Core Program Requirements

1. Fellowship Director

   1. A fellowship director must be named. This person has responsibility for designing and administering the educational program, the clinical schedule, and determining whether trainees have met the criteria for graduation from the program.
   2. The fellowship director must be a neurologist certified by the American Board of Psychiatry and Neurology (ABPN), the Royal College of Physicians and Surgeons of Canada (RCPSC), or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) and must possess a current license to practice in the State or Province in which the fellowship takes place.
   3. The fellowship director should be afforded an appropriate allocation of protected time to complete the duties required to administer the program. This time should take into consideration the development and growth of the program, the number of fellows, and what additional institutional support is available to sustain the program. This time should be comparable to other fellowship directors of similarly sized programs at the sponsoring institution.

2. Faculty

   1. Faculty in the program include any physician providing direct supervision of the Fellow during core clinical rotations (defined below in section 5.b.).
   2. Faculty must be certified by their respective American Medical or Osteopathic Specialties board or the RCPSC and must possess a current license to practice in the State or Province in which the fellowship takes place.
   3. All Faculty participating in the program at the time of accreditation application or continuing review must be listed and their board certification documented.
   4. An accredited program must have at least three faculty members, including the fellowship director.

3. Application and appointment process

   1. Eligible applicants must have graduated from an ACGME-accredited or CanERA-accredited adult or pediatric neurology residency program in the United States or Canada. The applicant must be eligible to obtain a license in the State or Province where the fellowship will take place, and must be eligible to live and work in the United States or Canada during the fellowship training period.
   2. When an applicant is offered a fellowship position, they must be informed of the following: salary and other financial support based on post-graduate year level, vacation, paid sick leave, parental leave, professional liability insurance, and insurance benefits including health, dental, vision, long-term and short-term disability.
   3. When the program and applicant mutually agree on a fellowship position, the applicant must be provided with a contract that contains the following:
      1. General responsibilities
      2. All items listed in 3.b.
      3. Requirements for program completion.

4. Length and size of program, and graduation requirements

   1. The length of appointment to a Clinical Neurohospitalist fellowship training program must be at least 12 months and not more than 24 months. Fellows must complete at least 6 but no more than 12 months of core clinical rotations (defined below) during the fellowship period.
   2. The program may train as many fellows as can be accommodated by the clinical training environment, such that fellows gain the experience necessary to reach the required competencies. The range of fellows trained each year must be specified (0 to n). Exceeding the maximum number of trainees may result in loss of accreditation.
   3. The program must be designed to allow fellows to achieve a level of entrustment that allows fully independent practice as a Neurohospitalist. Certification of completion must be based on the fellow’s achieving entrustment for independent Neurohospitalist practice in the six core competencies defined by the ACGME (patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, systems-based practice) and the Neurohospitalist core competencies as defined by the Neurohospitalist Society (Neurohospitalist core competencies).

5. Curriculum

   1. Learning goals and objectives
      1. It is the responsibility of the fellowship director to design a curricular program that ensures fellows graduate with a level of entrustment that allows fully independent practice as a Neurohospitalist in the six core competencies defined by the ACGME (patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, systems-based practice) and the Neurohospitalist core competencies.
      2. At the outset of the program, the fellowship director must provide trainees with the program’s goals and objectives.
      3. The program’s goals and objectives must address each of the six core competencies defined by the ACGME as well as the Neurohospitalist core competencies.
   2. Clinical Schedule
      1. For at least 6 months of the program, the fellow must be engaged in direct neurological patient care in an inpatient setting. Care in this setting may be provided in a primary or consultative role. These rotations constitute the core clinical rotations and may include neurology inpatient primary service, neurology inpatient consultative service, neurovascular/stroke, neurocritical care, etc.
      2. In a 12-month program, the remaining time may be distributed among additional inpatient clinical rotations, outpatient clinical experiences, elective clinical experiences, scholarly pursuits, and vacation in accordance with local institutional policies. The schedule requirements are designed to be flexible enough to allow fellows to complete the program even if a need to take leave arises (e.g., parental), as long as the minimum 6 months of core clinical rotations are completed and the leave is taken in accordance with local institutional policies.
      3. Programs seeking accreditation must provide a sample fellowship schedule listing clinical rotations and experiences. Each clinical rotation and experience must be linked to learning goals and objectives listed in 5.a.
   3. Didactics
      1. The program must provide a fellowship-specific didactic series. These may include lectures, seminars, one-on-one case review sessions, simulations, etc.
      2. A list of fellowship-specific didactic topics must be provided for accreditation. Each didactic must be linked to learning goals and objectives listed in 5.a.
   4. Learner Evaluation
      1. Evaluation of fellows must take place at least quarterly. Evaluations must include feedback from all program faculty, and a written record of evaluations must be kept. Evaluations should comment on the fellow’s progress toward the level of entrustment in the Neurohospitalist core competencies required for program completion.
      2. Evaluations must be discussed with the fellow at least twice per year by the fellowship director or a designated faculty member.
      3. Upon program completion, a written final evaluation must be provided, which incorporates feedback from all program faculty. This final summary evaluation serves as documentation the fellow has met the program requirements and can practice independently and must be signed by both the fellowship director and the graduating fellow.
   5. Faculty Evaluation
      1. Program faculty must be evaluated by the fellowship director annually.
      2. Faculty evaluation should include clinical competence and teaching ability.
      3. There must be a system in place for fellows to provide written feedback about program faculty at least annually. Routine evaluations need not be confidential, but there must be a system in place by which fellows can raise concerns and grievances, including those of inadequate supervision and professionalism, confidentially and without concern for retaliation. Effective options include but are not limited to a reporting system managed by the GME or Postgraduate Education Office, an ombudsperson, or other identified mentor independent of the Neurohospitalist fellowship program faculty.
   6. Program Evaluation
      1. The program must establish a system for routine evaluation of its effectiveness in achieving its goals and objectives. This must include a committee consisting of at least two members who are not the fellowship director, to whom the fellowship director must submit a report every two years. At least one of the members on the program evaluation committee must be core fellowship faculty, and at least one should have experience in medical education (e.g., clerkship director, residency or other fellowship program director). The program is encouraged to include a trainee representative on the committee. The fellowship evaluation committee is charged with reviewing the report and conducting a SWOT (strengths, weaknesses, opportunities, threats) analysis identifying areas for continuous improvement.
      2. The program evaluation should address the curriculum, outcomes (including fellows’ achievement of educational objectives, fellows’ careers, and quality and safety of patient care), written evaluations by fellows of both the program and faculty, faculty and fellow well-being, recruitment and retention, diversity, and scholarly work such as engagement in patient safety, quality improvement, and medical education.
      3. The program evaluation and fellowship evaluation committee’s SWOT analysis must be submitted to NHS every two years for continued accreditation.

6. Policies

   1. Supervision: The program must provide a written policy regarding fellow supervision. This policy must explain how the level of supervision facilitates increasing responsibility over the course of the fellowship to prepare graduates for independent practice. While the level of supervision may evolve during the fellowship, fellows must be supervised throughout the entirety of the program.
   2. Moonlighting: The program must provide a written policy regarding fellow moonlighting. The policy must specify that moonlighting can never be required, and may not impede a fellow’s ability to meet the goals and objectives of the training program. The program’s policies regarding moonlighting must be consistent with the Sponsoring Institution’s moonlighting policy.
   3. Diversity, Equity, and Inclusion: The program must provide a written policy describing practices that promote an equitable and inclusive learning and work environment. This must include fellow recruitment practices that value diversity.

7. The Learning and Work Environment

   1. Well-being:
      1. The program must provide, whether directly or through the Sponsoring Institution, its fellows the same access to confidential, affordable, and timely mental health care as provided to trainees in its ACGME- or CanERA-accredited training programs.
      2. The program must provide, whether directly or through the Sponsoring Institution, its fellows with a mechanism for reporting sexual harassment and other forms of mistreatment, and a system for addressing and resolving complaints without concern for retaliation.
      3. The program must provide, whether directly or through the Sponsoring Institution, its fellows with educational content training them to recognize symptoms of burnout, depression, substance use disorder, and fatigue in themselves and others, as well as how to seek care or assist others in seeking care for these conditions.
      4. The program must provide, whether directly or through the Sponsoring Institution, its fellows with access to food and refrigeration during clinical assignments, accessible sleep/rest facilities if fellows are expected to work in the hospital overnight, safe transportation options if fellows are too fatigued to drive home safely, clean and private lactation facilities and refrigeration for breast milk storage, and accommodations for fellows with disabilities consistent with the Sponsoring Institution’s policies.
   2. Educational Tools: The program must provide, whether directly or through the Sponsoring Institution, access to electronic medical literature search databases and electronic or print medical journals and resources.
   3. Patient Safety: The program must provide, whether directly or through the Sponsoring Institution, access to patient safety tools such as incident reporting to identify medical errors, near misses, and unsafe conditions. The program must allow fellows the opportunity to participate in root cause analysis or similar patient safety processes.
   4. Quality Improvement: The program must provide fellows with the opportunity to participate in quality improvement endeavors.

Timeline