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1 This form will allow you to save your responses and continue later. Please periodically save your responses by clicking the Save and continue later link located at the top of each following page to retain your work. You will be asked to enter an address, and a specific link to your answers will be sent to you. If you do not receive an , please check your spam folder. You may wish to designate SurveyGizmo.com as a safe sender." To complete this application, you must click on the next button at the bottom of the page. You will be asked to submit your application on the subsequent page. Contact Name Richard G. Ellenbogen, MD, FACS Contact Address rge@neurosurgery.washington.edu Name of Sponsoring Board(s): American Board of Neurological Surgery (ABNS) 1. Provide the name of the proposed area of focused practice: Pediatric Neurological Surgery 2. State the purpose of the proposed area of focused practice and include the rationale for how this area of focused practice is different than a subspecialty, in two paragraphs or less: The purpose of this application is to recognize an area of focused practice that has existed for over 26 years. We ask the ABMS to recognize and enfold a robust pediatric neurological surgery certification process that has existed for over 2 decades by the "American Board of Pediatric Neurological Surgery" (ABPNS), separate from the ABMS and ABNS and recognize Pediatric Neurological Surgery as a designation of Focused Practice in Neurological Surgery. The current certification process by the ABPNS is a respected and successful process that is accepted by children's hospitals, Leapfrog, US News and World Report, and pediatric patients/families worldwide, especially in USA and Canada. The ABNS should facilitate this process through an ABMS sanctioned focused practice designation at the request of their member board, the ABNS and all its Directors. An MOU has already been signed between the non- ABMS American Board of Pediatric Neurosurgery (ABPNS) and the American Board of Neurological Surgery (ABNS) to collaborate on this ABMS effort to recognize focused practice. In order to achieve focus practice designation a candidate must be certified in Neurological Surgery by the ABNS. Pediatric Neurological Surgery is not a subspecialty because the ABNS requires each of its ABNS/ABMS candidates to be trained in pediatric neurological surgery based on an ABNS/RRC mandatory case log system. Current Pediatric Neurological Surgery certification builds upon the core psychomotor, surgical and knowledge principles required by the ABNS for certification. Specifically, the basic training of an ABNS certified neurological surgeon includes pediatric neurological surgery. This requested focused practice designation will require additional non-acgme, post graduate training and/or clinical experierence so that it does not detract from the standard ACGME training that all neurosurgeons receive. A focused practice designation in pediatric neurological surgery will recognize that subset of ABNS certified neurological surgeons who have advanced the practice of pediatric neurological surgery by focusing their career and surgical efforts on children with surgically treatable neurological conditions. This group of neurological surgeons has advocated for the health and safety of children, improved the care and advanced the science in this particular focused area. Neurological surgeons who devote a significant portion of their practice to pediatric cases are encouraged to seek focused practice designation from the ABNS in pediatric neurological surgery, in addition to certification from the ABNS in general neurological surgery. However, the absence of focused practice designation from the ABNS in pediatric neurological surgery does not imply that a neurological surgeon is not competent to perform pediatric cases. The certificate from the ABNS in general neurological surgery is given to neurological surgeons who have met ABNS requirements across the full range of neurological surgery core principles.

2 3. Focused practice usually falls under one of these areas. Please describe which of the following this application addresses. a. Evolving area of practice b. Area of practice limited in scope or size c. Specialized procedure b. Area of practice limited in scope 4. Please outline the eligibility criteria required of candidates in the proposed area of focused practice, as it pertains to the following: 4a. Certification in a specialty or subspecialty by an ABMS Member Board: American Board of Neurological Surgery (ABNS) 4ai. If diplomates of multiple ABMS Member Boards would be allowed to apply for this area of focused practice, please list those Member Boards: Only ABNS diplomates can or will qualify and desire to apply for focused practice in Pediatric Neurological Surgery 4b. What specialty and/or subspecialty certificate(s) will a diplomate be required to hold in order to be eligible for this area of focused practice? American Board of Neurological Surgery (ABNS) certificate 4c. Clinical practice experience (both in terms of time and patient volume) in the area of focused practice, beyond initial training: Clinical based requirements: Physicians who wish to obtain both (a) an initial certification in general neurological surgery issued by the ABNS; and (b) an additional initial FOCUSED PRACTICE designation in pediatric neurological surgery requires: a. Successful completion of a neurological surgery residency program in the United States accredited by the ACGME; b. Successfully pass the ABNS primary (written) examination for credit during residency; c. Successful completion of a post-residency, non-acgme, pediatric neurological surgery fellowship of at least twelve (12) months duration accredited by the Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF); d. Successfully pass a primary pediatric neurological surgery subspecialty written examination (the "Pediatric Written Examination") following completion of their pediatric neurological surgery fellowship (post graduate) and prior to submitting their practice data for approval in connection with their application for the ABNS oral examination; of a case log with the time limits mandated by ABNS rules and the successful review of the case log by the Joint Credentials Committee of the ABNS and ABPNS; and e. Successful completion of the ABNS oral exam within the time limits mandated by ABNS rules. This includes an oral exam with one of three sessions that is a focused session on pediatric neurological surgery administered by ABNS Pediatric Neurological Surgeons. i. Case Logs: The number of cases to be submitted for initial ABNS designation (and the time period in which they must be performed) shall be the same as for physicians seeking to obtain ABNS certification only, but for the additional ABMS focused practice designation there are additional focused practice requirements. Specifically, for the focused practice designation the candidate will provide a case log that satisfies ABNS criteria: "Candidates for initial certification must submit a chronological log of 150 consecutive, major, surgical cases for which he or she was the responsible surgeon. Each must have a minimum of three months' follow-up. All cases must be within an 18-month time period and none may be older than 24 months at the time received. A list of minor procedures must be included with the application as well." In addition, the candidate will demonstrate case log evidence of a minimum of 95 (63%) major pediatric cases (less than 22 years of age) within the 150 major consecutive cases submitted. g. MOC Requirements: The requirements for successful completion of the ABNS MOC program in each ten year cycle, and the requirements for successful completion of the joint ABNS/ABPNS MOC program in each ten year cycle, shall be largely identical and overlapping (so as to avoid duplication), except that (a) those who seek to successfully complete the ABNS focused practice MOC cycle will have their applied learning exam (formerly called the cognitive exam, MOC Part III) geared to their pediatric practice; and (b) those who seek to successfully complete the ABNS focused pediatric neurosurgery practice MOC cycle must, in addition to completing all MOC elements that apply to all ABNS Diplomates, submit a case log to the ABPNS periodically (which must be approved by the ABPNS/ABNS) to demonstrate that their practice remains primarily geared to pediatric patients and those with congenital disorders.

3 4d. Additional qualifications (if any): SUMMARY OF NEW PROCESS FOR CANDIDATES WHO WISH TO OBTAIN AN ADDITIONAL DESIGNATION OF FOCUSED PRACTICE IN PEDIATRIC NEUROLOGICAL SURGERY As many pediatric neurological surgeons are aware, for years the American Board of Neurological Surgery ("ABNS") and the American Board of Pediatric Neurological Surgery ("ABPNS") have had parallel and somewhat overlapping certification processes. In an effort to streamline those processes, the following will apply. 1. Requirements for Obtaining Additional Focused Practice Designation in Pediatric Neurological Surgery: a. Successful completion of a neurological surgery residency program in the United States accredited by the ACGME; b. Successfully pass the ABNS primary (written) examination for credit during residency; c. Successful completion of a post-residency pediatric neurological surgery fellowship of at least twelve (12) months duration accredited by the Accreditation Council for Pediatric Neurosurgical Fellowships (the "ACPNF"); d. Successfully pass a primary pediatric neurological surgery subspecialty written examination ( "Pediatric Written Examination") following completion of their pediatric neurological surgery fellowship (post graduate, non-acgme) and prior to submitting their practice data for approval in connection with their application for the ABNS oral examination; e. Approval of the physician's credentials by the Directors of each of the ABNS and the ABPNS following review of the physician's credentials (e.g., licensure, hospital privileges, reference letters) by a Joint Credentials Committee of the ABNS and ABPNS; f. The submission of a case log with the time limits mandated by ABNS rules and the successful review of the case log by the Joint Credentials Committee; and g. Successful completion of the ABNS oral exam within the time limits mandated by ABNS rules. MOC Requirements. The requirements for successful completion of the ABNS MOC program in each ten year cycle, and the requirements for successful completion of the joint ABNS/ABPNS MOC program in each ten year cycle, shall be largely identical and overlapping (so as to avoid duplication), except that (a) those who seek to successfully complete the ABNS/ABPNS MOC cycle will have their applied learning exam (formerly called the cognitive exam, MOC Part III) geared to their pediatric practice; and (b) those who seek to successfully complete the ABNS/ABPNS MOC cycle must, in addition to completing all MOC elements that apply to all ABNS Diplomates, submit a case log to the ABPNS periodically (which must be approved by the ABPNS) to demonstrate that their practice remains geared to pediatric neurological surgery. Any Diplomate who successfully completes the ABNS/ABPNS MOC cycle will also have successfully completed the ABNS MOC cycle and will receive a renewal certificate from the ABNS in general neurological surgery and a renewal designation from the ABNS and ABPNS in pediatric neurological surgery. However, it is possible that an ABNS/ABPNS Diplomate could successfully complete the ABNS MOC program in a ten year cycle but not the ABNS/ABPNS MOC program. That could happen, for example, if the Diplomate's case log demonstrating an ongoing pediatric focus is not submitted or not approved, or if the Diplomate fails to take or successfully complete the applied learning tool in pediatric neurological surgery and opts instead to take (and successfully completes) the applied learning tool in general neurological surgery. In that event, the Diplomate would receive a renewal certificate from the ABNS in general neurological surgery but not a renewal designation from the ABNS/ABPNS in pediatric neurological surgery. 5. With regard to Board-based assessment for candidates prior to awarding this area of focused practice, which assessment methods would be required? (Check all that apply) Examination (Written) Examination (Oral/practical) Submission and review of case lists Other (please specify): see above 5a. Please describe the rationale behind the method(s) required in the assessment process: The rationale behind ABNS and ABPNS methods of assessment for candidates for this focused practice: 1) Written exam demonstrated knowledge base in focused practice of pediatric neurological surgery beyond general neurological surgery training in this field. 2) Oral exam demonstrates safety of practice in this focused practice 3) Submission of case logs demonstrate that in fact the practice is primarily pediatric neurological surgery/congenital neurological surgery. 4) MOC that includes new or evolving pediatric neurological surgery principles assure that new Level I/II data is included in diplomates' practice

4 6. Please outline the Maintenance of Certification (MOC) program planned for this area of focused practice: MOC Requirements: The requirements for successful completion of the ABNS MOC program in each year of a ten year cycle (Now called "Continuous Certification"), and the requirements for successful completion of the joint ABNS and pediatric neurological surgery focused practice MOC program in each ten year cycle, shall be largely identical and overlapping (so as to avoid duplication), except that (a) those who seek to successfully complete the ABNS focused practice MOC cycle will have their applied learning tool-part III MOC (formerly called the cognitive exam) geared to their pediatric practice; and (b) those who seek to successfully complete the ABNS focused practice MOC cycle must, in addition to completing all MOC elements that apply to all ABNS Diplomates, submit a case log to the ABPNS periodically (which must be approved by the ABPNS) to demonstrate that their practice remains geared to pediatric neurological surgery. Any Diplomate who successfully completes the ABNS focused practice MOC cycle will also have successfully completed the ABNS MOC cycle and will receive a renewal certificate from the ABNS in general neurological surgery and a renewal designation from the ABNS in the focused practice of pediatric neurological surgery. However, it is possible that an ABNS Diplomate could successfully complete the ABNS MOC program in a ten year cycle but not the ABNS pediatric focused practice MOC program. That could happen, for example, if the Diplomate's case log demonstrating an ongoing pediatric focus is not submitted or not approved, or if the Diplomate fails to take or successfully complete the applied learning tool in pediatric neurological surgery and opts instead to take (and successfully completes) the applied learning tool (Part III MOC) in general neurological surgery. In that event, the Diplomate would receive a renewal certificate from the ABNS in general neurological surgery but not a renewal designation from the ABNS in the focused practice of pediatric neurological surgery. 7. Document the professional and scientific status of this area of focused practice by addressing (a) through (d) below. 7a. Please describe how the existence of a body of scientific medical knowledge underlying the proposed area of focused practice is in large part distinct from, or more detailed than, that of other areas in which certification or focused practice are offered: The study of pediatric neurological surgery as a distinct focused practice began nearly 100 years ago when Harvey Cushing from the Peter Bent Brigham Hospital and the Harvard Medical School sent Franc Ingraham to Boston Children's Hospital to advance the basic and clinical science of pediatric neurological surgery pertaining to issues ranging from congenital anomalies to brain tumors. The field grew exponentially and spread throughout North America and the world. Although an ABNS neurological surgery diplomate is sufficiently trained to take care of emergency pediatric neurological surgery issues, the focused practice of pediatric neurological surgery became too broad and too complex to master without an additional year of postgraduate training and subsequent focused practice. The field includes but is not limited to pediatric/congenital disorders, trauma, spine, functional, vascular, and an entire curriculum that is additive but separate from the adult ABNS curriculum. Approximately, 26 years ago, when children's hospitals, pediatric services, parents, neurosurgeons and pediatric specialist desired special certification for those who study the unique body of scientific knowledge related to pediatric neurological surgery, thus a new focused practice in neurological surgery was recognized. ABNS certified neurosurgeons who practiced primarily on children started the American Board of Pediatric Neurological Surgery to recognize who pursued this clinical course as a matter of public health and safety. This process was not initially recognized by the ABNS/ABMS which is an error that must now be remedied. We are now asking the ABMS to join with the ABNS in recognizing this pediatric neurological surgery focused practice and the existence of an evolving body of scientific knowledge and pediatric clinical practice which supports it through an ABMS focused practice designation process. 7b. Explain how this proposed area of focused practice addresses a distinct and well-defined patient population and care need: This is a distinct and well defined patient population with often unique conditions and it parallels the patient population of Children's Hospitals which are uniformly neonates to age 21. There are some institutions where the population is limited to patients from birth to 16 years of age. This practice includes in utero surgery in some select Pediatric Centers. 7c. Please provide information about the group of diplomates concentrating their practice in the area of focused practice, if known:

5 7ci. The projected number of such diplomates (along with the source(s) of the data): There are currently 211 active ABNS diplomates whose focused practice is in pediatric neurological surgery and are certified by the ABPNS. There will likely be that range of pediatric focused practice diplomates in the future. In contrast there are currently a total of 4178 active ABNS diplomates. There are 2430 participating in MOC, 1513 retired and 1062 deceased. Since its founding in 1940, the ABNS has only certified 7022 diplomates. 7cii. The annual rate of change of such diplomates in the recent past and projected annual rate of change for the near future (along with the source(s) of the data): There is likely to be no change in the number of diplomates with a focused practice in pediatric neurological surgery because the ABPNS has been recognizing these ABNS diplomates for the past 26 years. All that would occur is the process would be absorbed and supported by the robust infrastructure of the ABNS, which is an ABMS member board. 7ciii. The current geographic distribution of this group of diplomates, its projected spread in the next five (5) years, and an explanation of how you arrived at this projection: There will likely be no change and the geographic spread is based on the job opportunities that depend on institutional support and pediatric population centers. The geographic distribution will follow the pediatric population needs throughout the USA. 7d. Please identify the existing national societies that have a principal interest in the area of focused practice: American Board of Neurological Surgery-ABNS American Board of Pediatric Neurological Surgery-ABPNS American Society of Pediatric Neurological Surgeons -ASPN Accreditation Council of Pediatric Neurological Surgery- ACPNF American Association of Neurological Surgeons (AANS) Congress of Neurological Surgeons (CNS) Society of Neurological Surgeons American Academy of Pediatrics- Section on Neurological Surgery (AAP-SONS) 7di. Indicate the existing national societies size and scope, along with the source(s) of the data: ACPNF- Accreditation Council of Pediatric Neurological Surgery- 7 Directors ABPNS-American Board of Pediatric Neurological Surgery- 10 Directors 7dii. Indicate the distribution of academic degrees held by their members, along with the source(s) of the data: MD primarily some DO (ABPNS source) 7diii. Indicate the relationship of the national societies membership with the proposed focused practice designation: ABPNS is now providing non-abms certification in this focused practice 8. Please describe how the cognitive knowledge, clinical and interpersonal skills, professional attitudes, and practical experience of diplomates in this area of focused practice will be distinct from diplomates in other specialties, subspecialties, and areas of focused practice in terms of: 8a. Clinical competence: It builds on the competencies and principles of neurological surgery but focuses on the conditions and population that is pediatric (less than 21 years of age) 8b. Scope of practice: Pediatric patients (less than 21 years of age)

6 8c. Body of knowledge and skills: The body of knowledge and skills is built upon the fundamental principles as put forth by the ABNS and ABPNS. The additional skills are those psychomotor skills that apply to performing operations on neonates and children, along with the perioperative management of these unique patients. The body of knowledge is outlined in the ACPNF curriculum. 9. For (a) through (e) below, please project the need for and the effect of the proposed new focused practice on the existing patterns of certification or other areas of focused practice. Please indicate how you arrived at your response. 9a. Please indicate whether there is any overlap between this area of focused practice and existing subspecialty certifications or other areas of focused practice. There is NO overlap between this area of focused practice and existing ABMS subspecialty certifications or other areas of focused practice. 9b. Please outline plans for evaluation of the impact of the proposed area of focused practice on your own programs of specialty and subspecialty certification and any other areas of focused practice: The ABNS has no other programs in focused practice or subspecialty certification. 9c. Please outline plans for evaluation of the impact of the proposed area of focused practice on other Member Boards programs of specialty and subspecialty certification and any other areas of focused practice: There are no other Member Boards' programs of specialty or subspecialty certification that overlap with Pediatric Neurological Surgery. 9d. The impact of the proposed area of focused practice on practice, both existing and long-term, specifically: 9di. Access to care (please include your rationale): Improved access and care. This has already occurred through the ABPNS. The ABPNS' mission is dedicated to encourage the study, improve the practice, elevate the standards of pediatric neurological surgery, and thereby to advance the cause of public health. 9dii. Quality and coordination of care (please include your rationale): Improved but this has already has occurred through the ABPNS and its mission as stated in 9di. The ABNS has an infrastructure that is more robust and can better support the exams and designation/moc process. In addition, the ABPNS and ABNS would prefer to place this 26 year process under the reputable ABMS umbrella. 9diii. Benefits to the public (please include your rationale): The ABNS and ABPNS have public health based missions. The benefits are in terms of Public Health and Safety when experts dedicated to children are providing evidence based care built upon the ABNS core principles and augmented by pediatric neurological surgery fellowship and practice. The practice and standards of pediatric neurological surgery are improved nationally by developing this ABMS focused practice designation. 9e. Please explain the effects, if known, of the proposed area of focused practice on: 9ei. Immediate costs and their relationship to the probable benefits (please indicate your methodology): In all disease processes focused practice in pediatric neurological surgery provides quality and safety benefits that are too numerous to count and their immediate costs and benefits will be no different than they are today because this designationhas been in effect for 26 years under the non-abms organization, ABPNS.

7 9eii. Long-term costs and their relationship to the probable benefits (please indicate your methodology): This area of practice has been recognized for 26 years by the ABPNS. The benefits of merging two parallel credentialing processes (ABNS and ABPNS) will improve the quality of the final ABMS proposed processes at a significant cost savings to our ABNS Diplomates. Furthermore, this would make the pediatric neurological surgery focused practice process an ABMS recognized process.the ABNS/ABPNS MOU has the added benefit of eliminating parallel process and reducing costs for Diplomate redesignation 9f. Please explain the effects if this area of focused practice is not approved: In the unlikely event that the ABMS does not approve this focused practice, the ABPNS will continue to execute the pediatric neurological surgery certification outside the ABMS parameters, as it successfully has for 26 years. This alternate certification by ABPNS will continue to be recognized by the ABNS and Children's Hospitals throughout North America thus continuing to undermine the fabric of the ABMS and relevance of the ABMS for neurological surgeons. 10. Please indicate how the proposed area of focused practice will be evaluated periodically (e.g., every five years) to assure that the area of focused practice remains viable: A new (2017) fully executed MOU exists between the ABNS and ABPNS to ensure that both organizations maintain the quality of the graduates, and the safety of the neurological surgeons. This pediatric neurological surgery focused practice has existed nearly 100 years and has not only been viable but grown since Harvey Cushing's legacy. 11. Please list key stakeholder groups from which ABMS may wish to solicit commentary on the proposed area of focused practice: ABNS ABPNS ACPNF AAP AANS ASPN CNS SNS To be completed for areas of focused practice for which formalized training is currently available to meet some of the requirements for clinical experience and patient volume: 12. Please provide the following information for those training programs that have a primary educational effort devoted to the proposed area of focused practice, along with their geographic locations and the source(s) of the data:

8 12a. Please list the names of training programs in the proposed area of focused practice: 1) Ann & Robert H. Lurie Children's Memorial Hospital Chicago, IL Northwestern University 2) Barrow Neurological Institute at Phoenix Children's Hospital Phoenix, AZ 3) Boston Children's Hospital Boston, MA Harvard University 4) Children's Healthcare of Atlanta at Egleston and Scottish Rite Atlanta, GA Emory University, Atlanta GA 5) Children's Hospital of Alabama /UAB Birmingham, AL University of Alabama 6) Children's Hospital of Los Angeles Los Angeles, CA University of Southern California 7) Children's Hospital of Philadelphia Philadelphia, PA University of Pennsylvania 8) Children's Hospital of Pittsburgh Pittsburgh, PA University of Pittsburgh 9) Children's Hospital, Denver Denver, CO University of Colorado 10) Children's Medical Center Dallas Dallas,TX University of Texas Southwestern 11) Children's National Medical Center Washington, DC George Washington University 12) Cincinnati Children's Hospital Medical Center Cincinnati, OH University of Cincinnati 13) Doernbecher Children's Hospital Portland, OR Oregon Health & Science University 14) Duke Children's Hospital & Health Center Durham, NC Duke University School of Medicine 15) Hospital for Sick Children Toronto, Ontario University of Toronto 16) James Whitcomb Riley Hospital for Children Indianapolis, IN University of Indiana 17) Johns Hopkins Hospital Baltimore, MD Johns Hopkins University 18) Lucile Packard Children's Hospital at Stanford Stanford, CA Stanford University 19) Miami Children's Health System / Nicklaus Children's Hospital Miami, FL University of Miami 20) Nationwide Children's Hospital Columbus, OH The Ohio State University 21) NYU Langone Medical Center New York, NY New York University 22) Primary Children's Hospital Salt Lake City, UT University of Utah 23) Rady Children's Hospital San Diego, CA University of California, San Diego 24) Seattle Children's Hospital Seattle,WA University of Washington 25) St. Louis Children's Hospital St. Louis, MO Washington University 26) Texas Children's Hospital Houston, TX Baylor College of Medicine 27) UCSF - Benioff Children's Hospital San Francisco & Oakland, CA 28) University of Tennessee / St. Jude Memphis, TN Semmes-Murphy 12b. Indicate the total number of trainee positions available currently (along with the source(s) of the data): ACPNF Website and officers 12c. Provide the number of trainees completing the training annually (along with the source(s) of the data): ACPNF Website and Officers can provide details: In general, approximately fellows (1/fellowship location) per year are graduated each year. 12d. Organization(s) providing accreditation or oversight for training programs: Accreditation Council of Pediatric Neurological Surgery: Pediatric Neurological Surgery Fellowships 13. How much additional clinical experience is required beyond training? The ABNS candidate (post ACGME residency graduation) will need 1 year of pediatric neurological surgery fellowship recognized by the ACPNF (Accreditation Council of Pediatric Neurological Surgery Fellowships) and then collect 150 consecutive patient cases. On average, the focused practice diplomate will need 2-5 years of practice before earning their focused practice designation in pediatric neurological surgery.

9 ACCREDITATION COUNCIL FOR PEDIATRIC NEUROSURGERY FELLOWSHIPS June 20, 2017 R. Michael Scott, MD Chairman ACPNF Pediatric Neurosurgery Boston Children s Hospital Boston, Massachusetts Cormac O. Maher, MD Secretary-Treasurer ACPNF Pediatric Neurosurgery University of Michigan Ann Arbor, Michigan Douglas Brockmeyer, MD Pediatric Neurosurgery University of Utah Salt Lake City, Utah James Drake, MD Pediatric Neurosurgery Hospital for Sick Children, Toronto, Ontario Phillip Pearl, MD Pediatric Neurology Boston Children s Hospital Boston, Massachusetts Ian F. Pollack, MD Pediatric Neurosurgery University of Pittsburgh Pittsburgh, Pennsylvania Robert Tasker, MD Director, Pediatric Neuro- Intensive Care Boston Children s Hospital Boston, Massachusetts Richard G. Ellenbogen, MD, FACS Secretary, American Board of Neurological Surgery rge@neurosurgery.washington.edu Dear Dr. Ellenbogen, As you know, the Accreditation Council for Pediatric Neurosurgery Fellowships (ACPNF) is the lead entity in the accreditation of pediatric neurological surgery fellowship programs in the United States. The ACPNF has been updated regarding the progress that has been made with the relationship between the American Board of Neurological Surgery (ABNS), a member board of the American Board of Medical Specialties, and the American Board of Pediatric Neurosurgery (ABPNS). The ACPNF is aware that the recently signed a memorandum of understanding between the ABNS and ABPNS will allow the ABNS to recognize the focused training and practice of pediatric neurosurgeons within the specialty of neurosurgery. In order to receive this recognition of pediatric focus, individuals must complete an ACPNF-accredited pediatric neurosurgery fellowship program, similar to the longstanding requirement for ABPNS certification prior to the new memorandum of understanding. The ACPNF believes that this new agreement between the ABNS and the ABPNS represents significant progress in aligning the pediatric neurosurgery certification process within the larger field of neurosurgery, offering advantages in order, transparency, and ease of regulation for the field of pediatric neurosurgery. We applaud the plan for the ABNS to begin recognizing properly trained pediatric neurological surgeons with an ABNS focused practice certificate. Thank you for your efforts in this matter. If you have any questions, please don t hesitate to contact either of us directly. Sincerely, R. Michael Scott, MD Cormac O. Maher, MD ACPNF Chairman ACPNF Secretary/Treasurer 3552 Taubman Ctr, 1500 E. Medical Center Dr, Ann Arbor, MI Phone (734)

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11 THE AMERICAN BOARD OF PEDIATRIC NEUROLOGICAL SURGERY DIRECTORS Frederick A. Boop, MD Chairman Memphis, Tennessee Alan Cohen, M.D. Vice-Chairman Boston, Massachusetts John Ragheb, MD Secretary-Treasurer Miami, Florida John R.W. Kestle, MD Salt Lake City, Utah James Drake, MD Toronto, Ontario Ian F. Pollack, MD Pittsburgh, Pennsylvania Bermans J. Iskandar, MD Madison, Wisconsin Bruce Kaufman, M.D. Milwaukee, Wisconsin Jeffrey Ojemann, M.D. Seattle, Washington David Gruber, M.D. Spokane, Washington June 2, 2017 Lois Margaret Nora, MD, JD, MBA President and Chief Executive Officer American Board of Medical Specialties 353 North Clark Street, Suite 1400 Chicago, IL LOI: Focused Practice Pediatric Neurological Surgery Dear Dr. Nora: In 1991, the American Board of Pediatric Neurological Surgery (ABPNS) was formed in order to advance the care of children with surgical diseases of the nervous system. The intent of the Board was to further certify individuals who were certified by the American Board of Neurological Surgery (ABNS), had completed formal fellowship training in pediatric neurosurgery and had proven a commitment to a practice in pediatric neurological surgery. At that time, it was the feeling of the leadership within the ABNS that neurological surgery was a small specialty and that further sub-specialization within the field would only fragment neurosurgery. Over the past twenty-six years, despite the ABPNS not having ABMS recognition, a Board certificate by the ABPNS has become recognized by children s hospitals throughout the United States and Canada, by the American Academy of Pediatrics, and by lay entities such as US News and World Report. Over the past two years, both the ABNS and the ABPNS have worked diligently to merge these two organizations to better serve our members and to gain formal recognition for those who specialize in pediatric neurological surgery. The ABNS and the ABPNS have now completed their merger through legal memoranda of understanding. As such, and by unanimous vote by both the directors of the ABNS and the ABPNS, we request permission of the ABMS to recognize Focused Practice in Pediatric Neurological Surgery. We thank you in advance for considering this important application on behalf of the ABNS/ABPNS and its diplomats. Respectfully, Kari Bollerman ABPNS Administrator Phone: kari.bollerman@mch.com Frederick A. Boop MD Chairman of the Board, American Board of Pediatric Neurological Surgeons

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13 June 5, Northwest Point Blv d Elk Grov e Village, IL Phone: 847/ Fax: 847/ kidsdocs@aap.org Lois Margaret Nora, MD, JD, MBA President and CEO American Board of Medical Subspecialties Dear Dr. Nora, Executive Committee President Fernando Stein, MD, FAAP President-Elect Colleen A. Kraf t, MD, FAAP Immediate Past President Benard P. Drey er, MD, FAAP CEO/Executive Director Karen Remley, MD, FAAP Board of Directors District I Wendy S. Dav is, MD, FAAP Burlington, VT District II Warren M. Seigel, MD, FAAP Brookly n, NY District III Dav id I. Bromberg, MD, FAAP Frederick, MD District IV Jane M. Foy, MD, FAAP Winston-Salem, NC District V Richard H. Tuck, MD, FAAP Zanesv ille, OH District VI Pamela K. Shaw, MD, FAAP Kansas City, KS District VII Anthony D. Johnson, MD, FAAP Little Rock, AR District VIII Ky le Yasuda, MD, FAAP Seattle, WA The American Academy of Pediatrics was established in 1930 and is an organization of 66,000 pediatricians and pediatric medical and surgical subspecialists committed to the optimal physical, mental and social health and well-being for all infants, children, adolescents, and young adults. The Academy advocates for the recognition of those with dedicated practice in pediatrics and pediatric medical and surgical subspecialties. Its strengths include a strong emphasis on policy, advocacy and education; serving as a public face for children s health and the profession; and a mission-driven culture. These services are driven by the Academy s core values and commitments as an organization. As advocates for the care of children, we are writing to you in support of the ABMS recognition of focused practice in pediatric neurological surgery through the American Board of Neurosurgery (ABNS). The surgical care of diseases in childhood is already recognized by several other surgical disciplines with the ABMS. Although the ABNS requires candidates for certification to have completed formal training in pediatric neurosurgery taught by dedicated pediatric neurosurgeons, the ABNS recently has determined it important to recognize pediatrics as an area of special focus within neurosurgery. This represents a significant step toward recognizing this specialty care for children. The endorsement by the ABMS of focused practice in pediatric neurosurgery will support the unique training, experience and achievement required to care for children with neurosurgical diseases. The ABMS endorsement is consistent with the AAP s efforts to improve care for infants, children, adolescents and young adults. The AAP supports recognition by the ABMS of focused practice in pediatric neurological surgery through the ABNS and asks that the ABMS endorse this effort. Thank you for this consideration. Sincerely, District IX Stuart A. Cohen, MD, FAAP San Diego, CA District X Sara H. Goza, MD, FAAP Fay ettev ille, GA Fernando Stein, MD, FAAP President American Academy of Pediatrics