The Program Requirement Committee, which will be responsible for the creation of fellowship requirements.
The Appeals Committee, which will be charged with evaluating and adjudicating appeals.
The Outcomes Committee, which will access the impact of fellowship training on residencies.
The actual review of the fellowships will be performed by an Ad Hoc Committee whose membership will consist of two or three Senior Society members with relevant background (i.e., members of Joint Sections). Committee members will be asked to review the actual fellowship application and, if necessary, will make site visits.
Key Points
The key points of the fellowship requirements are outlined below:
Institutional eligibility: Fellowships must remain within institutions with ACGME approved (or equivalent) neurological surgery residency training programs.
Applicant eligibility: The fellowship will commence after completion of an approved residency program or at a senior level of residency.
Duration of training: Six months at a minimum and extensions must be based on educational rationale.
Duration of program approval: Five years at a maximum; re-review will coincide with six months of the ACGME review of the sponsoring residency program.
Qualification of program director: Must possess special expertise in designated area and be appointed by the Chair of the sponsoring neurological surgery residency.
Applications and guidelines for fellowships in peripheral nerve, spine and cerebrovascular have been sent to program directors for distribution to interested individuals. Applications are currently being accepted for review. The goal of CAST is to have fellowship applications reviewed and accepted by July 2002. More information and applications will be available on the Society of Neurological Surgeons’ Web site at https://www.societyns.org.
H. Richard Winn, MD, is Chairman of the Committee on Accreditation of Subspecialty Training (CAST). David C. Piepgras, MD, is Secretary/Treasurer of CAST. Marty Weiss, MD, is President of the Society of Neurological Surgeons.