Neurocritical Care Entrustable Professional Activities for Pediatric Critical Care Medicine Education and Professional Development: Standardizing Curriculum, Training, and Assessment

Andrew E Becker^{1

2}, Nicholas S Abend³, Giulia M Benedetti⁴, Sandra D W Buttram⁵, Melissa G Chung⁶, Jennifer C Erklauer⁷, Stuart H Friess⁸, Sue J Hong⁹, Jimmy Huh¹⁰, Matthew P Kirschen¹⁰, Kerri L LaRovere¹¹, Marlina E Lovett¹², Michelle E Schober¹³, Kristen A Smith¹⁴, Katie Wolfe⁸, Adrian D Zurca¹⁵, Alexis A Topjian¹⁰, Donald L Boyer¹⁰; Collaborators

Collaborators, Affiliations

Collaborators

Collaborators:
Kenya Agarwal¹⁶, Brian L Appavu¹⁷, Brenda Banwell¹⁸, Lauren A Beslow⁴, Danny Castro¹⁹, Jessica L Carpenter²⁰, Cheryl Dominick²¹, Aaron J Donoghue²², Christopher Donohue⁹, Nina A Fainberg²³, Michael R Flaherty²⁴, France W Fung³, Kristin P Guilliams²⁵, Melinda Fiedor Hamilton²⁶, Zachary T Hodges²⁷, Rebecca Ichord³, Marin N Jacobwitz²⁸, Benjamin C Kennedy²⁹, Shih-Shan Lang²⁹, Justin L Lockman¹⁰, April Lydon¹⁶, Jennifer R Milillo³⁰, Richard B Mink³¹, Caitlyn A Mulvihill³², Robert E Newmyer¹⁵, Rachel S Poeppelman³³, Craig A Press³, Samuel A Rosenblatt¹⁰, Kevin R Semless², Dennis W Simon²⁶, Craig M Smith³⁴, Michael C Spaeder³⁵, Arastoo Vossough³⁶, Mark S Wainwright³⁷, Jason A Werner³⁸

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ.
² Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA.
³ Department of Neurology and Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
⁴ Division of Pediatric Neurology, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI.
⁵ Division of Pediatric Critical Care Medicine, Department of Child Health, Phoenix Children's and University of Arizona College of Medicine, Phoenix, AZ.
⁶ Divisions of Critical Care Medicine and Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
⁷ Divisions of Pediatric Critical Care Medicine and Pediatric Neurology and Developmental Neurosciences, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
⁸ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
⁹ Division of Pediatric Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁰ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
¹¹ Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
¹² Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
¹³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
¹⁴ Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
¹⁵ Department of Pediatrics (Critical Care), Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
¹⁶ Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA.
¹⁷ Departments of Child Health and Neurology, Phoenix Children's and University of Arizona College of Medicine, Phoenix, AZ.
¹⁸ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
²⁰ Departments of Pediatrics and Neurology, University of Maryland, Baltimore, MD.
²¹ Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, PA.
²² Division of Emergency Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
²³ Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA.
²⁴ Division of Pediatric Critical Care Medicine, MassGeneral for Children, Boston, MA.
²⁵ Department of Neurology, Pediatrics, and Radiology, Washington University School of Medicine, St. Louis, MO.
²⁶ Division of Pediatric Critical Care, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
²⁷ Division of Pediatric Critical Care, University of Texas Southwestern, Dallas, TX.
²⁸ Developing Brain Institute, Children's National Hospital, Washington, DC.
²⁹ Division of Neurosurgery, Children's Hospital of Philadelphia and Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
³⁰ Division of Pediatric Critical Care, Cooper University Healthcare, Camden, NJ.
³¹ Department of Pediatrics, The David Geffen School of Medicine at UCLA and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Los Angeles, CA.
³² Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA.
³³ Division of Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
³⁴ Department of Pediatrics (Critical Care) and Neurology (Pediatric Neurocritical Care), Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
³⁵ Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA.
³⁶ Department of Radiology, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
³⁷ Division of Pediatric Neurology, University of Washington School of Medicine, Seattle, WA.
³⁸ Division of Pediatric Critical Care, SSM Health Cardinal Glennon Children's Hospital and Saint Louis University School of Medicine, St. Louis, MO.

PMID: 40923857
DOI: 10.1097/PCC.0000000000003818

Neurocritical Care Entrustable Professional Activities for Pediatric Critical Care Medicine Education and Professional Development: Standardizing Curriculum, Training, and Assessment

Andrew E Becker et al. Pediatr Crit Care Med. 2025.

. 2025 Sep 9.

doi: 10.1097/PCC.0000000000003818. Online ahead of print.

Authors

Collaborators

Collaborators:
Kenya Agarwal¹⁶, Brian L Appavu¹⁷, Brenda Banwell¹⁸, Lauren A Beslow⁴, Danny Castro¹⁹, Jessica L Carpenter²⁰, Cheryl Dominick²¹, Aaron J Donoghue²², Christopher Donohue⁹, Nina A Fainberg²³, Michael R Flaherty²⁴, France W Fung³, Kristin P Guilliams²⁵, Melinda Fiedor Hamilton²⁶, Zachary T Hodges²⁷, Rebecca Ichord³, Marin N Jacobwitz²⁸, Benjamin C Kennedy²⁹, Shih-Shan Lang²⁹, Justin L Lockman¹⁰, April Lydon¹⁶, Jennifer R Milillo³⁰, Richard B Mink³¹, Caitlyn A Mulvihill³², Robert E Newmyer¹⁵, Rachel S Poeppelman³³, Craig A Press³, Samuel A Rosenblatt¹⁰, Kevin R Semless², Dennis W Simon²⁶, Craig M Smith³⁴, Michael C Spaeder³⁵, Arastoo Vossough³⁶, Mark S Wainwright³⁷, Jason A Werner³⁸

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ.
² Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA.
³ Department of Neurology and Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
⁴ Division of Pediatric Neurology, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI.
⁵ Division of Pediatric Critical Care Medicine, Department of Child Health, Phoenix Children's and University of Arizona College of Medicine, Phoenix, AZ.
⁶ Divisions of Critical Care Medicine and Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
⁷ Divisions of Pediatric Critical Care Medicine and Pediatric Neurology and Developmental Neurosciences, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
⁸ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
⁹ Division of Pediatric Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁰ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
¹¹ Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
¹² Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
¹³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
¹⁴ Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
¹⁵ Department of Pediatrics (Critical Care), Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
¹⁶ Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA.
¹⁷ Departments of Child Health and Neurology, Phoenix Children's and University of Arizona College of Medicine, Phoenix, AZ.
¹⁸ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
²⁰ Departments of Pediatrics and Neurology, University of Maryland, Baltimore, MD.
²¹ Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, PA.
²² Division of Emergency Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
²³ Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA.
²⁴ Division of Pediatric Critical Care Medicine, MassGeneral for Children, Boston, MA.
²⁵ Department of Neurology, Pediatrics, and Radiology, Washington University School of Medicine, St. Louis, MO.
²⁶ Division of Pediatric Critical Care, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
²⁷ Division of Pediatric Critical Care, University of Texas Southwestern, Dallas, TX.
²⁸ Developing Brain Institute, Children's National Hospital, Washington, DC.
²⁹ Division of Neurosurgery, Children's Hospital of Philadelphia and Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
³⁰ Division of Pediatric Critical Care, Cooper University Healthcare, Camden, NJ.
³¹ Department of Pediatrics, The David Geffen School of Medicine at UCLA and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Los Angeles, CA.
³² Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA.
³³ Division of Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
³⁴ Department of Pediatrics (Critical Care) and Neurology (Pediatric Neurocritical Care), Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
³⁵ Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA.
³⁶ Department of Radiology, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
³⁷ Division of Pediatric Neurology, University of Washington School of Medicine, Seattle, WA.
³⁸ Division of Pediatric Critical Care, SSM Health Cardinal Glennon Children's Hospital and Saint Louis University School of Medicine, St. Louis, MO.

PMID: 40923857
DOI: 10.1097/PCC.0000000000003818

Abstract

Objective: To develop a set of pediatric neurocritical care (PNCC) entrustable professional activities (EPAs) for pediatric critical care medicine (PCCM).

Design: Survey and Delphi methodology in a panel of experts from the Pediatric Neurocritical Care Research Group (PNCRG) and the Education in Pediatric Intensive Care (EPIC) Research Collaborative.

Setting: Interprofessional local focus group, national focus group, and subsequent national multi-institutional, multidisciplinary expert panel in the United States.

Subjects: The interprofessional local group of 23 members carried out work March 2022 to June 2022 and the national group of 19 members October 2022 to November 2022. Subsequently, 38 physicians from the PNCRG and EPIC networks carried out work December 2022 to August 2024.

Interventions: None.

Measurements and main results: First, a preliminary set of 15 PNCC EPAs was developed by two local and national interprofessional groups. The EPAs were based on the American Board of Pediatrics (ABP) practice analysis for PCCM, the ABP PCCM content outline, and stakeholder opinion. Next, a panel of critical care, neurology, and education experts used Delphi methodology to generate consensus, edit, and finalize the EPAs, with content validity. All EPAs were edited; two were deemed non-essential and not included in the final set of 13 EPAs. The EPAs fit three categories: general management and principles; disease-specific management; and neuroprognostication and end-of-life care. Consensus was reached after three Delphi rounds, with response rates of 31 of 38, 29 of 31, and 29 of 31, respectively. The final set of EPAs was approved by 30 respondents (response rate 30/31), with content validity indices 0.81-1.00.

Conclusions: The 2024 set of 13 EPAs are intended to be a valuable framework for competency-based curriculum and assessment to ensure consistent PCCM proficiency in the provision of neurocritical care while also promoting standardization in curriculum development for PCCM fellowship trainees.

Keywords: competency-based education; critical care; graduate medical education; neurocritical care; physician training.

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Conflict of interest statement

Dr. Benedetti receives support from the NIH (grants R01NS124051-01A1 and 1R01NS111166-03) and from Pediatric Epilepsy Research Foundation (Grant for Infrastructure and CNS Shields Research Grant Award). Dr. Huh receives support from the NIH/National Institute of Neurological Disorders and Stroke (NINDS) (grants R01 NS110898 and R01 NS113945). Dr. Kirschen receives support from the NIH/NINDS (grant K23NS116120). Dr. Schober receives support from NIH/NINDS (grant R01NS114635). Dr. Topjian receives support from the NIH (grants UG3-HL159134 and U24 HL159132) and is the associated editor for the journal Resuscitation; she received funding from Elsevier. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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Neurocritical Care Entrustable Professional Activities for Pediatric Critical Care Medicine Education and Professional Development: Standardizing Curriculum, Training, and Assessment

Collaborators

Affiliations

Neurocritical Care Entrustable Professional Activities for Pediatric Critical Care Medicine Education and Professional Development: Standardizing Curriculum, Training, and Assessment

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources