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Subspecialty Training & Fellowships


    1. Accreditation of residency training programs is an established process through the Accreditation Council of Graduate Medical Education (ACGME) and its specialty Residency Review Committees (RRC). For neurosurgery, the role of the RRC relative to supplemental training (i.e. subspecialty fellowships) is limited to the evaluation of impact of the fellowship on residency training.

    2. Certification (by the ABNS) constitutes an affirmation that the specialist has completed established training requirements, has met professional standards established by peers, and has successfully passed examinations for fundamental knowledge and judgment. Maintenance of Certification is an ongoing process of meeting competency requirements, also administered by the ABNS.

    3. Among the requirements for ACGME recognition and accreditation of subspecialty (fellowship) training are:

      1. The content of the fellowship must represent a "new body of knowledge".

      2. The fellowship must be twelve months in duration.


    After considerable deliberation and discussions, a Summit meeting was held in conjunction with the 1999 AANS meeting to make resolutions relative to neurosurgery subspecialty training and fellowships. Attending were representatives of the Residency Review Committee for Neurological Surgery, The Society of Neurological Surgeons, American Board of Neurological Surgery, Congress of Neurological Surgeons and American Association of Neurological Surgeons. During this meeting the SNS was assigned responsibility for development of a process for oversight of neurosurgery fellowship training programs and the subspecialty training requirements.

    The Summit meeting proposed the following guidelines to the SNS:

    1. Certification for supplemental training will be from the sponsoring fellowship program.

    2. There will be no subspecialty certification by the ABNS

    3. Unless ACGME accreditation of the subspecialty training exists, the RRC will evaluate fellowships only in regard to their impact on resident training: The training of fellows must not adversely affect residents' core training.

    4. Flexibility in regard to timing and duration of additional subspecialty training is desirable. Enfolding of subspecialty training into residency elective time should be preserved and encouraged.

    In May 2001, the SNS membership adopted Structure, Policies and Procedures to provide oversight and accreditation of subspecialty training and fellowships for neurosurgery under a Committee on Accreditation of Subspecialty Training (CAST).


    1. Principles Pertaining to Neurosurgery Subspecialty Training

      Neurosurgery fellowship accreditation will be based on the following principles:

      1. Completion of ACGME approved residency training is sufficient to allow practice of neurosurgery. Post-residency fellowship is not needed for either competent practice of or reimbursement for delivery of neurosurgical patient care within the definition of neurosurgery promulgated by the ABNS and RRC for Neurological Surgery.

      2. The development and management of accreditation of neurosurgical fellowships by The Society of Neurological Surgeons through the CAST structure is in the best interest of neurosurgery by helping to ensure the quality of the educational experience.

      3. “Fellowships” are a post-graduate subspecialty training experience. Fellowships are usually one year in duration, but in certain instances may be shorter or longer as determined by the qualifications of the trainee, the body of knowledge, and the skills to be learned.

      4. “Enfolded subspecialty training” is done during the residency years. This type of training does not constitute a “fellowship”, but it may in itself be of sufficient depth and breadth to provide a higher level of subspecialty expertise than that achieved during the usual residency training.

      5. Training requirements for the aforementioned postgraduate fellowship are established by the subspecialty, preferably through its neurosurgical joint section and will specify duration and components of training, requirements for facilities, faculty, affiliated services and minimum case material at the fellowship site. Fellowship requirements must include a curriculum for knowledge and procedural objectives to be attained in the fellowship. Requirements can stipulate minimum case requirements for each fellow.

    2. Committee on Accreditation of Subspecialty Training

      The Committee on Accreditation of Subspecialty Training shall be responsible for accreditation of subspecialty training fellowships in neurosurgery and for development and updating of subspecialty training requirements. Additionally, this Committee shall have responsibility for promulgating study and analysis of outcomes relative to neurosurgical subspecialty training and when necessary developing and monitoring programs for a neurosurgery fellowship match.

    3. Committee Structure & Responsibilities

      The Committee on Accreditation of Subspecialty Training (CAST) will function under and be responsible to the Council of The Society of Neurological Surgeons. The Committee will be comprised of a Chair, a Secretary/Treasurer, and three additional members. The membership of CAST will be appointed by the Council from the Active SNS membership. Representation on CAST by current or past members of the RRC for Neurological Surgery is desirable so as to maintain familiarity with training programs and principles of the accreditation process. Terms of service on CAST will be staggered among the members and will be for two years with one renewal option for a maximum term of four years.

      The Chair of CAST will have responsibility for directing the Committee’s activities and convening meetings as necessary to meet its responsibilities. When necessary, meetings of CAST may be carried out by conference calls and electronic media so as to facilitate completion of its agenda. The Chair of CAST will be an ad hoc member of the SNS Council for the purpose of communicating CAST deliberations and facilitating Council oversight of CAST activities.

      The Secretary/Treasurer of CAST shall maintain records of CAST deliberations and actions as well as accreditation status and review cycles of accredited fellowships. The Secretary/Treasurer will be responsible for pertinent and timely notifications of each fellowship involved in and related to the accreditation process. Further it shall be the responsibility of the Secretary/Treasurer to collect application fees and maintain financial books relative to income and disbursements.

      The three non-officer members of CAST will have responsibility for one of the following:

      1) Application/Training Requirements; 2) Appeals; and 3) Outcomes.

      1. Applications and Training Requirements

        It is the responsibility of the CAST member so designated to assure that subspecialty training requirements are reviewed and updated every five years, seeking input from the SNS membership, the subspecialty sections and fellowship training directors. It will be the responsibility of this CAST member to collate and establish a consensus for final approval of revised requirements by CAST.

      2. Appeals

        The CAST member for Appeals will be responsible for managing all accreditation appeals according to the prescribed procedures.

      3. Outcomes

        The CAST member for Outcomes shall have the responsibility to convene a subcommittee for the study of outcomes related to fellowship training.

    4. Fellowship Review Committee

      There shall be a Fellowship Review Committee (FRC) comprised of SNS members with acknowledged interest and active clinical practice in each of the subspecialty areas to assist CAST in the review of programs and development/maintenance of subspecialty training requirements. Members of the FRC will serve without defined terms of service. The Chair or Secretary/Treasurer of CAST will, with input from the Joint Section leadership, appoint FRC members (2 or 3 in number) to constitute a panel for assisting in review of applications for fellowship accreditation and making recommendations to CAST in this regard. Additionally members of this body may serve in development and revision of fellowship training requirements as determined by the CAST member responsible for this activity.

    5. Accreditation Process

      SNS accreditation is limited to those fellowships which exist within ACGME accredited neurosurgery training programs (or the Canadian equivalent) and have current RRC for Neurological Surgery authorization for existence of the specific fellowship. An application fee will be paid by the sponsoring residency training program to a separate CAST account. Fees will be set by CAST and will be consistent and in an amount to cover application, review and administration costs. Application fees will be subject to review and approval by the SNS Council.

      Applications for fellowship accreditation will be submitted to the Secretary of the SNS. These will be forwarded to the Chair and Secretary/Treasurer of CAST who will have the discretion to complete the review within CAST or utilize additional subspecialty reviewers from the FRC. At a minimum, two CAST members must review the application and prepare a critique with accreditation recommendations for discussion and action at the next CAST meeting. An alternate review process may be carried out by one member of CAST and two or three appointed subspecialty reviewers from the FRC. Critique and recommendations from the FRC reviewers shall be collated and summarized by the designated CAST reviewer for presentation to CAST at its next working meeting.

      Judgments regarding accreditation shall be made based on compliance with the established fellowship training requirements. All deliberations will be in accordance with established policies regarding conflict of interest. A minimum of four members of CAST must be present for accreditation decisions. Accreditation decisions will be made by a majority vote of CAST members.

      The CAST may at its discretion require a site visit by a CAST member to obtain information not adequately represented in the application. The expense of this visit will be predetermined to cover transportation, meal and lodging expenses as well as an honorarium for the reviewer and will be the responsibility of the sponsoring program’s department/division. These arrangements will be made prior to the site visit.

      After initial accreditation, re-review of a fellowship will coincide with the ACGME reviews of the sponsoring department/division residency training program and must be completed within six months of RRC final accreditation decisions.

      For fellowship training programs in which there has been ACGME (or equivalent) re accreditation without adverse actions and all aspects of the fellowship program are stable, fellowship re-accreditation may be decided by CAST exclusive of additional FRC review, which in such cases shall be at the discretion of CAST.

      When a CAST accredited subspecialty fellowship makes a significant change in program structure or undergoes major changes in fellowship faculty, especially fellowship program director, the residency program director shall inform the SNS or CAST Secretary within six months of the change. Likewise, the SNS or CAST Secretary must be informed within six months of major ACGME accreditation rulings regarding the sponsoring residency training program. Substantial changes, such as change in program director, in the sponsoring residency training program or fellowship may, at the discretion of CAST, be cause for review of fellowship and its accreditation.

    6. Appeals

      Appeal of a decision by CAST will be submitted in letter form to the Secretary of the SNS. The letter must address specifics in detail. The Secretary of the SNS will send the appeal to the member of CAST in charge of Appeals who will convene an ad hoc appeals committee to hear the appeal which may be presented in writing or in person by the fellowship director and/or program chair of the fellowship in question. The Ad Hoc Appeals Committee shall consist of three members from the SNS with expertise in the subspecialty, who have not participated in the original review and have no other conflict of interest. The recommendation of the Appeals Subcommittee shall be presented to the Council by the CAST member for Appeals at its annual or interim meeting for ratification.

    7. Outcomes

      Outcome studies relative to fellowship training will be directed by the CAST member so charged. Appropriate areas for review may include review of fellowship training experience, impact of fellowship on residents within the training program, proficiencies and special competencies gained from fellowship training, the role of fellowship training for future practicing and academic neurosurgeons, as well as other outcome issues. These studies and pertinent recommendations will be reported to CAST, the Council and the SNS membership as appropriate.

    8. Fellowship Match

      When deemed necessary by a coalition of fellowship program directors and the SNS membership, mechanisms and procedures may be developed or contracted under direction of CAST and the SNS Council for a subspecialty fellowship match. The cost for such a match will be borne equitably by the accredited fellowship programs and not by SNS or CAST.

  4. SNS/CAST Members

    • Volker K. H. Sonntag, MD, Chair
    • Steven L. Giannotta, MD, Secretary/Treasurer
    • Robert H. Rosenwasser, MD
    • Dennis D. Spencer, MD
    • Frederick A. Boop, MD


    Approved Program List


    Advanced Training in NeuroCritical Care: Neurological Surgery

    Cerebrovascular Neurosurgery

    Endovascular Neurosurgery

    Neurologic Surgery of the Spine

    Neurosurgical Oncology

    Clinical Curriculum for Subspecialty Training in Neurosurgical Oncology

    Pediatric Neurologic Surgery

    Peripheral Nerve

    Stereotactic and Functional Neurosurgery

    Curriculum for Subspecialty/Fellowship Training
    in Stereotactic and Functional Neurosuregry


    Application Accreditation of Neurologic Surgery Subspecialty Fellowship: PDF Document (55KB) Word Document (838KB)

Copyright © 2008 The Society of Neurological Surgeons