Perceived Benefits and Barriers to a Career in Neuroanesthesiology: A Pilot Survey of Anesthesiology Clinicians Shobana Rajan, MD,* Marie A. Theard, MD,† Jane Easdown, MD,‡ Keshav Goyal, MBBS, MD, DM,§ and Jeffrey J. Pasternak, MD∥ Background: Despite advances in perioperative neuroscience, there is low interest among anesthesiology trainees to pursue subspecialty training in neuroanesthesiology. We conducted a pilot survey to assess attitudes about neuroanesthesiology fel- lowship training. Materials and Methods: A confidential survey was distributed to an international cohort of anesthesiology attendings and trainees between January 15, 2017 and February 26, 2017. Results: A total of 463 responses were received. Overall, 309 (67%), 30 (6%), 116 (25%), and 8 (2%) of respondents identified themselves as attendings, fellows, residents, and “other,” re- spectively. In total, 390 (84%) of respondents were from the United States. Individuals typically pursue anesthesiology fel- lowship training because of interest in the subspecialty, acquis- ition of a special skill set, and the role of fellowship training in career planning and advancement. Overall, 64% of attendings, 56% of fellows, and 55% of residents favored accreditation of neuroanesthesiology fellowships, although opinion was divided regarding the role of accreditation in increasing interest in the specialty. Respondents believe that increased opportunities for research and greater exposure to neurocritical care and neuro- logical monitoring methods would increase interest in neuro- anesthesiology fellowship training. Perceived barriers to neuroanesthesiology fellowship training were perceptions that residency provides adequate training in neuroanesthesiology, that a unique skill set is not acquired, and that there are limited job opportunities available to those with neuroanesthesiology fellowship training. Conclusions: In this pilot survey, we identified several factors that trainees consider when deciding to undertake subspecialty training and barriers that might limit interest in pursuing neu- roanesthesiology subspecialty training. Our findings may be used to guide curricular development and identify factors that might increase interest among trainees in pursuing neuroanesthesiology fellowship training. Key Words: neuroanesthesiology, neuroscience, fellowship, medical education, career choice (J Neurosurg Anesthesiol 2019;00:000–000) W ith major advances in clinical neurosciences, there is a belief that management by subspecialty-trained specialty physicians improves patient outcomes. 1 How- ever, few residents seek fellowship training in neuro- anesthesiology, and the reasons for this are not currently known. Efforts to identify and eliminate perceived barriers to neuroanesthesiology fellowship training will be key to ensuring the continued growth of this subspecialty of anesthesiology. The Neuroanesthesia Education Special Interest Group of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) conducted a survey of attendings, fellows, and residents in anesthesi- ology to assess attitudes about neuroanesthesiology fel- lowship training. SNACC is an international organization comprised anesthesiologists, intensivists and researchers committed to advancing the care of the neurologically impaired patient through education, training, and research in perioperative neuroscience. The aim of this survey was to identify attitudes to neuroanesthesiology fellowship programs and provide guidance to support the growth and development of such programs. MATERIALS AND METHODS A survey created by the authors in consultation with the SNACC leadership was circulated to attending anes- thesiologists and anesthesiology trainees. The full survey Received for publication June 26, 2019; accepted September 16, 2019. From the *Department of Anesthesiology, Allegheny General Hospital, Pittsburgh, PA; †Department of Anesthesiology, Legacy Emmanuel Medical Center, Portland, OR; ‡Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; §Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, India; and ∥Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN. Presented in abstract form at the 45th Annual Meeting of the Society for Neuroscience in Anesthesiology and Critical Care in Boston, MA on October 20, 2017. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Shobana Rajan, MD. E-mail: shobanarajan5@ gmail.com. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.jnsa. com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/ANA.0000000000000655 CLINICAL REPORT J Neurosurg Anesthesiol  Volume 00, Number 00, ’’ 2019 www.jnsa.com | 1 Copyright r 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.