anterior circulation aneurysms SURGICAL OUTCOMES When (if ...

anterior circulation aneurysms SURGICAL OUTCOMES When (if ...

CAST SNS Annual Meeting Seattle 21 May 2019 Arthur L Day, MD Charles Branch, MD Agenda I. CAST Membership II. CAST Fellowship Accreditation NESAC/NCCTRAC Update Form 2 and Guidelines ACGME ADS/Form 3 Requirement 2 year activity rule Fee schedule Non Neurosurgery ACGME Associated CAST Fellowships III. ABNS - CESAC IV. Leadership Transition and Recognition CAST after MAY 2019 SNS Meeting CAST Members (3 yr. term, renewable x 1 total 6 yrs.) Nicholas Barbaro (Chair) 2019 functional Sander Connolly

2019 CV Cormac Maher 2017 pediatrics Charles Branch (Secretary) Linda Liau 2018 tumor Shelly Timmons 2014 trauma/NCC Doug Kondziolka 2016 functional Vince Traynelis 2018 spine

ABNS ad hoc Kevin Cockroft 2018 NES ABNS Secretary Carl Heilman 2018 Ex-Officio 2011 spine CAST Accreditation of Programs (as of May 2019) Programs: Approved a. Cerebrovascular b. Endovascular 11 47 c. Neuro Critical Care 27

d. Neurological Oncology 15 e. Peripheral Nerve 7 f. Pediatric 28 g. Stereotactic/Functional 25 h. Spine 44 TOTAL 204 CAST Program Accreditations 20-30 New/Renewal applications /yr Web application and review system outdated Increasing linkage top ACGME Program Data 250 202 200 186

163 149 150 129 98 100 76 64 50 38 10 12 0 12 13 13 16 19 43 49

19 6 14 12 22 31 20 15 23 16 5 3 3 2 1 2 2002 2003 2004 0 2005 2006 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total by Year Trending

CAST Program Accreditations Neuroendovascular Surgery (NES) (as of May 2019) 50 47 45 40 37 35 30 27 25 19 20 14 15 10 5 0 7 11 2

1 3 1 3 4 3 3 9 2 11 8 2 3 10 10 5 0 0

0 0 0 2002 0 2003 0 2004 0 2005 0 2006 0 2007 2008 2009 2010 0 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total by Year Trending Total CAST Individual Certifications NeuroEndovascular Surgery (NES) (as of April 2019) Certificates: Approved a. Neurosurgeons 119 b. Neurologists 85 c. Radiologists 105 TOTAL

309 NESAC Membership Neurosurgery JSCVS Neurology SVIN Radiology SNIS Name Institution Term Start Brian Hoh, MD** University of Florida-Gainesville 2015 2020 Adnan Siddiqui, MD SUNY Buffalo 2015

2019 Howard Riina, MD New York University 2015 2018 Adam Arthur University of Tennessee 2019 2022 Name Institution Tudor Jovin, MD** University of Pittsburgh 2015 2020 Sam Zaidat, MD Medical College of Wisconsin

2015 2019 Italo Linfante, MD Miami, FL 2015 2018 Johanna T. Fifi Mount Sinai 2019 2022 Name Institution Philip Meyers, MD** Columbia University Term Start Term Start 2015 Term End

Term End Term End 2020 ** denotes signing member of NESAC formation document, Colin Derdeyn, MD Washington University at St. Louis 2015 2019 Aquilla Turk, MD Medical University of South Carolina 2015 2018 David Fiorella Stoneybrook 2019 2022 finalized Jan 2015

CAST Program Accreditations NeuroCritical Care (as of April 2019) 30 26 27 25 21 20 15 15 10 10 5 5 11 0 16 0 0 0

0 0 0 1 2 1 2 5 5 5 5 3 1 0 1 2002 0 2003 0 2004 0 2005 0 2006

0 2007 0 2008 0 2009 2010 0 2011 2012 0 2013 2014 2015 2016 2017 2018 2019 Total by Year Trending Total CAST Individual Certifications NeuroCritical Care(NCC) (as of April 2019) Certificates: Approved a. Neurosurgeons 43 b. Neurologists 45 c. Pulmonologist 19 d. Anesthesiologist 13 e. Neurointensivist

9 Emergency Medicine f. Pediatrician TOTAL 2 131 NCCTRAC Membership NeuroCritical Care/NeuroTrauma Name Institution Shelly D. Timmons, MD Penn State Hershey/Neurosurgery Robert E. Harbaugh, MD Penn State Hershey/Neurosurgery Start Date Original Original Original Alex B. Valadka, MD

Virginia Commonwealth University Richard Rodgers, MD Indiana University New Thomas Bleck , MD Rush University Medical Center New Mount Sinai New UCNS New Jaime Ullman, MD Cheryl Chang Advisor/Liaison Term End New CAST Fellowship Requirements Post Chief Resident year (NCC and NES exceptions) Form 2 (Specialty Specific) submission with new/renewal applications Form 3 (Individual Activity) submission annually for CAST Diploma of Fellowship completion

ADS submission annually CAST Fellowship Accreditation: Data/Form Requirements Initial application and renewal Form 1: institutional case report general. Includes all cases done by sponsoring institution residency training program (due at time of initial application or renewal) Form 2: institutional case report subspecialty. Includes all pertinent subspecialty cases done by sponsoring institution residency training program (due at time of initial application or renewal) Annual Form 3: individual case report form training. Validates the experience of the individual during the fellowship (updated to CAST annually) ACGME ADS: annual fellowship update (updated and submitted to CAST through ACGME annually) Form 1: INSTITUTIONAL CASE REPORT GENERAL all cases done by institution sponsoring training program same for all sub-specialties does program have enough cases to justify a fellowship? Form 2: INSTITUTIONAL CASE REPORT SUBSPECIALTY all pertinent cases done by institution sponsoring

training program defined by subspecialty FRC different for each subpecialty (sample from neuroendovascular surgery) does program have enough subspecialty cases to justify a fellowship? Form 2: Institutional Case Minimums for Neurosurgical Oncology Form 3: INDIVIDUAL CASE REPORT TRAINING all cases done by fellow during fellowship defined by subspecialty FRC different for each subspecialty (minimal case number requirements) (sample from neuroendovascular surgery) validates the fellowship experience Form 3: Individual Fellow Case Minimums for Neurosurgical Oncology ACGME ADS: Annual submission through ACGME site all CAST accredited fellowships must be linked to ACGME

approved residency program In the current form, the fellow will be substituted for the term resident Faculty CV/Scholarly activity will not be required for ADS Block diagram submission is required for ADS and initial application Sample ADS courtesy of Indiana University CV Fellowship ADS Block Diagram Illustrates planned fellowship experience at sponsoring training program Sample ADS courtesy of Indiana University CV Fellowship CAST Program Accreditation Considering a two year activity rule 2 year limit on non-receipt of an ADS indicating fellowship status no fellow activity or failure to submit Form 3 for each graduating fellow citation issued ACCREDITATION 2019 CAST FEE STRUCTURE CAST Function

Accreditation application fee type Revenue Expense new program $3,000 ---- (5-year cycles) renewal ACGME/ADS $2,000 ---- $1,000 CAST Accredited Fellowships in programs without ACGME Neurosurgery Individual Certification NES/NCC ABNS Interactions CAST Certificate to RFP NESAC CESAC

CAST Individual Certifications NeuroEndovascular Surgery (NES) (as of April 2019) specialty # approved a. Neurosurgeons 119 b. Neurologists 85 c. Radiologists 105 TOTAL 309 RFP CNS Neuroendovascular Surgery This purpose of this document is to detail the organizational construct, training, accrediting, and credentialing requirements for the Recognized Focused Practice (RFP) in CNS Neuroendovascular Surgery. This RFP is co-sponsored by the American Board of Neurological Surgery, American Board of Radiology, and the American Board of Psychiatry and Neurology.. The ABNS will serve as the managing ABMS board. This RFP has been approved by the ABMS and has the goal of recognizing candidates who have successfully completed standardized neuroendovascular training and practice criteria, thereby elevating and advancing patient care for the public good. Organizational Structure: There will be two committees, NESAC (Neuro-Endovascular Surgery Advisory Committee) and CESAC (Credentialing Endovascular Surgery Advisory Committee),that will work collaboratively in the work of fellowship accreditation (NESAC) and fellow credentialing (CESAC). Once established, they will work

independently to accomplish their charges. Membership of each committee will consist of equal numbers of representatives from neurological surgery, neuroradiology, and neurology. The chair of NESAC will be selected by SNS-CAST. The CESAC Chair may be from any of the 3 disciplines, and CESAC will consist of equal representation of the 3 parent organizations. The chairs will be responsible for providing timely reports back to the parent organizations and for coordinating the timing of and agenda for meetings between the parent organizations and the committee members. NESAC and CESAC will be self-governed with the oversight and approval of their parent organizations. Fellowship Accreditation: NESAC Accreditation of fellowships will be done by NESAC under the authority of the Society of Neurological Surgeons through its Committee for Advanced Subspecialty Training (CAST). This committee will establish fellowship educational and training requirements based on agreed upon criteria which will include procedural case volumes Endovascular Pathway for Neurosurgeons Complete residency training Complete ABNS eligibility requirements for CNS Endovascular Fellowship and provide letters of completion/ documentation Complete subspecialty fellowship in CNS Neuroendovascular Fellowship Pass primary exam for credit Letter of completion from CNS

Endovascular Surgery, fellowship program director Submit case log with 2 years of practice data (unless cases already submitted in POST for ABNS oral exam). 65 cases/ yr 30 cases reviewed in POST 12 interventions/yr Pass endovascular Add text here RFP exam Administered by ABNS via online with virtual proctoring Offered at least once per year Pass all 3 parts of ABNS oral exam Sit for endovascular focused session during oral exam

Sit for case review focused on endovascular cases during oral exam Awarded dual Add text here credential by ABNS Dual credential awarded for RFP in endovascular neurological surgery Endovascular Pathway for Neurologists Complete residency training Per primary board specifications Complete ABPN requirements for eligibility for CNS Endovascular fellowship and provide letters of completion/ documentation

Submit case log with 2 years of practice data Complete subspecialty fellowship in CNS Neuroendovascular Fellowship Letter of completion from CNS Endovascular Surgery, fellowship program director Submit case log with 2 years of practice data Awarded additional credential by ABPN 65 cases/ yr 30 cases reviewed in POST 12 interventions/yr Pass endovascular RFP exam Administered by ABNS via online with virtual

proctoring Offered at least once per year Additional credential awarded for RFP in endovascular neurological surgery Endovascular Pathway for Radiologists Complete residency training Per primary board specifications Complete ABR requirements for eligibility for CNS Endovascular fellowship and provide letters of completion/ documentation Complete subspecialty fellowship in CNS Neuroendovascular Fellowship

Letter of completion from CNS Endovascular Surgery, fellowship program director Submit case log with 2 years of practice data Awarded additional Add text here credential by ABR 65 cases / yr 30 cases reviewed in POST 12 interventions/yr Pass endovascular Add text here RFP exam Administered by ABNS via online with virtual proctoring Offered at least once per year Additional credential

awarded for RFP in endovascular neurological surgery CAST Individual Certifications NeuroCritical Care(NCC) (as of April 2019) specialty: # approved a. Neurosurgeons 43 b. Neurologists c. Pulmonologists 45 19 d. Anesthesiologists 13 e. Neurointensivists 9 Emergency Medicine

f. Pediatricians 2 Leadership Transition and Recognition Steve Giannotta and Kathy Guzman USC CAST Secretary and Fellowship Counseling Team Shannon Gignac SNS Office CAST Administration and one armed paper hanger Art Day Outgoing Chair Nick Barbaro Incoming Chair Forecast A statement of what is judged likely to happen in the future, especially in connection with a particular situation. In our season change, I am confident the ForeCAST is good!

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