The Present State of Neurointensivist Training in the United States: A Comparison to Other Critical Care Training Programs

Objective: This manuscript describes the state of neurocritical care fellowship training, compares its written standards to those of other critical care fellowship programs, and discusses how programmatic oversight by the United Council for Neurological Subspecialties should evolve to meet American College of Graduate Medical Education standards. This review is a work product of the Society of Critical Care Medicine Neuroscience section and was reviewed and approved by the Council of the Society of Critical Care Medicine. Data Sources: We evaluated the published training criteria and requirements of American College of Graduate Medical Education Critical Care subspecialty fellowships programs of Internal Medicine, Surgery, and Anesthesia and compared them with the training criteria and required competencies for neurocritical care. Study Selection: We have reviewed the published training standards from American College of Graduate Medical Education as well as the United Council for Neurologic Subspecialties subspecialty training documents and clarified the definition and responsibilities of an intensivist with reference to the Leapfrog Group, the National Quality Forum, and the Joint Commission. Data Extraction: No data at present exist to test the concept of similarity across specialty fellowship critical care training programs. Data Synthesis: Neurocritical care training differs in its exposure to clinical entities that are directly associated to other critical care subspecialties. However, the core critical care knowledge, procedural skills, and competencies standards for neurocritical care appears to be similar with some important differences compared with American College of Graduate Medical Education critical care training programs. Conclusions: The United Council for Neurologic Subspecialties has developed a directed program development strategy to emulate American College of Graduate Medical Education standards with the goal to have standards that are similar or identical to American College of Graduate Medical Education standards. Dr. Seder is on the Board of Directors for the Neurocritical Care Society (NCS) and co-chair of the guideline committee. Dr. Bonomo is on the Board of Directors of NCS. Dr. Bleck is a founding past president of NCS. He also received funding from Edge Therapeutics, Sage Therapeutics, and Zoll Corporation. Dr. Hemphill is the past president of NCS. His institution received funding from Cerebrotech Medical (research grant), and he received funding from Ornim (stock options for scientific advisory board service) and from several legal firms for expert witness review. Dr. Shutter’s institution received funding from National Institutes of Health/Department of Defense for research; she received funding from a legal firm for an expert witness testimony for the defendant (medical case), and she disclosed that she is on the Board of Directors for the NCS, serves as chairman on a NCS committee, and is director of the Multidisciplinary Critical Care Training Program at University of Pittsburgh Medical Center. Dr. Rincon is on the Board of Directors, NCS. Dr. Timmons received funding from AONeuro (International Neurosurgical Educational Foundation), and she disclosed she is the President Elect for the American Association of Neurological Surgeons, is a member of the Committee on Advanced Subspecialty Training for the Society of Neurological Surgeons, and is the Chair of the Fellowship Review Committee for Neurocritical Care. Dr. Nyquist is on the Board of Directors, NCS, United Council on Neurological Subspecialties, neurocritical care test writing committee, recent past voting member of the executive board of the United Council on Neurological Subspecialties for Neurocritical Care. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: emarcolini@gmail.com Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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