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

  • Michael Robert HalsteadEmail author
  • Paul A. Nyquist
Part of the Current Clinical Neurology book series (CCNEU)


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.


Neurocritical care fellowship Certification in neurocritical care Neurocritical care training Neurocritical care curriculum Medical education UCNS (United Council of Neurologic Subspecialties) CAST (Committee on Advanced Subspecialty Training) ACGME (American Council on Graduate Medical Education) 


  1. 1.
    Bleck TP. Historical aspects of critical care and the nervous system. Crit Care Clin. 2009;25(1):153–64, ix.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Wijdicks EFM. Chapter 1 - the history of neurocritical care. Handb Clin Neurol. 2017;140:3–14. Scholar
  3. 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. Accessed 12/1/2017.
  4. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 6.
    Korbakis G, Bleck T. The evolution of neurocritical care. Crit Care Clin. 2014;30(4):657–71. Scholar
  7. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 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.PubMedPubMedCentralGoogle Scholar
  11. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Hodgson TS, Brorson JR, Ardelt AA, Lukas RV. Accrediting neurology fellowships accelerates subspecialization. Front Neurol. 2013;4:94.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 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. Scholar
  19. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    United Council for Neurological Subspecialties. Neurocritical care program requirements. Updated 2014. Accessed Feb 2018.
  22. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    United Council for Neurological Subspecialties. Eligibility requirements and information for applicants for recertification in neurocritical care. Updated 2018. Accessed Mar 2018.
  25. 25.
    United Council for Neurological Subspecialties. UCNS certification in neurocritical care eligibility criteria and information for applicants. Updated 2017. Accessed Feb 2018.
  26. 26.
    United Council for Neurological Subspecialties. Neurocritical care written examination content outline. Updated 2014. Accessed February, 2018.
  27. 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. 28.
    Barr DA. Revolution or evolution? Putting the flexner report in context. Med Educ. 2011;45(1):17–22.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Safar P, Grenvik A. Organization and physician education in critical care medicine. Anesthesiology. 1977;47(2):82–95.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Hitchcock MA. Introducing professional educators into academic medicine: stories of exemplars. Adv Health Sci Educ. 2002;7(3):211–21.CrossRefGoogle Scholar
  31. 31.
    Swanwick T. Understanding medical education. In: Swanwick T, editor. Understanding medical education. Hoboken: Wiley; 2013. p. 1–6. Scholar
  32. 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.§ionid=72056554. Accessed 2018/02/07.
  33. 33.
    Wilkerson L, Irby DM. Strategies for improving teaching practices: a comprehensive approach to faculty development. Acad Med. 1998;73(4):387–96.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Srinivasan M, Li ST, Meyers FJ, et al. “Teaching as a competency”: competencies for medical educators. Acad Med. 2011;86(10):1211–20.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Irby DM. What clinical teachers in medicine need to know. Acad Med. 1994;69(5):333–42.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Kauffman DM, Mann KV. Teaching and learning in medical education. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 7–29. Scholar
  38. 38.
    Schott CK. Teaching critical care. In: Textbook of critical care. 7th ed; 2017. p. 1297–300.Google Scholar
  39. 39.
    Russell SS. An overview of adult-learning processes. Urol Nurs. 2006;26(5):349–52, 370.PubMedGoogle Scholar
  40. 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.PubMedPubMedCentralGoogle Scholar
  41. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 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.PubMedPubMedCentralGoogle Scholar
  43. 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.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Schmidt HG. Problem-based learning: rationale and description. Med Educ. 1983;17(1):11–6.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 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)PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Bullock A, de Jong PG. Technology-enhanced learning. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 149–60. Scholar
  50. 50.
    Treasure-Jones T, Joynes V. Co-design of technology-enhanced learning resources. Clin Teach. 2018;15(4):281–6.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 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.CrossRefGoogle Scholar
  53. 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.CrossRefGoogle Scholar
  54. 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. Print 2012.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 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.CrossRefGoogle Scholar
  56. 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.CrossRefGoogle Scholar
  57. 57.
    Ker J, Bradley P. Simulation in medical education. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 175–92. Scholar
  58. 58.
    Maran NJ, Glavin RJ. Low- to high-fidelity simulation - a continuum of medical education? Med Educ. 2003;37(Suppl 1):22–8.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 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.CrossRefGoogle Scholar
  61. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Issenberg SB, McGaghie WC. Clinical skills training – practice makes perfect. Med Educ. 2002;36(3):210–1.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 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.CrossRefGoogle Scholar
  65. 65.
    Silverman J, Wood DF. New approaches to learning clinical skills. Med Educ. 2004;38(10):1021–3.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Dunkin MJ. A review of research on lecturing. High Educ Res Dev. 1983;2(1):63–78.CrossRefGoogle Scholar
  68. 68.
    Verner C, Dickinson G. The lecture, an analysis and review of research. Adult Educ. 1967;17(2):85–100.CrossRefGoogle Scholar
  69. 69.
    Long A, Lock B. Lectures and large groups. In: Swanwick T, editor. Understanding medical education. Chichester: Wiley; 2013. p. 137–48. Scholar
  70. 70.
    Van DV, Schuwirth LWT, Driessen EW, Govaerts MJB, Heeneman S. Twelve tips for programmatic assessment. Med Teach. 2015;37(7):641–6.CrossRefGoogle Scholar
  71. 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.CrossRefGoogle Scholar
  72. 72.
    Powell DE, Carraccio C. Toward competency-based medical education. N Engl J Med. 2018;378(1):3–5.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Ramaprasad A. On the definition of feedback. Behav Sci. 1983;28(1):4–13.CrossRefGoogle Scholar
  74. 74.
    Launer J. Giving feedback to medical students and trainees: rules and realities. Postgrad Med J. 2016;92(1092):627.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Tham TC, Burr B, Boohan M. Evaluation of feedback given to trainees in medical specialties. Clin Med (Lond). 2017;17(4):303–6.CrossRefGoogle Scholar
  76. 76.
    Hesketh EA, Laidlaw JM. Developing the teaching instinct, 1: feedback. Med Teach. 2002;24(3):245–8.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Neurology, Neuroanesthesiology and Critical Care MedicineJohns Hopkins UniversityBaltimoreUSA
  2. 2.Departments of Neurology, Neurosurgery, Anesthesiology & Critical Care Medicine, and MedicineJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations