International Council on Perioperative Neuroscience Training (ICPNT)
Society for Neuroscience in Anesthesiology and Critical Care (SNACC)
Amended July 30, 2018
Amended September 4, 2018
Amended October 10, 2018
April 4, 2020
Amended March 25, 2022
Amended November 29, 2022
The following document represents the Charter for the International Council on Perioperative Neuroscience Training (ICPNT) based on the SNACC Bylaws. It has been approved by the ICPNT Executive Committee as of November 29, 2022 and may be subsequently amended by the SNACC Executive Committee.
I. Mission Statement
The mission of the International Council on Perioperative Neuroscience Training (ICPNT) is to set educational standards, foster engagement, and supervise activities that promote high quality subspecialty education in perioperative neurosciences and ultimately improve outcomes of patients with neurologic conditions in the peri-procedural period.
II. Vision Statement
Our vision is to ensure the maintenance of an exceptional worldwide educational system in perioperative neuroscience.
III. ICPNT structure
A. ICPNT. Scope, Composition, and Terms
Scope. ICPNT is comprised of the international collective membership of program directors and core faculty of accredited neuroanesthesia fellowships. ICPNT members participate in international educational activities (generally organized by the NPR committee) and may be invited to participate in accreditation and re-accreditation of fellowship programs. ICPNT members may occasionally participate in council-wide votes as directed by ICPNT EC.
ICPNT organization and function are maintained in this charter which shall be publicly available on the SNACC and ICPNT websites.
Composition. Voting members of the ICPNT are made up of 1) Program Directors of accredited programs and 2) members of ICPNT EC
Non-voting members of ICPNT are made up of Assistant Program Directors, Core Faculty, and Active Fellows in accredited fellowship programs.
Membership in the ICPNT will abide by the diversity and inclusivity policies of SNACC and the World Health Organization.
Terms. ICPNT membership (non-EC) does not connote a specific term but is rather a function of position and responsibilities in an accredited program or in ICPNT. Membership via participation on the EC is term-limited.
B. ICPNT Executive Committee. Scope, Composition, and Terms
Scope: The ICPNT EC has the decision-making authority to determine the structure, actions and plans of the organization. The EC will consult with the broader council whenever possible when enacting fundamental changes to the program (e.g. program curricula requirements, bylaws, charter). The EC has the authority to appoint ad hoc committees or working groups to address specific issues or tasks as needed.
Composition: The ICPNT Executive Committee (EC) shall be comprised of a Chair, Vice-Chair, Past-Chair, Secretary, five (5) Members-at-Large and Chair of the Neuroanesthesia Program Relations Committee. In addition, the SNACC Secretary/Treasurer will serve on the EC ex officio.
The Chair of ICPNT will have responsibility for directing the Council’s activities and convening meetings as necessary to meet its responsibilities. The chair or a designee will be present during SNACC Board of Directors’ meetings, or Executive Committee meetings as requested, for the purpose of communicating ICPNT deliberations and facilitating oversight of ICPNT activities. The chair shall have the responsibility to document outcomes related to fellowship training as subsequently delineated. The chair shall have the responsibility to assign and oversee the communications of the Council. The chair will be a non-voting member of the SNACC Board of Directors.
The vice chair will participate in EC activities as directed by the chair. The vice chair will perform functions of the chair in the chair’s absence. If both chair and vice chair are unable to contribute, then the secretary will perform functions of the chair.
The Secretary of ICPNT will maintain records of ICPNT deliberations and actions as well as accreditation status and review cycles of accredited fellowships and the certification and certificate status of fellows. The Secretary will be responsible for pertinent and timely notifications of each member fellowship program in matters related to the accreditation process. The Secretary will present the suggested application fee for programs to the Executive Committee and after Executive Committee approval, monitor collection of application fees and, with the SNACC treasurer, and maintain financial books relative to income and disbursements. The Secretary functions will be performed with support of the SNACC management company unless the ICPNT, with SNACC Executive Committee support, chooses an alternate mechanism of administrative support. The ICPNT Secretary will be responsible for managing all accreditation appeals according to the prescribed procedures subsequently delineated.
The ICPNT shall have its own set of financial statements overseen by the SNACC secretary/treasurer. The financials shall be incorporated as necessary with the SNACC Form 990 and other related tax documents.
Terms: The Chair, Past-Chair, Vice-Chair, and at least 5 (five) Members-at-Large will serve terms of 2 (two) years. The secretary will serve a 2 year term which may be renewed once. As an ex officio position, the SNACC Secretary/Treasurer position will be filled in accordance with the process outlined in the SNACC bylaws (Election of Officers). Every 2 (two) years, the Vice-Chair will be will be elected as described in the SNACC bylaws. The Chair and Past-Chair are filled by succession from the Vice-Chair and Chair, respectively. The Members-at-Large will be appointed by the ICPNT Chair, or other internal process, and are renewable for one successive term. The Chair of the Neuroanesthesia Program Relations (NPR) Committee is a voting position, described elsewhere.
C. ICPNT Committees
1. Communications committee
i. The communications committee will be responsible to formulate and implement activities which support promulgation of information regarding the vision, mission, and activities of ICPNT. Such activities will encompass but not necessarily be limited to: regular publications in the SNACC newsletter, and periodic publications in other professional society newsletters(e.g, AUA, ASA, etc).
ii. Moreover, as feasible the communications committee, working as needed with the research committee, will support peer reviewed publications in the form of editorials or review articles.
iii. Oversight of the ICPNT web page and links of the ICPNT webpage to those of other organizations
2. Neuroanesthesia program relations (NPR) committee
i. The Neuroanesthesia Program Relations (NPR) Committee will work to provide collaborative offerings and activities, both in person and virtually, which will serve to foster academic, scholarly, professional relations, and networking among ICPNT accredited programs, in accordance with its Mission Statement. The NPR committee will organize interactions with and between accredited fellowships participating in the ICPNT network. This may include a variety of activities which include but are not necessarily limited to:
1) Organize, oversee presentation, and recording of international educational webinars
2) Organize and support between-program interactions which may include
3) Developing an infrastructure or directory of opportunities for fellow exchange, either for clinical, scholarship, or observership experience
ii. Organize an annual in person or virtual boot camp available to accredited program faculty and fellows for overview of major aspects of the foundations and practice of neuroanesthesia
iii. As needed and feasible provide for appropriate educational credits for those participating in NPR educational activities
iv. Develop a fee structure for participation in NPR ICPNT educational activities
i. The Neuroanesthesia Program Relations (NPR) Committee will be composed of a Chair and the rest of the committee members, delegated to various tasks within the scope of the committee’s activities, comprised of ICPNT-accredited fellowship Program Directors and Assistant Program Directors.
ii. Committee members are appointed on a rolling basis at the discretion of the NPR Chair, with a view to their educational, scholarly, and professional aptitude and desire to foster the mission of the committee.
iii. The Chair of the NPR is appointed at the behest of the Chair of ICPNT as approved by the ICPNT EC and will serve a term of two (2) years, renewable for a successive term.
3. Procedural certification
a. Charge: The procedural certification committee will
i. Develop and implement criteria for individuals to receive certification in cognitive and technical aspects of select procedures relevant to neuroanesthesia. These procedures may include but not be limited to
1) Transcranial Doppler
2) Processed and unprocessed EEG
3) Near infrared spectroscopy
4) Scalp blocks
5) Awake craniotomy
7) Venous air embolism monitoring and management
8) Intracranial pressure monitoring
9) Multimodality monitoring
10) Evd and spinal drain management
11) Airway management in various intracranial conditions
12) Perioperative neurological assessment
ii. Working with the NPR committee and SNACC education committee develop and implement educational products needed to support attainment of certification in a given procedure. This may include written reviews, virtual presentations, webinars, and simulation.
iii. Develop and implement fee schedules for procedural certification
iv. Develop and approve instructors in designated procedures
4. Fellowship review committee(FRC)
i. The FRC will review, evaluate and adjudicate applications for accreditation or re-accreditation on behalf of ICPNT. The Committee has the authority to request further information and make recommendations for improvement to individual programs.
ii. The FRC functioning under the oversight of the ICPNT secretary will develop and implement procedures related to approval and maintenance of accreditation of fellowship programs. This will include but not be limited to the following responsibilities
1) Update the fellowship application form as needed
2) Develop and update the fellowship review form used by reviewers
3) Review program annual reviews
4) Oversee fellow logbooks maintained by fellowships and provide technical support, preferably online, for fellow logs as feasible
5) Oversee the program review meetings following procedures outlined in ICPNT SOPs
6) Assign reviewers
7) Working with the ICPNT management keep records of all communications with programs
8) Act as a consultative resource for programs that are new or for established programs undergoing change.
9) Assure that each training program provide a certificate of successful completion and indicate SNACC ICPNT accreditation of the successfully completed fellowship program, as allowed by institutional protocols.
10) Upon request of a successful graduate or program director, ICPNT may provide a supplemental certificate of completion of accredited training to candidates after confirmation of successful completion by the program director. This certificate shall be signed by the council chair, SNACC president and program director.
11) Provide ICPNT logo to program directors for graduate certificates from their fellowships
iii. Secretary will provide oversight of ICPNT. Working with FRC:
1) The Secretary of ICPNT will maintain records of ICPNT deliberations and actions as well as accreditation status and review cycles of accredited fellowships and the certification and certificate status of fellows.
2) The Secretary will be responsible for pertinent and timely notifications of each member fellowship program in matters related to the accreditation process.
3) The Secretary will present the suggested application fee for programs to the Executive Committee and after Executive Committee approval, collect application fees and maintain financial books relative to income and disbursements.
4) The Secretary functions will be performed with support of the FRC and the SNACC management company unless the ICPNT, with Executive Committee support, chooses an alternate mechanism of administrative support.
5) The ICPNT Secretary will be responsible for managing all accreditation appeals according to the prescribed procedures subsequently delineated.
i. Composition and Terms: The Accreditation Review Committee will be composed of the ICPNT Executive Committee ex-officio. The FRC Chair will appoint individuals from the ICPNT membership who will serve as reviewers as needed. Lead Program Reviewers must be ICPNT members, however additional ad hoc reviewers may be consulted from the International Neuroanesthesia Community based on expertise and geographic familiarity.
5. Research committee
i. The research committee will oversee, collaborate, publish, and advise regarding research projects performed by accredited programs. Such activities may include but not be limited to:
1) Education research regarding perioperative neuroscience methods and outcomes
2) Surveys which entail use of the ICPNT network for potential respondents
3) Multi-institutional research involving ICPNT accredited programs, designed to create new knowledge regarding perioperative neuroscience
4) Educational activities related to research
i. Members will be the chair and those selected by the chair.
6. Examination committee
a. Charge: the examination committee with develop and implement procedures to support the following which can include but not be limited to
i. In-training and internal assessments of fellows. This may include
ii. Perioperative neuroscience question banks
iii. Oral examinations/interviews of fellows
iv. Provide evaluation and feedback mechanisms, forms, and software as needed by fellowship programs
v. Establish metrics for program directors to determine successful completion of a fellowship program, which will include ICPNT designated competencies and milestones;
vi. Develop and provide examinations internally administered by programs.
vii. Members include the chair and members chosen by the chair
IV. Description of Terminology
Accreditation. The process of validating the fellowship program by the ICPNT, a non-profit peer review organization, based on a standardized evaluation process utilizing ICPNT established criteria for conducting a standardized training experience and knowledge competencies.
Accredited. A program that is officially recognized as meeting the essential requirements of clinical and academic excellence by the accrediting organization.
Competency. An element of expertise indicating that a fellow has sufficient familiarity with a topic, concept, or procedure to be able to safely perform or deliver that specific competency in the course of being a neuroanesthesiologist.
Core Faculty. Individuals identified by the program director who meet the neuroanesthesiology qualification criteria outlined by ICPNT. These individuals have a prominent role in training and evaluating the candidates within a program.
Fellow. An individual who is a trainee in a fellowship program. In this capacity the fellow, who otherwise can conduct an anesthetic independently may be granted varying degrees of autonomy to perform clinical activity in the area of study. This judgment is delegated to the program director by the sponsoring organization. In situations of an enfolded (in-residency) fellowship, wherein the fellow will not have been fully trained and locally licensed in anesthesiology, the degree of supervision and independence will be consistent with the fellow’s level of experience and local custom. It will be determined by the sponsoring organization’s customary performance assessment process.
Fellowship. A post-graduate subspecialty training experience acquired during or after specialty training in anesthesiology. Fellowships are a minimum of 12 months of neuroanesthesia education which generally must occur over a maximum of 24 continuous months. The time required will be determined by individual program and trainee. Special circumstances may exist where the program alters this ICPNT requirement. The program director or sponsoring organization will notify the ICPNT of this change.
Fully Trained Anesthesiologist. A physician who has successfully completed a post medical school training experience in anesthesiology and is eligible for licensing as an independently practicing physician.
Program Director. The person in the core faculty who has a subspecialty leadership position and the recognized responsibility for ensuring ICPNT curriculum-defined competencies are available within the accredited program and that the fellow has participated in these activities before graduating.
Residency. A post medical school specialty training program. In anesthesiology, the residency duration, clinical competencies, and knowledge assessment will be as mandated by the region or country where it is performed.
Subspecialty Training Program. An educational program within a clinical environment comprising teaching faculty with appropriate staff support and facilities, which altogether delivers a specified curriculum to educate subspecialists within a defined time period.
Synthetic Knowledge in Neuroanesthesiology. Synthetic knowledge is gained by combining and integrating a diverse combination of clinical and basic neurosciences knowledge relevant to complex patient care issues in neuroanesthesiology. Truth is knowable by both knowing the meaning of the words and something about the world.
The International Council on Perioperative Neuroscience Training (ICPNT) will oversee the development and maintenance of subspecialty fellowship curricula and support international educational activities in accordance with the scientific and clinical advancements in Neurosciences pertaining to perioperative medicine. The council will also determine eligibility criteria for accreditation of fellowship programs that will offer such training. The Council will evaluate written applications from fellowship programs, provide feedback and make a determination about subspecialty neuroanesthesia accreditation status.
A. The specific responsibilities of ICPNT are to:
1) Develop, review, and update the subspecialty training curricula in consultation with current subspecialty program directors, specifying duration and components of training requirements for facilities, faculty, affiliated services and minimum case material at the fellowship site.
2) Establish fellowship requirements which must include
a. A curriculum for knowledge and procedural objectives based on competencies approved by ICPNT.
b. Allowance of adoption of subspecialty training curricula according to generally agreed or codified requirements of a region or country of a fellowship, while ensuring adherence to the general minimum standard set by ICPNT in the program requirements document.
3) Receive and administer applications from programs, reviewing eligibility and program attributes, granting accreditation to subspecialty training programs, initially for three years and then at appropriate intervals up to five (5) years.
4) Assign application fees for member programs according to set criteria
5) Establish metrics for program directors to determine successful completion of a fellowship program, which will include ICPNT-designated competencies; and may include examinations internally administered by programs.
6) Communicate with program directors in order to keep records of individuals enrolled in each fellowship with respect to successful completion, unsuccessful completion, and program withdrawal or termination. Documentation of the basis for each outcome will be provided to ICPNT.
7) Act as a consultative resource for programs that are new or for established programs undergoing change.
8) Assure that each training program provide a certificate of successful completion and indicate SNACC ICPNT accreditation of the successfully completed fellowship program, as allowed by institutional protocols. Upon request of a successful graduate or program director, ICPNT may provide a supplemental certificate of completion of accredited training to candidates after confirmation of successful completion by the program director. This certificate shall be signed by the council chair, SNACC president and program director. Notably, ICPNT accredits programs and does not certify individual trainees.
9) ICPNT will not determine licensing required for fellowship training. Licensing requirements will be determined by the local institution and applicable licensing bodies in keeping with regional laws governing licensing to practice medicine.
10) Develop and maintain a network of neuroanesthesia programs’ collaborative educational activities
VI. Accreditation Process
A. The fellowship review committee (FRC) will consist of ICPNT EC, ICPNT members asked to review program(s), and external consultants. Non EC participants will be appointed by the ICPNT chair with assent of ICPNT EC.
B. FRC responsibilities
i. Review program applications or communications as assigned by the council chair or secretary with as requested, a written recommendation and being prepared to provide a constructive verbal summary of the recommendations.
ii. Review assigned programs for maintenance of accreditation and re-accreditation.
iii. Committee members shall abide by their established Conflict of Interest policy. Any perceived conflicts shall be disclosed to the Chair.
iv. Committee members shall attend either physically or by remote connection FRC meetings involving programs which they have reviewed
v. FRC meetings will be scheduled at least annually with a frequency and time determined by the chair but with due consideration of the international composition of the committee.
C. Fellowships will be reviewed by at least three committee members who will lead discussion and present recommendations for accreditation decisions to the full fellowship review committee. A vote will then follow upon which an accreditation decision will be made.
D. For unusual situations or where regional geographic/cultural knowledge is not present among council, the FRC may ask the SNACC or other world-wide subspecialists who are interested and knowledgeable in subspecialty competencies and fellowships to assist ICPNT as consultants in the confidential review of programs, appeals, and development/maintenance of subspecialty training requirements.
i. The ICPNT Chair will appoint these consultants for assisting in confidential review of applications for fellowship accreditation and making recommendations to ICPNT in this regard.
E. Accreditation is open to fellowships worldwide. Each program should submit a letter of intent to ICPNT, whereupon access will be provided to an application. The application will include a non-refundable fee.
F. After review, the ICPNT will decide if the program meets the requirements and will give the program one of the following accreditation designations
i. A1 – Full approval- fulfills all expectations- Strong Program- 5 years
ii. A2 – Approval- minor deficiencies and areas of concern – 3 years approval
iii. A3 – Approval with remediable citations – program has to get back in 1 year for continuing approval
iv. A4-Incomplete; invite to resubmit for a later deadline
G. Numbers of fellows participating in a given fellowship will not be a criterion for accreditation although the ratio of fellows to teachers should follow ICPNT guidelines. Moreover, a program needn’t have active fellows at the time of application for accreditation.
H. Fellowships enfolded within an institution’s anesthesiology residency continuum will be allowed.
I. Applications for fellowship accreditation will be submitted to the ICPNT Secretary as per instructions posted on the ICPNT website. The Secretary of ICPNT will review applications and approve for transmittal to the chair of the FRC.
J. Judgments regarding accreditation will be made based on compliance with the established fellowship training requirements. All deliberations will be confidential. After the exclusion of the FRC members with a conflict of interest, a minimum of half of the fellowship review committee members will constitute a quorum for participation in accreditation decisions. Accreditation decisions will be made by a majority vote of participating ICPNT members. Decisions to not grant accreditation or to place a program on probation will be accompanied by a constructive summary of the basis for such judgments
K. When an ICPNT accredited subspecialty fellowship makes a significant change in program structure or undergoes major changes in fellowship faculty, especially the fellowship program director, the fellowship program director or the institutional supervisor, shall inform the ICPNT Secretary at the program’s annual review. Substantial changes such as a change in program director or institutional leadership may, at the discretion of ICPNT, be cause for a probationary status and review of fellowship and its accreditation. The cost of such reevaluation events will be included in the original application and annual maintenance fees.
L. An annual report will be required by each program to maintain accreditation
M. After expiration of a program’s accreditation, a new application with a reaccreditation application fee will be required.
N. Failure to pay accreditation, re-accreditation, or maintenance fees will subject a program to withdrawal of ICPNT accreditation
A. Appeal of a decision by ICPNT will be submitted in writing to the ICPNT Secretary. The written communication must address specific concerns in detail. The ICPNT Secretary will present the appeal to the ICPNT for deliberation and voting by the fellowship review committee. The appeal must be presented in writing by the fellowship director and/or program chair of the fellowship in question. The result of deliberation will be presented to the SNACC Executive Committee before informing the program. The SNACC Executive Committee should approve the decision before it is communicated with the program. If the SNACC Executive Committee disagrees with the appeals decision it will assign a separate Appeals Ad Hoc Committee consisting of three members with expertise in the subspecialty who are not members of ICPNT EC or fellowship review committee, have not participated in the original review, and have no other conflict of interest to reevaluate the appeal. The recommendation of the Ad Hoc Appeals Subcommittee will be presented to the SNACC Executive Committee, which will provide comment as needed and forward to ICPNT for a final decision.
A. Training program irregularities related to lack of compliance with ICPNT curricula and guidelines can be reported in writing to ICPNT by any individual associated with a given fellowship program.
i. An ad hoc committee can be formed, appointed by the ICPNT chair, to address issues and facts forming the basis for a given complaint.
ii. Internal issues are not addressed by ICPNT (e.g. interpersonal issues, finances, etc.)
A. A transcript describing the experiences of each fellow who successfully completes the accredited fellowship program will be provided to ICPNT by the program director. ICPNT will maintain such records as part of its mandate to collate outcomes of fellowship training. The graduate may request or approve that such information may be provided to any external source.
B. Outcome studies relative to fellowship training will be directed by ICPNT members so charged. Appropriate areas for review may include review of fellowship training experience, impact of fellowship on residents within the institution if applicable, proficiencies and special competencies gained from fellowship training, the role of fellowship training for future practicing and academic subspecialists, post fellowship appointments and productivity, as well as other outcome issues.
In the event of dissolution of the Council, all of the assets and property of every nature and description whatsoever remaining after the payment of liabilities and obligations of the Council, but not including assets held by the Council upon condition requiring return, transfer or conveyance, which condition occurs by reason of the dissolution of the Council, shall be paid over and transferred to the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) and no portion of said assets and property shall inure to the benefit of any member of the Council, SNACC Executive Committee or Board member, or any enterprise organized for profit.