In March 2000, the American Board of Neurological Surgeons (ABNS) at the encouragement of the American Board of Medical Specialties (ABMS) committed to instituting a recertification program for neurosurgeons through Maintenance of Certification (MOC®). The expectations of MOC® are that training and acquisition of knowledge and skills in medical practice will begin in medical school, be enhanced in residency, and maintained throughout the neurosurgeon’s career. MOC® has four basic components: 1) evidence of professional standing; 2) evidence of lifelong learning and self-assessment; 3) evidence of cognitive knowledge; and 4) evidence of performance in practice. In assessing compliance with these components, participants in MOC® will be required to complete the Self-Assessment in Neurological Surgery (SANS) course. SANS, developed by the Congress of Neurological Surgeons (CNS), is an on-line learning tool that contains material covering the full breadth of neurosurgery. Included is material relevant to the “non-clinical core competencies” (competencies). Appropriate knowledge of these competencies is required by the American College of Graduate Medical Education (ACGME) and the ABMS as part of professional training and certification in all medical specialties. The four competency areas include professionalism, communication, practice based learning, and systems based practice.
In response to this relatively new requirement for competency knowledge, the CNS formed an ad hoc committee on competencies to develop appropriate curriculum in this area to incorporate into SANS. The committee identified 36 specific topics that addressed each of the four competency areas. Examples of these topics include Emergency Medical Treatment and Active Labor Act (EMTALA), Health Insurance Portability and Accountability Act (HIPAA), principles of medical coding and billing, risk management, ethical principles of informed consent, disclosure of errors, critical reading of the medical literature, cross-cultural issues, and quality assurance. To assist in the development of the rather large amount educational material necessary to cover these topics, the CNS asked for the help of the Council of State Neurosurgical Societies (CSNS).
The CSNS, originally formed as the Socio-Economics Committee of the CNS in 1963, is a representative organization of delegate neurosurgeons with an interest in socioeconomic and healthcare policy and serves as a resource for socioeconomic knowledge and education for neurosurgeons. In April 2006, the CSNS passed a resolution to develop the requisite competency educational material and review questions for SANS. Each CSNS committee chairman was tasked with organizing their respective members to cover a specific set of competency topics pertinent to the committee’s area of interest. For example, the CSNS Communication and Education committee was responsible for developing curriculum for topics such as graduate medical education, patient communication, scientific ethics in publication, and information technology. Over the next several months, the seven committees of the CSNS developed and edited more than 100 questions covering the competency requirements. These questions were edited, formatted and submitted to the SANS Executive Committee for implementation in the current on-line version of SANS in January 2007.
Neurosurgeons purchasing the on-line SANS curriculum are eligible for 24 hours of Category I CME upon completion of the program. Each SANS question is accompanied by a peer-reviewed expert critique and “instant-learning” hyperlinks to PubMed abstracts of peer-reviewed literature and other high quality, web-based learning and regulatory resources. This allows neurosurgeons to not only test their knowledge of both cognitive and “competency” related neurosurgical issues but to also immediately link to educational sources of further information and instruction.