|
 NUMBER
22
AMERICAN BOARD OF NEUROLOGICAL SURGERY
2004
NEUROLOGICAL
SURGERY
is a discipline of medicine and that
specialty of surgery that provides
the operative and non-operative management
(i.e. prevention, diagnosis, evaluation,
treatment, critical care, and rehabilitation)
of disorders of the central, peripheral,
and autonomic nervous systems, including
their supporting structures and vascular
supply; the evaluation and treatment
of pathological processes that modify
the function or activity of the nervous
system, including the hypophysis;
and the operative and non-operative
management of pain. As such, Neurological
Surgery encompasses the surgical,
non-surgical, and stereotactic radiosurgical
treatment of adult and pediatric patients
with disorders of the nervous system:
disorders of the brain, meninges,
skull, and skull base, and their blood
supply, including the surgical and
endovascular treatment of disorders
of the intracranial and extracranial
vasculature supplying the brain and
spinal cord; disorders of the pituitary
gland; disorders of the spinal cord,
meninges, and vertebral column, including
those that may require treatment by
fusion, instrumentation or endovascular
techniques; and disorders of the cranial
and spinal nerves throughout their
distribution.
The broad aim of the
AMERICAN BOARD OF NEUROLOGICAL SURGERY
is to encourage the study, improve
the practice, elevate the standards,
and advance the science of neurological
surgery, and thereby to serve the
cause of public health.
ARTHUR L. DAY, MD
CHAIRMAN, 2003-2004
VOLKER K. H. SONNTAG,
MD VICE-CHAIRMAN, 2003 - 2004
MARC A. MAYBERG, MD
TREASURER
RALPH G. DACEY, JR.,
MD SECRETARY, 2000-2004
ARTHUR L.
DAY, MD CHAIRMAN, 2003-2004
The Directors of the American Board
of Neurological Surgery face increasing
responsibilities and challenges as
the business of certifying neurosurgeons
becomes inextricably bound with the
processes of education and competency
assessment. In this Newsletter I want
to report our progress, particularly
in the area of Maintenance of Certification.
Let me start by reviewing the most
recent statistics pertinent to the
Board’s duties and functions.
Resident Numbers and Neurosurgical
Match
There were 95 accredited neurosurgical
residency programs in the United States
during the 2003-2004 academic year.
Eight hundred twenty-six residents
were in training; 136 graduated in
June 2003. In January 2003 301 individuals
registered with the Neurological Surgery
Match. Two hundred fifty-two submitted
rank lists, and 137 were matched.
Over the past five years, the number
of individuals registering for the
Match has declined by 22%, but the
number of rank lists submitted has
decreased by only 2%.
Primary Examination
The Primary Examination is administered
annually to neurosurgical trainees
and neurosurgeons re-entering the
certification process. The examination
covers the breadth of our specialty’s
clinical and basic science curricula.
It may be taken for self-assessment
but must be taken and passed for credit
prior to applying for oral examination
and certification. For residents entering
training after June 30, 1998, ABNS
and Residency Review Committee for
Neurological Surgery requirements
specify that it must be passed while
in residency in order to successfully
complete training. Many Program Directors
require trainees to pass it before
progressing to chief resident.
The March 2003 Primary Examination
was administered to 498 examinees.
Two hundred fifteen took it for credit;
the fail rate was 14%.
Oral Examination
Oral examinations, the final step
in the certifi- cation process, are
administered each spring and fall.
Candidates must have graduated from
accredited US or Canadian residency
programs, hold unencumbered licenses
and hospital privileges, demonstrate
good professional standing as assessed
by mentors and peers, and show satisfactory
practice performance through review
of a minimum of one year’s inpatient
cases. In November 2002 90 candidates
sat for oral examination with an 11%
failure rate.
In May 2003 90 individuals were examined
with 8% failing. Candidate performance
is scored independently by 6 examiners.
Raw scores are fed into a computer
program that adjusts for variations
in examiner severity, thus maximizing
the objectivity of the process. From
the resulting statistics, Directors
determine candidates’ pass/fail
status. Standardized questions are
being tested for a portion of the
examination.
Residents entering Canadian programs
as of July 16, 1997 are ineligible
for ABNS certi- fication. Directors
recently reviewed this policy with
a representative of the Canadian Board.
After extensive debate, no change
was made.
Maintenance of Certification
(MOC)
The ABNS issued its first time-limited
certifi- cate in May 1999. Since then
Directors have developed many of the
components of its MOC program in preparation
for meeting the requirements of the
ABMS. Dr. Sonntag, chairman of the
MOC Committee, did a spectacular job
in leading this effort and setting
the ABNS on solid footing to reach
our goals with reasonable effort from
Diplomates.
Evidence of Professional Standing
will require an unrestricted licensure
and some manner of evaluation by peers.
Cognitive Expertise will be assessed
with a secure, multiple choice examination
that covers basic knowledge, as well
as subspecialty specific information.
Methodologies for demonstration of
involvement in Life Long Learning
and Self-Assessment will be fulfilled
by periodic completion of the Self-
Assessment in Neurological Surgery
(SANS) program produced by the Congress
of Neurological Surgeons. For Continuing
Education the ABNS is working with
the American Association of Neurological
Surgeons to develop a program that
will document fulfillment of 150 CME
credits every three years. This corresponds
to the requirements for membership
in the AANS and CNS. Practice Performance
will include an outcome analysis of
key cases every three years (for instance,
lumbar disk or AVM), plus submission
of six months of practice data every
ten years for a review similar to
that required for initial certification.
NeuroLog
NeuroLog is an internet based, data
collection tool developed by the ABNS
to facilitate the gathering of practice
information for primary certification
and MOC, as well as RRC resident case
log accumulation and site reviews.
The system is highly secure, HIPAA
compliant, and can be used from residency
through the life of a practice.
- Primary Certification: Candidates
must submit a twelve month report
of all inpatients. NeuroLog provides
the necessary data fields to complete
this requirement and incorporates
an efficient online mechanism for
review of the data by the Board.
- MOC: While the exact criteria
for practice data documentation
as a component of MOC has yet to
be defined, NeuroLog will be amended
to meet the standards. Diplomates
certified prior to 1999 (who are
not required to enter the MOC process
but are encouraged to do so) would
be free to use NeuroLog for their
own practice assessment. The system
gathers demographics, as well as
diagnostic, procedural, and outcome
information, that should be useful
for the specialty.
- Program Directors, Residents,
and RRC: NeuroLog has also been
adapted for use by Program Directors
to accumulate the data required
by the RRC. It tracks the necessary
elements for residents, fellows,
and attending physicians to meet
current documentation standards.
The cataloging of operative data
is streamlined and driven by a hierarchical
“drill down” paradigm
that yields both CPT codes and appropriate
ABNS/RRC procedural categories.
As an added advantage, residents
can learn to use and understand
the CPT coding structure.
Revocation of Certification
Directors have amended the
Bylaws to provide more flexibility
in disciplining Diplomates for licensure,
practice, and ethical problems. In
the past the Board’s only option
was to take no action or to take the
extreme measure of revoking a certificate.
Now the ABNS may impose lesser sanctions
when appropriate, such as suspension
or probation. Cases are vetted by
the Credentials Committee, which makes
recommendation for action to Directors.
Resident Duty Hours
Being committed to the welfare of
our residents and the safe delivery
of care to patients, the ABNS, RRC,
and Society of Neurological Surgeons
have major concerns regarding the
resident duty hours restrictions mandated
by the Accreditation Council for Graduate
Medical Education. There is serious
concern that their lack of flexibility
will adversely impact resident opportunities,
expectations for continuity of care,
overall operative experience, and
development of essential neurosurgical
discipline and professionalism. The
ACGME rejected a proposal from the
ABNS for a specialty wide exemption
to the requirements. Recently, however,
the ACGME and RRC have extended the
80 hour requirement to 88 hours for
senior residents at programs that
have obtained local approval and filed
appropriate forms describing the educational
value of such an extension and how
resident fatigue will be monitored.
The extensions are valid until the
next RRC site review for the program.
ABNS Directors
The Advisory Council, which previously
consisted of current officers and
the last six past chairmen, has been
expanded to include all Directors
as they leave the Board. The change
was made to keep the expertise of
Directors within the ABNS for an extended
period. The group meets at AANS and
American Academy of Neurological Surgeons
meetings for updates and to discuss
issues, and add their experienced
counsel on problems facing the organization.
At its spring 2003 meeting, Drs.
David G. Piepgras and R. Michael Scott
completed their six years of contributions
and leadership on the ABNS and moved
to the Advisory Council. Newly elected
Directors were Drs. M. Sean Grady
and Robert L. Martuza. New officers
were Dr. Day, chairman; Dr. Sonntag,
vice chairman, and Dr. Marc R. Mayberg,
treasurer. Dr. Ralph G. Dacey, Jr.
remains as secretary.
Click
here if you would like to respond
to the article above
VOLKER K.
H. SONNTAG, MD VICE-CHAIRMAN, 2003
- 2004
The American Board of Neurological
Surgery is working to launch its MOC
process in 2005. The American Board
of Medical Specialists is reviewing
the ABNS application for three of
the four components of the program:
• Evidence of Professional Standing
• Evidence of Life-Long Learning
and Self-Assessment • Evidence
of Cognitive Knowledge Evidence of
Performance in Practice is still being
developed by most Boards, including
the ABNS, and will be evaluated by
the ABMS in 2005. Directors have made
several changes in the process that
should streamline it for Diplomates.
Initially, the cycle of requirements
for Evidence of Professional Standing,
Life-Long Learning and Self-Assessment,
and Performance of Practice was on
a two-year basis. In order to make
these less onerous, the cycle has
been lengthened to three years. Documentation
of an unrestricted license to practice
medicine will be reported every three
years, and key cases will be submitted
every three years. Initially, Diplomates
were to be required to have evidence
of completing 100 CMEs every two years,
but that has been changed to 150 every
three years. The ABNS is working with
the AANS on tracking CMEs. Once Directors
have decided what can be applied to
fulfill the requirement, the AANS
will track them. The AANS automatically
tracks programs they sponsor or co-sponsor,
and other credits will be accounted
for as Diplomates send documentation
to the AANS. The service will have
no charge for AANS members, though
a minimal fee will be assessed to
nonmembers. With the help of the CNS,
the ABNS will include the SANS program
as one of the components for Life-Long
Learning and Self- Assessment. Diplomates
will take it every three years.
The complete MOC process is based
on a ten year cycle. The first nine
years are on three year rotations
as described. The tenth year will
be dedicated to a cognitive examination.
Dr. William F. Chandler is in the
process of putting together the first
MOC examination. A pilot test will
be given in October 2005, and in 2007
the first examination will be available
for Diplomates certified in 1999.
Notwithstanding the ten-year time-frame,
the examination may be taken as early
as the seventh year of the cycle.
During the final year, six months
of practice data may also need to
be logged for review.
Directors are exploring methods of
evaluating Diplomate communication
skills as a component of Evidence
of Performance in Practice. Current
and several former Directors and guest
examiners participated in a pilot
program administered by the ABMS to
test their assessment tool and determine
whether it could be used by the ABNS.
It consisted of 25 patients answering,
via the telephone or internet, 18
relatively simple questions on his
or her neurosurgeon’s ability
to communicate.
Directors are actively working to
educate and communicate the MOC program
to Diplomates. You should have received
a general letter in March and might
want to check the ABNS.org website
where updates on MOC will be posted
regularly. Neurosurgical organizations,
societies, and program directors have
been asked to help by allowing Directors
to present the program to their members.
Directors believe that MOC should
be educational and non-punitive, rewarding
not only to participants, but also
to patients. They hope all Diplomates
will participate.
Click
here if you would like to respond
to the article above
MARC A. MAYBERG,
MD TREASURER
The financial status of the American
Board of Neurological Surgery is solid
due to substantial efforts by Dr.
Day, the previous treasurer, who reorganized
the ABNS financial structure and the
office in Houston. The outmoded computer
system was replaced so that, with
a relatively small capital investment,
the office now processes records,
invoices, and correspondence in a
more efficient manner. This has enabled
a reduction in office staff from three
to two and is producing significant
improvements in effi- ciency. In addition,
the project has enabled accurate,
real-time, financial accounting, which
provides up-to-the-moment statements
regarding account balances, revenues,
and historical expense records. It
has, thus, been possible to reduce
funds sequestered in checking accounts
and run the office on a budget-neutral
basis throughout the year. An audit,
instead of a review, was undertaken
by the Board for the year 2001. This
provided additional external oversight
and an accurate analysis of revenue
and expense categories. Another audit
will be performed for 2004.
Using information derived from the
improved fiscal analysis, Directors
have matched the annual assessment
of actively practicing Diplomates,
Primary Examination fee, and candidate
application and oral examination fees
to the expenses for various activities.
For 2004 Directors approved a fee
of $2,500 for oral examination but
did not raise the $420 fee for the
Primary Examination. The application
for oral examination fee was prorated
to encourage submission of applications
and practice data during the early
years after residency since late submission
is unusually time-consuming for office
personnel and delays the processing
of other applications. Fees approved
for 2004 are: submission up to 36
months after residency $500; 37 through
48 months $750; and 49 through 60
months $1,000. The annual assessment
of actively practicing Diplomates
remains at $125.
The ABNS was able to maintain a budget-neutral
status in 2003, although net income
was negligible. Major expenses included
payments to DataHarbor to develop
NeuroLog. It is anticipated that expenses
for office supplies and printing,
postage and delivery, and payroll
will decrease as utilization of electronic
data transmission and a paperless
office reduce dependence upon manual
copying and mailing. Expense categories
that have increased in recent years
relate to insurance and professional
fees for legal consultation, both
of which are substantially due to
the changing medical-legal environment.
Rates based on volume discounts have
been negotiated with selected vendors
to decrease expenses for meetings.
The ABNS maintains a reserve invested
in balanced funds, which over the
past two years has provided returns
better than those achieved by a comparative
index of the S&P 500. Although
it has occasionally been necessary
to withdraw from the reserves, no
withdrawals were made in 2003. Accurate
fiduciary accounting has enabled Directors
to plan for future projects, including
MOC, which will be a major consideration
for future budgets. Specific costs
for the program are being calculated,
although several aspects and their
practical implementations remain under
development. There is no question
that MOC will necessitate additional
costs and likely additional office
personnel; however, it is anticipated
that charges to Diplomates can be
kept low.
Click
here if you would like to respond
to the article above
RALPH G.
DACEY, JR., MD SECRETARY, 2000-2004
Directors of the American Board of
Neurological Surgery are often asked
how they are selected. Briefly, six
organizations sponsor Directors.
American Association of Neurological
Surgeons 4
Society of Neurological Surgeons
4
Congress of Neurological Surgeons
3
American Academy of Neurological
Surgeons 1
American College of Surgeons 1
Neurosurgical Society of America
1
Terms of Director, who serve for
six years, are staggered so that each
year two or three new individuals
are appointed. About six months prior
to the end of a Director’s term,
the sponsoring organization submits
a list of at least five neurosurgeons
for consideration. These are sent
to the fourteen current Directors
for vote. The ABNS Nominating Committee-Directors,
with input from the Advisory Council,
makes up a slate, which Directors
vote on at their May meeting. Selection
is based on several factors, including
the candidate’s interest in
neurosurgical education, performance
as a guest oral examiner, expertise
the individual would bring to the
Board, and maintaining a geographic
balance and balance of academic versus
private practice. All Directors serve
without compensation. On the next
page is a list of Directors with their
sponsoring organization.
Click
here if you would like to respond
to the article above
The fourteen Directors
of the American Board of Neurological
Surgery hope this Newsletter has been
of interest to you. If you have any
questions, advice, or comments, please
write to the office or e-mail us at
abns@tmh.tmc.edu. Notices of change
of address are always appreciated,
and it is helpful to learn of change
of status to retired since assessment
statements are sent only to active
practitioners. Diplomates overwhelmingly
continue to support the Board’s
commitment to continuing improvement
of the certification process and the
search for an acceptable MOC process
through the voluntary dues program.
Thank you.
CURRENT DIRECTORS AND THEIR
SPONSORING ORGANIZATIONS
American Academy of Neurological Surgeons
Robert L. Martuza, MD American Association
of Neurological Surgeons M. Sean Grady,
MD Hal L. Hankinson, MD A. John Popp,
MD Warren R. Selman, MD American College
of Surgeons Paul C. McCormick, MD
American Medical Association Jon H.
Robertson, MD (Will revert to the
CNS in 2006)
Congress of Neurological Surgeons
Marc R. Mayberg, MD William F. Chandler,
MD Neurosurgical Society of America
Richard B. Morawetz, MD Society of
Neurological Surgeons H. Hunt Batjer,
MD Kim J. Burchiel, MD Ralph G. Dacey,
Jr., MD Robert A. Solomon, MD
Administrator Mary Louise Sanderson |
