FAQs, Updates, and Information For Programs
Updates For All Subspecialties
FAQ: What happens if our program doesn’t submit an annual report?
With the annual report now offering continuous accreditation, if you don’t submit an annual report your program will go on immediate probation with the application accreditation fee still due. If that fee isn’t paid, and/or the annual report is not submitted on time the following year, the program will lose accreditation.
2023 Annual Report Cycle – Closes July 31, 2023
The CAST Annual Report application cycle is now open. This annual report will be reviewing the 2022-2023 academic year. Your program is responsible for obtaining your annual report application from the SM Apply website. All CAST accredited fellowships (unless a new fellowship approved in fall 2022 or spring 2023). This must be submitted whether or not you had a fellow for the 2022-2023 academic year.
Here are the steps to obtain your application:
- Go to SM Apply with this link: https://applications.abns.org/
- Log in, select the role of applicant
- Click on the “Programs” link in the upper right-hand corner
- Click on the CAST 2023 Annual Report for Accredited Fellowship Program application
- Click on the green apply button
- Name your application with the following format: Program Name, Subspecialty, 2023AR
- For example: ABC Hospitals and Clinics, CNS Endo, 2023AR or
- All Annual Reports must be submitted by July 31, 2023
FAQ: We didn’t have a fellow this past year. Do we still need to submit an annual report?
Annual Report submission is required each year to maintain CAST accreditation WHETHER OR NOT you have a fellow. If you didn’t have a fellow for the academic year you are reviewing, you will only need to submit your institutional numbers. Even if you aren’t planning on having a fellow, your program still need to show that you have enough institutional cases to support your residency as well as maintain your fellowship.
CPT Codes and Case Logs
Ensure you aren’t using CPT codes for case numbers to ensure an accurate case log submission in new or Annual Report applications.
FAQ: When my fellow graduates, will they be “CAST Certified?”
No they will not be “CAST Certified.” Fellows that graduate from a CAST Accredited fellowship are able to receive a diploma or letter from their program that states they have graduated from a CAST accredited fellowship. CAST fellowship graduates are not “CAST Certified.” Programs are welcome to use the CAST logo in the design/format of their document, choosing for what they want to give to their graduating fellows.
Estimating Case Log Numbers
When entering your case log numbers into any CAST application, it is important that exact case numbers are used and you are not estimating. Case log numbers should not all be ending in multiples of five or ten.
FAQ: To participate in a CAST fellowship, do residents need to have graduated from an ACGME accredited residency program?
No. For international fellows, program are able to accept qualified residents into their fellowship if they have graduated from the ACGME accreditation equivalent in their home area. Additionally, programs are at liberty to accept fellows form DO programs as well if they feel they are qualified. Of note, if it is a subspecialty that has a pathway to RFP, the RFP requirements are defined by ABNS, not CAST.
FAQ: When does a program have to start doing annual reports?
If you are approved for a CAST fellowship you will submit your first annual report the following year. For example, you are approved spring of 2023 cycle. You will fill out your first annual report in the summer of 2024 that reviews the 2023-2024 academic year, whether you had a fellow or not.
Subspecialty Specific Updates
CNS Endovascular
What is a program complement?
Your program complement is how many fellows can graduate in any academic year. That does NOT include anyone in a prerequisite year or first year of a two year fellowship.
Why are support letters form the Chairs of Radiology and Neurology required for new applications and Annual Report applications.?
The NESAC Committee requires letters of support from Neurology and Radiology, as well as Neurosurgery because all three specialties influence the CNS Endovascular subspecialty. Since CAST CNS Endovascular fellows can be neurosurgeons, neurologists, or radiologists, it is important that your program has support of all three of those specialties for your CAST fellowship.
Program Director Requirements
For a CAST accredited fellowship in CNS Endovascular, the Fellowship Program Director must have a subspecialty credential. The credential required should be either a CAST Certificate or Recognition of Focus Practice (RFP) credential that is awarded by the ABNS.
CAST Certificate to RFP Conversions
NeuroEndovascular CAST Certificates have not been awarded since the fall of 2019. If you have a CAST Certificate, you have until December 31, 2023 to take advantage of the CAST Certificate to RFP conversion application offered by the ABNS.
Why are Cerebrovascular case numbers required on new (and previously renewal) CNS Endovascular applications?
By including the Cerebrovascular case numbers, as well as the Endovascular numbers, provides a snapshot of the entire Cerebrovascular activity of the program, which allows the the Endovascular cases to be seen in a larger context. They are not required for Annual Report applications.
New addition to CNS Endovascular case log
As the number of Middle Meningeal Artery embolization procedures has grown substantially, CAST would like to include this procedure in its own category on the annual case report form this year. This will allow us to better understand how many of these cases are being performed at each institution. There will be no minimum MMA embolization case number requirements for the 2023 Annual Report, but we ask that all programs try to fill out these numbers. If a program is unable to calculate this number coming up in the 2023 Annual Report the category can be left blank, however, this category will be mandatory to include case numbers next year in the 2024 Annual Report. This information will help determine whether MMA embolization continues to be an isolated case category or incorporated into one of the existing case categories.
Neurocritical Care
Program Director Requirements
For a CAST accredited fellowship in Neurocritical Care, the Fellowship Program Director must have a subspecialty credential. The credential required can be either a CAST Certificate, UCNS or ABPN credential or Recognition of Focus Practice (RFP) credential that is awarded by the ABNS.
Faculty Neurosurgeon Requirements
For a CAST accredited fellowship in Neurocritical Care, one of the Core Faculty must be a Neurosurgeon that has a subspecialty credential in Neurocritical Care. The credential required can be a CAST Certificate, UCNS or ABPN credential or Recognition of Focus Practice (RFP) credential that is awarded by the ABNS, or at a minimum passed the RFP NCC exam administered by the ABNS.
CAST Certificate to RFP Conversions
Neurocritical Care CAST Certificates have not been awarded since the fall of 2019. If you have a CAST Certificate, you have until December 31, 2023 to take advantage of the CAST Certificate to RFP conversion application offered by the ABNS.
Coverage of other ICUs
Fellows should be experiencing a full fellowship experience by covering in other units rather than just the Neurosurgical ICU. Programs needs to detail the units covered (Surgical ICU, Medical ICU, Cardiac ICU, etc.) in the block diagram including length of rotation in a new or annual report application.
Reporting Fellow Numbers
Neurocritical Care is the only subspecialty that the fellowship can be done prior to PGY7 (after PGY6 Chief) year. Blocks of the fellowship can be done starting as a PGY4. (See the Neurocritical Care program requirements for more info). Fellow case numbers should be submitted in the first annual report after they complete their fellowship, even if they are not graduating residency.
Stereotactic & Functional
Case minimums were updated for CAST accredited Stereotactic & Functional fellowships in 2022.
Peripheral Nerve
Case minimums were updated for CAST accredited Peripheral Nerve fellowships in 2023.
Cerebrovascular
If your program is not able to meet the case minimums for your CAST accredited Cerebrovascular fellowship, you can look into switching to a CAST accredited Skull Base fellowship instead. If your program would like to change subspecialties, CAST will need a support letter from the Chair of Neurosurgery, we well as a letter from the Fellowship Program Director that details the following:
- Why you are requesting this change
- The support system you have in place for for the new subspecialty (coordinator, Faculty, etc.)
- If approved, is the subspecialty change to start immediately during the current academic year? (If so you will be expected to submit both institutional and fellow numbers for the your new subspecialty in the next Annual Report; or
- If approved, will your new subspecialty start at the start of the new academic year? (If so you will submit your current subspecialty numbers for your next Annual Report. The Annual Report one year from that will require your new subspecialty numbers.
Skull Base
Starting in 2024, CAST accredited Skull Base fellowships will have INSTITUTIONAL case number minimum requirements. This will include the 2024 spring new application cycle, as well as the 2024 Annual Report which reviews the 2023-2024 academic year. They are as follows:
Endoscopic endonasal cases (Min 60)
• Pituitary Adenoma
• Other
Anterior Skull Base Microsurgery (Min 30)
• Tumor
• Trauma
• Infection
• Congenial
• CSF leak repair
Middle Skull Base Microsurgery (Min 30)
• Tumor
• Trauma
• Infection
• Congenial
• CSF leak repair
Posterior Skull Base Microsurgery (Min 30)
• Tumor
• Trama
• Infection
• Congenial
• CSF leak repair
Craniocervical junction microsurgery (Min 10)
Open vascular skull base microsurgery (Min 10)
Skull base radiosurgery (Min 10)
Total Institutional case minimum: 200
Fellow case minimums remain the same.
Neurosurgical Oncology
Starting in 2024 with the new application spring cycle, there will be updated case minimums for all CAST Accredited Neurosurgical Oncology fellowships. This will include the 2024 spring new application cycle, as well as the 2024 Annual Report which reviews the 2023-2024 academic year.
INSTITUTIONAL
Craniotomy for intra-axial tumor (min. 120)
• Glioma/Primary brain tumor
• Metastasis
Craniotomy for extra-axial tumor (min. 50)
• Meningioma (min. 30)
• Intra-ventricular (min. 10)
Radiosurgery (min. 60)
Biopsy/Stereotactic (e.g. LITT) (min. 20)
Craniotomy for skull base tumor (min. 20)
• Vestibular schwannoma
• Other skull base surgery
EEA/craniotomy for sellar/parasellar (min. 40)
• Spinal Tumors (min. 10)Intramedullary (min. 5)
• Extramedullary/metastasis (min. 5)
Total institutional case minimum: 320
FELLOW(S)
Craniotomy for intra-axial tumor (min. 60)
• Glioma/Primary brain tumor
• Metastasis
Craniotomy for extra-axial tumor (min. 25)
• Meningioma
• Intra-ventricular
Radiosurgery (min. 30)
Additional cases from the categories below:
• Biopsy/Stereotactic insertion (e.g. LITT)
• Craniotomy for skull base tumor
• Vestibular schwannoma
• Other skull base surgery
EEA/Craniotomy for sellar/parasellar tumor
• Spinal Tumors
• Intramedullary
• Extramedullary/metastasis
Total fellow case minimum: 150