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J Neurosurg Anesthesiol
J Neurosurg Anesthesiol
ANA
Journal of Neurosurgical Anesthesiology
0898-4921
1537-1921
Lippincott Williams & Wilkins Hagerstown, MD

38354097
JNA-D-23-00153
10.1097/ANA.0000000000000958
00011
3
Clinical Investigations
Assessment and Recommendations for Website Platforms of Neuroanesthesiology Fellowship Programs
Zhitny Vladislav P. MD *†Vladislav.zhitny@nyulangone.org

Do Kenny BS †dok3@unlv.nevada.edu

Kawana Eric BS †kawana@unlv.nevada.edu

Do Jenifer ‡doj4@unlv.nevada.edu

Wajda Michael C. MD *Michael.Wajda@nyulangone.org

Gallegos Jose MD *Jose.Gallegos@nyulangone.org

Carey Kyle MD *Kyle.Carey@nyulangone.org

Yee Geoff MD *Geoffrey.Yee@nyulangone.org

Hollifield Lauren C. MD §lauren.hollifield@pennmedicine.upenn.edu

Montes Arturo Jr MD arturo.montes@med.usc.edu
∥
Walton Edward MD *Edward.Walton@nyulangone.org

Ahmed Shah MD *Shah.Ahmed@nyulangone.org

* Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University, New York City, NY
† Kirk Kerkorian School of Medicine
‡ School of Life Sciences, University of Nevada, Las Vegas, NV
§ Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
∥ Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
Address correspondence to: Vladislav P. Zhitny, MD. E-mail: vladislav.zhitny@nyulangone.org.
10 2024
14 2 2024
36 4 341345
8 8 2023
17 1 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

Background:

Websites serve as recruitment and educational tools for many fellowship programs, including neuroanesthesiology. Since the COVID-19 pandemic, when interviews, conferences, and institutional visits were moved online, websites have become more important for applicants when deciding on their preferred fellowship program. This study evaluated the content of the websites of neuroanesthesiology fellowship programs.

Methods:

Neuroanesthesiology fellowship program websites were identified from the websites of the International Council on Perioperative Neuroscience Training and the Society for Neuroscience in Anesthesiology and Critical Care. The content was assessed against 24 predefined criteria.

Results:

Fifty-three fellowship programs were identified, of which 42 websites were accessible through a Google search and available for evaluation. The mean number of criteria met by the 42 fellowship websites was 12/24 (50%), with a range of 6 to 18 criteria. None of the evaluated fellowship websites met all 24 predefined criteria; 20 included more than 50% of the criteria, whereas 7 included fewer than 30% of the criteria. Having a functional website, accessibility through a single click from Google, and a detailed description of the fellowship program were the features of most websites. Information about salary and life in the area, concise program summaries, and biographical information of past and current fellows were missing from a majority of websites.

Conclusion:

Important information was missing from most of the 42 evaluated neuroanesthesiology fellowship program websites, potentially hindering applicants from making informed choices about their career plans.

Key Words:

anesthesiology
neuroanesthesiology
residency
graduate medical education
training
SDCT
OPEN-ACCESSTRUE
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pmcIncreases in the number and complexity of neurosurgical cases have created more demand for neuroanesthesiologists.1 The pathway to becoming a neuroanesthesiologist includes completion of medical school training followed by an accredited anesthesiology residency, the length of which varies among different countries. After completion of residency, anesthesiologists may apply to a neuroanesthesiology fellowship program for further, specialized, training. Neuroanesthesiology fellowships are usually 1 to 2 years in duration, during which fellows are trained in the preoperative, intraoperative, and postoperative management of patients undergoing neurosurgery.1 Fellowship programs may accept 1, 2, or several fellows a year, and various factors, such as letters of recommendations, residency performance, research productivity, and geographical ties, may be considered by prospective fellows during the application process.

The Accreditation Council for Graduate Medical Education (ACGME) is an accrediting board for US physicians, but neuroanesthesiology fellowships are non-ACGME accredited.2 The International Council for Perioperative Neuroscience Training (ICPNT), sponsored by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), is a recently formed global accreditation body for neuroanesthesia fellowships. The ICPNT standardizes training pathways and ensures that accredited programs meet quality benchmarks, with the aim of eliminating unwarranted variations in training in perioperative neuroscience.3 At the time of writing (June 2023), there were 30 neuroanesthesiology fellowship programs across the world accredited by ICPNT, including programs in the United States, United Kingdom, Australia, Denmark, Germany, Spain, Columbia, China, Qatar, and Canada.4 Of the many major academic anesthesiology programs in the United States offering a neuroanesthesiology fellowship, 16 had been accredited by the ICPNT as of June 2023.4 Accreditation of neuroanesthesiology fellowships by the ICPNT has been a significant milestone by promoting standardization in neuroanesthesiology training in a collaborative effort for the international community.

The COVID-19 pandemic required many fellowship programs to conduct virtual interviews and recruitment events.5 This ushered in a new era in which potential applicants now rely more on the websites of various fellowship institutions to learn about the programs and guide their decision.6 One survey study found that 98% of Stanford anesthesia applicants who responded to the survey used residency program websites during their application process, and 56% of them had visited Stanford’s website before applying to that program.7 High-quality websites allow neuroanesthesiology fellowship programs to display their strengths and provide potential applicants with the necessary information to make well-informed decisions when choosing their preferred fellowship institution. This is especially important at a time when more recruitment events, program visits, and interviews have remained in the virtual realm after the pandemic.5

To date, there has been no structured assessment of neuroanesthesiology fellowship program websites. The aim of the study was to evaluate the comprehensiveness of neuroanesthesiology fellowship websites and provide recommendations on how the content of the pages could be improved to captivate prospective fellows.

METHODS

This study reviewed information that is freely accessible to the general public on the websites of neuroanesthesiology fellowships. As such, it did not require Institutional Review Board approval or exemption.

The websites of neuroanesthesiology fellowship programs were identified through the ICPNT4 and SNACC8 websites and evaluated using 24 predefined criteria: having a functional website, accessibility through one click from Google, detailed program description, research, director contact, types of acute procedures or advanced training, applicant process description, program address, call responsibility, coordinator contact, faculty involved, journal club/conferences, accreditation status, schedule, didactics, clinic/office responsibilities, case numbers, number of available positions, alumni, current fellows, summary, life in the area, salary, and video summary. These criteria were identified following a review of the literature evaluating the content of other fellowships, including anesthesiology, pain medicine, regional anesthesia, and neurology fellowships.7,9–11 The survey of self-reported information needs of anesthesia residency applicants reported by Chu et al7 influenced the selection criteria for this evaluation of neuroanesthesiology fellowship programs. In addition, 24 of the criteria reported in the study by Nguyen et al9 which investigated the websites of accredited and nonaccredited regional anesthesiology and acute pain medicine fellowship programs, were included in our study after the exclusion of “application deadline” and “past fellow current employer,” which were captured in the “applicant process description” and “alumini” criteria, respectively, in our study. Patel et al10 and Daniel et al11 used similar criteria when evaluating physical medicine and rehabilitation and neurology residency websites, respectively.

Two investigators (E.K. and K.D.) reviewed each neuroanesthesiology fellowship website individually and determined which of the 24 criteria were met. A third investigator (J.D.) evaluated the websites to see if the assessments from the 2 initial reviewers were not concordant. Each program was assessed based on the number of criteria met and reported as a percentage of the 24 criteria. For example, if a program fulfilled 12 of the 24 criteria, 50% of the content was assessed as included for the purposes of this study.

RESULTS

Fifty-three neuroanesthesiology fellowship programs were identified from the ICPNT and SNACC websites, of which 37 were in the United States and 16 in other countries. Thirty of the identified fellowship programs were accredited by the ICPNT and identified through the ICPNT website. An additional 23 neuroanesthesiology fellowship programs were identified through the SNACC website roster, of which 21 were in the United States. The websites of 11 of the 53 fellowship programs (20.7%) could not be identified using the Google search engine, leaving 42 (79.2%) websites available for detailed review. All of the evaluated websites used English as their primary language.

The criteria met by each of the 42 fellowship websites are shown in Table 1. The mean number of criteria included on the websites was 12 (50%), with a range of 6 to 18 criteria. None of the 42 fellowship websites met all 24 criteria; 20 (47.6%) included more than 50% of the 24 predefined criteria, whereas 7 included fewer than 30% of the criteria. Having a functional website (100%), accessibility through a single click from Google (100%), and inclusion of a description of the fellowship program (98%) were the most frequently met criteria. Inclusion of a video summary (2%), salary details (5%), life in the area (12%), concise program summary (14%), biographical information of past and current fellows (14%), and alumni (19%) were the criteria most frequently missing from the majority of websites. Annual case numbers and types of cases by institution are shown in Supplemental Digital Content 1, http://links.lww.com/JNA/A676. Indicative case numbers for each specific procedure were not available on the websites, which included only overall institutional case numbers.

TABLE 1 Proportion of Fellowship Program Websites Containing the Evaluated Criteria

Criteria	Number (%) including the criteria (n=42)	
Functional website: the program has a website that is accessible, operational, and free from technical issues	42 (100)	
One click from Google: the program is easily accessible within one click from the search results on Google	42 (100)	
Program description: a section or page on the website that provides an overview of the program	41 (98)	
Research: information of the research opportunities and projects available within the program	39 (93)	
Director contact: contact information for the program director is available	35 (83)	
Types of acute procedures or advanced training: details about the specific procedures and advanced training opportunities offered within the program	33 (79)	
Applicant process description: information on the application process, including requirements, deadlines, and any other steps	32 (76)	
Program address: the location or address of the neuroanesthesiology fellowship program is provided	30 (71)	
Call responsibility: information about the on-call responsibilities expected of fellows during their training	27 (64)	
Coordinator contact: contact information for the program coordinator	25 (60)	
Faculty involved: a list of faculty members who are actively involved in teaching and mentoring fellows during their training	24 (57)	
Journal club/conferences: information provided on any journal clubs, conferences, or academic meetings that are part of the program’s educational activities	19 (45)	
Accreditation status: indicates whether the neuroanesthesiology fellowship program has received accreditation from the International Council on Perioperative Neuroscience Training	17 (40)	
Schedule: an overview of the fellowship program’s schedule, including core rotations, electives, breaks, and other important events	17 (40)	
Didactics: information provided about didactic components of the program, such as lectures, seminars, and other educational resources	15 (36)	
Clinic/office responsibilities: details about clinical or office-based responsibilities during training	15 (36)	
Case numbers: the number of cases or procedures that are completed during a given year by the institution	13 (31)	
Number of available positions: the number of fellowship positions available to applicants in a given year*	12 (29)	
Alumni: information about past fellows who have completed the program*	8 (19)	
Current fellows: information about the fellows currently enrolled in the program*	6 (14)	
Summary: a concise summary in a prominent section or a page of the website that overviews the program’s key features and strengths*	6 (14)	
Life in the area: information about the region or city where the program is located including details on living conditions, local amenities, and overall lifestyle*	5 (12)	
Salary: information regarding the compensation or stipend provided to fellows during training*	2 (5)	
Video summary: a video that offers a visual overview of the fellowship program, its facilities, faculty, and other aspects*	1 (2)	
* These criteria were met in <30% of all of the programs examined in this study.

DISCUSSION

There is an increased need for specialist neuroanesthesiologists given the increasing numbers and complexity of neurosurgical cases. Neuroanesthesiologists are specifically trained to manage patients undergoing all types of intracranial and spinal neurosurgery, as well as those with neurological disease undergoing non-neurological surgery, throughout the entire perioperative period.2 Currently, more than 70% of anesthesiology residents in the United States pursue fellowship in one of the ACGME-accredited programs.1 However, despite the need for more neuroanesthesiologists, only 10% of anesthesiology residents responding to a recent survey wished to pursue a neuroanesthesiology fellowship.12 More opportunities to learn about neurocritical care and research were identified as factors that could encourage more residents to undertake neuroanesthesiology fellowships. In the absence of ACGME accreditation, the ICPNT was developed to accredit neuroanesthesiology fellowship programs globally.3 Given this new opportunity for fellows to join accredited neuroanesthesiology fellowship programs, it is important that the fellowship websites contain all relevant information. This could not only highlight the specific fellowship program but also the subspecialty more widely. In an era where virtual site “visits” and fellowship interviews are becoming more common, websites and social media platforms have become essential vehicles for informing and recruiting prospective fellowship applicants.13,14

The websites of 11 of the 53 neuroanesthesiology fellowship programs identified through the ICPNT and SNACC webpages could not be found using a Google search. Of the 42 fellowship programs that did have accessible websites, only 20 contained more than 50% of the content predefined as providing essential information, and 7 contained less than 30% of this information. This finding supports the need for website improvements so that fellowship programs provide the most relevant and up-to-date information for potential applicants. The criteria most commonly included were having a functional website accessible with a single click from Google and a description of the fellowship program. Important content, such as salary, case numbers, inpatient and outpatient responsibilities, alumni, and life in the area, was missing from most of the websites, which could hinder applicants’ decisions about their choice of program. To provide a comprehensive resource for potential applicants, fellowship websites should provide all relevant information.

Details about current fellows were missing from the majority of websites reviewed in this study; only 14% reported this information. Summary biographies of current fellows may help prospective applicants connect with individuals in the program to learn about specific details of the available experiences and research opportunities, as well as work-life balance and future career plans. A previous study found that only 16% of anesthesiology websites contained information about current fellows, whereas 73% of ophthalmology fellowship websites contained this information.13 While there are valid privacy concerns about sharing fellows’ information on program websites, this information can be valuable to prospective applicants. Institutions should respect the privacy of individuals and ensure that appropriate consent has been provided by a fellow whose details are made available, or provide anonymized examples of relevant information.

Institutions can concisely and effectively convey pertinent information about their mission, structure, successes, and leadership by including a program summary in a prominent section of their fellowship websites, but only 14% of the websites included such a summary. The plethora of content on many of the websites could overwhelm prospective applicants, whereas a summary of the programs can quickly and concisely highlight the program’s distinguishing elements. Short videos can also serve as great summaries and provide an engaging and immersive way of displaying a program’s best qualities. Incorporating videos into a website is a great way to showcase the work environment, fellows’ achievements, research advancements, career trajectories, and other important things that the fellowship program can offer. However, only one of the fellowship websites reviewed in this study included video content. Certain content may not be included in websites due to resource constraints, and videos are financially and time-resource-demanding. This may have restricted the inclusion of these elements on most of the websites.

Potential fellows may prioritize the location of a neuroanesthesiology training program because of family or work-life balance concerns. Important characteristics of a specific city or area include the cost of living, climate, family friendliness, proximity to family and friends, entertainment opportunities, and availability of housing. Despite this, only 12% of the neuroanesthesiology fellowship websites reviewed in this study described what it is like to live in the city or area of the respective programs. Fellows will most likely be happier and perform better in training if they enjoy living in the area. The cost of living in a particular location is an important consideration for prospective fellows, but none of the websites shared this information or the salaries or other benefits offered to incoming fellows. While fellowship programs might be reluctant to present accurate salary information, which can be subject to change depending on inflation, time, and other factors, the provision of indicative information on the website would allow applicants to appreciate their likely income versus expenses and plan ahead. It would also give them the opportunity to compare the benefits offered by each fellowship institution.

Information regarding the number of available fellowship positions was missing from most of the websites, with only 29% of programs reporting this. Providing the number of accepted fellows each year would allow applicants to assess the competitiveness, capacity, and work environment of a specific institution. While smaller programs may provide more direct mentorship for fellows, the limited number of available positions may suggest that there will be a more competitive pool. Providing comprehensive information on the website would allow an individual to target their applications to those programs that meet their expectations regarding work environment, program size, level of mentorship, and application competitiveness.

Other criteria that were met by only some of the program websites were clinic/office responsibilities and case numbers; only 36% and 31% of the websites, respectively, provided this information. Clinic or office responsibilities may include supervision of Certified Registered Nurse Anesthetist or other staff, teaching residents, preoperative assessments, and other clinical services.15 Case numbers outlining the numbers of certain procedures that residents and fellows might undertake can be useful to showcase the type of training that applicants should expect to receive in each program. Some applicants may desire programs that emphasize procedural and on-call training more than office duties, or vice versa. While fellowship program websites did provide annual caseloads, they did not specify the numbers of cases for certain procedures, which could be useful information for applicants with specific interests. Fellowship programs could also consider including information about related programs such as neurosurgery, neurocritical care, or interventional neuroradiology on their websites, fostering an interdisciplinary approach to perioperative neuroscience.

In addition to providing comprehensive and clear information on their websites, neuroanesthesiology fellowships can also advertise their programs on social media platforms. A survey conducted at the Mayo Clinic in Arizona found that 57.5% of applicants to their anesthesiology residency program reported that Twitter, Instagram, and other social media positively influenced their opinions about the program.16 As well as increasing visibility and engagement for fellowship programs, social media can provide applicants with an opportunity to ask questions and network with faculty, current fellows, and alumni. Hosting virtual tours and other outreach events could also help applicants make informed decisions about where they want to pursue their fellowship.

This study has several limitations. The fellowship programs evaluated in this study were identified through the ICPNT and SNACC websites. However, the ICPNT website lists only those fellowship programs it has accredited, and the list of programs on the SNACC website is not comprehensive as the society does not require or actively seek inclusion on its website of fellowships from any country. A majority of the international programs evaluated in this study did not have an identifiable neuroanesthesiology website, with 6 not having a website for their institutions and 2 only having a website for general anesthesiology programs. Of the 16 non-US neuroanesthesiology fellowship programs listed on the SNACC website, 50% were excluded from this study because they did not have identifiable websites. However, it is possible that these websites could have been overlooked because of language barriers, particularly when seeking information on fellowship programs in countries where English is not the first language.

In conclusion, comprehensive and immersive websites can help neuroanesthesiology fellowship programs display their strengths and allow applicants to gain a better insight into where they want to train based on their individual requirements and expectations. Much pertinent information was missing from most of the 42 neuroanesthesiology fellowship program websites evaluated in this study, potentially hindering applicants from making an informed choice about their career plans. Neuroanesthesiology fellowship programs can improve their reach to potential applicants by including more comprehensive information on their websites.

Supplementary Material

SUPPLEMENTARY MATERIAL

The authors have no conflicts of interest to declare.

Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website, www.jnsa.com.
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