Skip to main content
SpringerLink
Log in

Training, Certification, and Continuing Education of Fellows and Attendings in the Neurocritical Care Unit

  • Chapter
  • First Online:
Book cover Neurointensive Care Unit

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

The specialty of neurocritical care developed out of a need to care for post-neurosurgical patients and polio patients around the turn of the twentieth century. However, it was not until 2005 that the United Council of Neurologic Subspecialties (UCNS) formally recognized neurocritical care, providing the first examination for subspecialty certification. The advent of formal training demanded an outline of specific criteria for management of neurologic and medical sequela of neurologic injury and surgery. Core cognitive and procedural domains are now outlined and are a prerequisite for certification in neurocritical care, with board certification possible through UCNS. Fellowship training programs are required to evaluate their programs’ rigor and ability to meet these requirements to ensure they are training the highest quality trainee. Lastly, an approach to the adult learner is provided, targeted at educating within critical care generally and neurocritical care more specifically. In this chapter, we will touch on fundamental concepts of education important for medical educators, including strategies for effective delivery of material, evaluating trainees, and providing effective feedback.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    San Francisco Match, Neurocritical Care Fellowship, https://www.sfmatch.org/SpecialtyInsideAll.aspx?id=17&typ=1&name=Neurocritical%20Care

  2. 2.

    “Accreditation Interface” UCNS, 2018. http://tools.ucns.org/ai/Home/Authentication; Accessed in 2/2018

References

  1. Bleck TP. Historical aspects of critical care and the nervous system. Crit Care Clin. 2009;25(1):153–64, ix.

    Article  PubMed  Google Scholar 

  2. Wijdicks EFM. Chapter 1 - the history of neurocritical care. Handb Clin Neurol. 2017;140:3–14. https://doi.org/10.1016/B978-0-444-63600-3.00001-5.

    Article  CAS  PubMed  Google Scholar 

  3. Posner J, Saper C, Schiff N, Plum F. Plum and posner’s diagnosis of stupor and coma. In: 4th edn. New York: Oxford University Press. https://www.r2library.com/Resource/Title/0195321316. Accessed 12/1/2017.

  4. Marcolini EG, Seder DB, Bonomo JB, et al. The present state of neurointensivist training in the United States: a comparison to other critical care training programs. Crit Care Med. 2018;46(2):307–15.

    Article  PubMed  Google Scholar 

  5. Mayer SA, Coplin WM, Chang C, et al. Core curriculum and competencies for advanced training in neurological intensive care: United council for neurologic subspecialties guidelines. Neurocrit Care. 2006;5(2):159–65.

    Article  PubMed  Google Scholar 

  6. Korbakis G, Bleck T. The evolution of neurocritical care. Crit Care Clin. 2014;30(4):657–71. https://doi.org/10.1016/j.ccc.2014.06.001.

    Article  PubMed  Google Scholar 

  7. Mirski MA, Chang CW, Cowan R. Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care: evidence-based support for an intensivist-directed specialty ICU model of care. J Neurosurg Anesthesiol. 2001;13(2):83–92.

    Article  CAS  PubMed  Google Scholar 

  8. Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001;29(3):635–40.

    Article  CAS  PubMed  Google Scholar 

  9. Suarez JI, Zaidat OO, Suri MF, et al. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med. 2004;32(11):2311–7.

    Article  PubMed  Google Scholar 

  10. Sarpong Y, Nattanmai P, Schelp G, et al. Improvement in quality metrics outcomes and patient and family satisfaction in a neurosciences intensive care unit after creation of a dedicated neurocritical care team. Crit Care Res Pract. 2017;2017:6394105.

    PubMed  PubMed Central  Google Scholar 

  11. Varelas PN, Conti MM, Spanaki MV, et al. The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit. Crit Care Med. 2004;32(11):2191–8.

    Article  PubMed  Google Scholar 

  12. Burns JD, Green DM, Lau H, et al. The effect of a neurocritical care service without a dedicated neuro-ICU on quality of care in intracerebral hemorrhage. Neurocrit Care. 2013;18(3):305–12.

    Article  PubMed  Google Scholar 

  13. Dhar R, Rajajee V, Finley Caulfield A, et al. The state of neurocritical care fellowship training and attitudes toward accreditation and certification: a survey of neurocritical care fellowship program directors. Front Neurol. 2017;8:548.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sheth KN, Drogan O, Manno E, Geocadin RG, Ziai W. Neurocritical care education during neurology residency: AAN survey of US program directors. Neurology. 2012;78(22):1793–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hodgson TS, Brorson JR, Ardelt AA, Lukas RV. Accrediting neurology fellowships accelerates subspecialization. Front Neurol. 2013;4:94.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Markandaya M, Thomas KP, Jahromi B, et al. The role of neurocritical care: a brief report on the survey results of neurosciences and critical care specialists. Neurocrit Care. 2012;16(1):72–81.

    Article  PubMed  Google Scholar 

  17. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110.

    Article  PubMed  Google Scholar 

  18. Mirski MA. Establishing and organizing a neuroscience critical care unit. In: Bhardwaj A, Mirski MA, editors. Handbook of neurocritical care. 2nd ed. New York: Springer New York; 2010. p. 3–12. https://doi.org/10.1007/978-1-4419-6842-5_1.

    Chapter  Google Scholar 

  19. Mayer SA, Coplin WM, Chang C, et al. Program requirements for fellowship training in neurological intensive care: united council for neurologic subspecialties guidelines. Neurocrit Care. 2006;5(2):166–71.

    Article  PubMed  Google Scholar 

  20. Hawkins RE, Welcher CM, Holmboe ES, et al. Implementation of competency-based medical education: are we addressing the concerns and challenges? Med Educ. 2015;49(11):1086–102.

    Article  PubMed  Google Scholar 

  21. United Council for Neurological Subspecialties. Neurocritical care program requirements. https://www.ucns.org/globals/axon/assets/11594.pdf. Updated 2014. Accessed Feb 2018.

  22. Witteles RM, Verghese A. Accreditation council for graduate medical education (ACGME) milestones-time for a revolt? JAMA Intern Med. 2016;176(11):1599–600.

    Article  PubMed  Google Scholar 

  23. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system – rationale and benefits. N Engl J Med. 2012;366(11):1051–6.

    Article  CAS  PubMed  Google Scholar 

  24. United Council for Neurological Subspecialties. Eligibility requirements and information for applicants for recertification in neurocritical care. https://www.ucns.org/globals/axon/assets/12688.pdf. Updated 2018. Accessed Mar 2018.

  25. United Council for Neurological Subspecialties. UCNS certification in neurocritical care eligibility criteria and information for applicants. https://www.ucns.org/go/subspecialty/neurocritical/certification. Updated 2017. Accessed Feb 2018.

  26. United Council for Neurological Subspecialties. Neurocritical care written examination content outline. https://www.ucns.org/globals/axon/assets/3657.pdf. Updated 2014. Accessed February, 2018.

  27. Flexner A. Medical education in the United States and Canada : a report to the carnegie foundation for the advancement of teaching, vol. 4. New York: Carnegie Foundation for the Advancement of Teaching; 1910. p. 346.

    Google Scholar 

  28. Barr DA. Revolution or evolution? Putting the flexner report in context. Med Educ. 2011;45(1):17–22.

    Article  PubMed  Google Scholar 

  29. Safar P, Grenvik A. Organization and physician education in critical care medicine. Anesthesiology. 1977;47(2):82–95.

    Article  CAS  PubMed  Google Scholar 

  30. Hitchcock MA. Introducing professional educators into academic medicine: stories of exemplars. Adv Health Sci Educ. 2002;7(3):211–21.

    Article  CAS  Google Scholar 

  31. Swanwick T. Understanding medical education. In: Swanwick T, editor. Understanding medical education. Hoboken: Wiley; 2013. p. 1–6. https://doi.org/10.1002/9781118472361.ch1.

    Chapter  Google Scholar 

  32. Hall JB, Schmidt GA, Wood LDH. An approach to critical care. In: Hall JB, Schmidt GA, Kress JP, editors. Principles of critical care, 4e. New York: McGraw-Hill Education; 2015. https://accessmedicine-mhmedical-com.proxy1.library.jhu.edu/content.aspx?bookid=1340§ionid=72056554. Accessed 2018/02/07.

  33. Wilkerson L, Irby DM. Strategies for improving teaching practices: a comprehensive approach to faculty development. Acad Med. 1998;73(4):387–96.

    Article  CAS  PubMed  Google Scholar 

  34. Coates WC, Runde DP, Yarris LM, et al. Creating a cadre of fellowship-trained medical educators: a qualitative study of faculty development program leaders’ perspectives and advice. Acad Med. 2016;91(12):1696–704.

    Article  PubMed  Google Scholar 

  35. Srinivasan M, Li ST, Meyers FJ, et al. “Teaching as a competency”: competencies for medical educators. Acad Med. 2011;86(10):1211–20.

    Article  PubMed  Google Scholar 

  36. Irby DM. What clinical teachers in medicine need to know. Acad Med. 1994;69(5):333–42.

    Article  CAS  PubMed  Google Scholar 

  37. Kauffman DM, Mann KV. Teaching and learning in medical education. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 7–29. https://doi.org/10.1002/9781118472361.ch2.

    Chapter  Google Scholar 

  38. Schott CK. Teaching critical care. In: Textbook of critical care. 7th ed; 2017. p. 1297–300.

    Google Scholar 

  39. Russell SS. An overview of adult-learning processes. Urol Nurs. 2006;26(5):349–52, 370.

    PubMed  Google Scholar 

  40. Dunnington G, Witzke D, Rubeck R, Beck A, Mohr J, Putnam C. A comparison of the teaching effectiveness of the didactic lecture and the problem-oriented small group session: a prospective study. Surgery. 1987;102(2):291–6.

    CAS  PubMed  Google Scholar 

  41. Jin J, Bridges SM. Educational technologies in problem-based learning in health sciences education: a systematic review. J Med Internet Res. 2014;16(12):e251.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Al-Azri H, Ratnapalan S. Problem-based learning in continuing medical education: review of randomized controlled trials. Can Fam Physician. 2014;60(2):157–65.

    PubMed  PubMed Central  Google Scholar 

  43. Chilkoti G, Mohta M, Wadhwa R, Saxena AK. Problem-based learning research in anesthesia teaching: current status and future perspective. Anesthesiol Res Pract. 2014;2014:263948.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Schmidt HG. Problem-based learning: rationale and description. Med Educ. 1983;17(1):11–6.

    Article  CAS  PubMed  Google Scholar 

  45. Cohen-Schotanus J, Muijtjens AM, Schonrock-Adema J, Geertsma J, van der Vleuten CP. Effects of conventional and problem-based learning on clinical and general competencies and career development. Med Educ. 2008;42(3):256–65.

    Article  PubMed  Google Scholar 

  46. Polyzois I, Claffey N, Mattheos N. Problem-based learning in academic health education. A systematic literature review. Eur J Dent Educ. 2010;14(1):55–64.

    Article  CAS  PubMed  Google Scholar 

  47. Schmidt HG, Vermeulen L, Van Der Molen HT. Longterm effects of problem-based learning: a comparison of competencies acquired by graduates of a problem-based and a conventional medical school. Med Educ. 2006;40(6):562–7.

    Article  PubMed  Google Scholar 

  48. Steadman RH, Coates WC, Huang YM, et al. Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills. Crit Care Med. 2006;34(1)

    Article  PubMed  Google Scholar 

  49. Bullock A, de Jong PG. Technology-enhanced learning. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 149–60. https://doi.org/10.1002/9781118472361.ch11.

    Chapter  Google Scholar 

  50. Treasure-Jones T, Joynes V. Co-design of technology-enhanced learning resources. Clin Teach. 2018;15(4):281–6.

    Article  PubMed  Google Scholar 

  51. Pickering JD, Joynes VC. A holistic model for evaluating the impact of individual technology-enhanced learning resources. Med Teach. 2016;38(12):1242–7.

    Article  PubMed  Google Scholar 

  52. Reyna J, Hanham J, Meier P. The internet explosion, digital media principles and implications to communicate effectively in the digital space. E-Learning Digital Media. 2018;15(1):36–52.

    Article  Google Scholar 

  53. Hugenholtz NI, de Croon EM, Smits PB, van Dijk FJ, Nieuwenhuijsen K. Effectiveness of e-learning in continuing medical education for occupational physicians. Occup Med (Lond). 2008;58(5):370–2.

    Article  Google Scholar 

  54. Wallace S, Clark M, White J. ‘It’s on my iPhone’: attitudes to the use of mobile computing devices in medical education, a mixed-methods study. BMJ Open. 2012;2(4):e001099. https://doi.org/10.1136/bmjopen-2012-001099. Print 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Gaglani SM, Topol EJ. iMedEd: the role of mobile health technologies in medical education. Acad Med: J Assoc Am Med Coll. 2014;89(9):1207–9.

    Article  Google Scholar 

  56. Shortt SE, Guillemette JM, Duncan AM, Kirby F. Defining quality criteria for online continuing medical education modules using modified nominal group technique. J Contin Educ Heal Prof. 2010;30(4):246–50.

    Article  CAS  Google Scholar 

  57. Ker J, Bradley P. Simulation in medical education. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 175–92. https://doi.org/10.1002/9781118472361.ch13.

    Chapter  Google Scholar 

  58. Maran NJ, Glavin RJ. Low- to high-fidelity simulation - a continuum of medical education? Med Educ. 2003;37(Suppl 1):22–8.

    Article  PubMed  Google Scholar 

  59. MacDougall BJ, Robinson JD, Kappus L, Sudikoff SN, Greer DM. Simulation-based training in brain death determination. Neurocrit Care. 2014;21(3):383–91.

    Article  PubMed  Google Scholar 

  60. Hocker S, Schumacher D, Mandrekar J, Wijdicks EF. Testing confounders in brain death determination: a new simulation model. Neurocrit Care. 2015;23(3):401–8.

    Article  PubMed  Google Scholar 

  61. Scalese RJ, Obeso VT, Issenberg SB. Simulation technology for skills training and competency assessment in medical education. J Gen Intern Med. 2008;23(Suppl 1):46–9.

    Article  PubMed  Google Scholar 

  62. Issenberg SB, McGaghie WC. Clinical skills training – practice makes perfect. Med Educ. 2002;36(3):210–1.

    Article  PubMed  Google Scholar 

  63. Liddell MJ, Davidson SK, Taub H, Whitecross LE. Evaluation of procedural skills training in an undergraduate curriculum. Med Educ. 2002;36(11):1035–41.

    Article  PubMed  Google Scholar 

  64. Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100(3):363–406.

    Article  Google Scholar 

  65. Silverman J, Wood DF. New approaches to learning clinical skills. Med Educ. 2004;38(10):1021–3.

    Article  PubMed  Google Scholar 

  66. Schwartzstein RM, Roberts DH. Saying goodbye to lectures in medical school - paradigm shift or passing fad? N Engl J Med. 2017;377(7):605–7.

    Article  PubMed  Google Scholar 

  67. Dunkin MJ. A review of research on lecturing. High Educ Res Dev. 1983;2(1):63–78.

    Article  Google Scholar 

  68. Verner C, Dickinson G. The lecture, an analysis and review of research. Adult Educ. 1967;17(2):85–100.

    Article  Google Scholar 

  69. Long A, Lock B. Lectures and large groups. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 137–48. https://doi.org/10.1002/9781118472361.ch10.

    Chapter  Google Scholar 

  70. Van DV, Schuwirth LWT, Driessen EW, Govaerts MJB, Heeneman S. Twelve tips for programmatic assessment. Med Teach. 2015;37(7):641–6.

    Article  Google Scholar 

  71. der Vleuten CPM V, Swanson DB. Assessment of clinical skills with standardized patients: state of the art. Teach Learn Med. 1990;2(2):58–76.

    Article  Google Scholar 

  72. Powell DE, Carraccio C. Toward competency-based medical education. N Engl J Med. 2018;378(1):3–5.

    Article  PubMed  Google Scholar 

  73. Ramaprasad A. On the definition of feedback. Behav Sci. 1983;28(1):4–13.

    Article  Google Scholar 

  74. Launer J. Giving feedback to medical students and trainees: rules and realities. Postgrad Med J. 2016;92(1092):627.

    Article  PubMed  Google Scholar 

  75. Tham TC, Burr B, Boohan M. Evaluation of feedback given to trainees in medical specialties. Clin Med (Lond). 2017;17(4):303–6.

    Article  Google Scholar 

  76. Hesketh EA, Laidlaw JM. Developing the teaching instinct, 1: feedback. Med Teach. 2002;24(3):245–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Neuroanesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    Michael Robert Halstead

  2. Departments of Neurology, Neurosurgery, Anesthesiology & Critical Care Medicine, and Medicine, Johns Hopkins University, Baltimore, MD, USA

    Paul A. Nyquist

Authors
  1. Michael Robert Halstead
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul A. Nyquist
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Robert Halstead .

Editor information

Editors and Affiliations

  1. Johns Hopkins University, Baltimore, MD, USA

    Sarah E. Nelson

  2. Johns Hopkins University, Baltimore, MD, USA

    Paul A. Nyquist

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Halstead, M.R., Nyquist, P.A. (2020). Training, Certification, and Continuing Education of Fellows and Attendings in the Neurocritical Care Unit. In: Nelson, S., Nyquist, P. (eds) Neurointensive Care Unit. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-36548-6_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-36548-6_19

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-36547-9

  • Online ISBN: 978-3-030-36548-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation