Views of Recently First-Certified US Child Neurologists on Their Residency Training

Gilbert, Donald L.; Patterson, Marc C.; Pugh, John; Ridel, Keith R.; Reynolds, Thomas Q.; Valencia, Ignacio

doi:10.1177/0883073812473644

Cited by 9 publications

(15 citation statements)

References 10 publications

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“…Before 2014, a survey of neurologists completing first certification between 2001 and 2010 showed that 68% of respondents reported their training programs involved 10-12 months of adult neurology in the PGY-3. 6 While the responders to the aforementioned survey were a different population than those of the PD surveys, these data still support the notion that, over This study also found that programs with children's hospital GME funding (for either 2 or 3 years) tended to be larger than those using predominantly adult institution GME funding. One possible explanation for the association is that children's hospitals with their own GME funding are more likely to be large regional referral centers with greater patient volume and more need for residents.…”

Section: Discussionsupporting

confidence: 52%

“…4 Reflecting these changes, the 2015 American Academy of Pediatrics and Child Neurology Society (CNS) Workforce Survey demonstrated that CN residents and practicing physicians favor an increased training emphasis on child-centric disciplines such as genetics and developmental disorders and a decrease in the amount of adult neurology training. 5 Other surveys have reinforced these changing ideas about the content of CN training 6,7 ; however, these viewpoints remain controversial. [8][9][10][11] The Program Requirements for Graduate Medical Education in Child Neurology, set by the Accreditation Council for Graduate Medical Education (ACGME) to achieve eligibility for board certification by the American Board of Psychiatry and Neurology, have also evolved.…”

Section: Discussionmentioning

confidence: 99%

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Adult Neurology Rotations for Child Neurology Residents

et al. 2022

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Background and Objectives:We aimed to identify how child neurology and neurodevelopmental disabilities residency program directors (PDs) implemented revised Accreditation Council for Graduate Medical Education requirements for adult neurology training for child neurology residents. Prior to 2014, American Board of Psychiatry and Neurology certification for child neurology required an “adult year,” with no specified rotation requirements. At that point, programs scheduled a median of 10 months of adult neurology rotations during the third postgraduate year (PGY-3). In 2014, the adult neurology requirements were modified to include 6 months of hospital-based, 3 months of outpatient, and 3 months of other elective (may include neurophysiology, neuropathology, and/or neuroradiology) rotations. However, the effects of these changes on child neurology residency training nationally have not been characterized.Methods:A 16-item online survey was emailed to 79 PDs in the United States in September 2020. Survey responses were collected from September to October 2020. Descriptive statistics were calculated, and associations with departmental affiliation (pediatrics/neurology), graduate medical education (GME) funding source, and program size were compared using non-parametric tests.Results:Response rate was 72% (53 pediatric neurology, 3 neurodevelopmental disabilities). Programs’ median adult months per year were: 9 PGY-3, 2 PGY-4, and 1 PGY-5. Nearly all had both hospital inpatient and consult rotations with night and/or weekend shifts. 57% included neurocritical care and 36% epilepsy monitoring units. 48% of programs scheduled night and weekend shifts (including 25% that scheduled 24-hour call) for residents on outpatient and elective rotations. Few programs required adult neurophysiology (20%), neuropathology (32%), or neuroradiology (25%). Programs with children’s hospital GME funding (for either 2 or 3 years) tended to be larger (p = 0.008). Otherwise, departmental affiliation, funding source, and program size were not associated with rotation timing.Discussion:Most child neurology residency programs still consolidate adult training in the PGY-3 year, and often schedule additional hospital shifts during outpatient and elective months. However, there is a small shift toward adult neurology rotations occurring in the PGY-4 and PGY-5 years. Departmental affiliation, funding source, and program size do not consistently affect training practices. Few programs mandate adult neurophysiology, neuropathology, or neuroradiology rotations.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Adult Neurology Rotations for Child Neurology Residents

et al. 2022

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“…The responses may not be representative of all training programs, although response rates were similar to other survey-based studies. 9,10 Selection bias may have skewed the results toward a greater importance/emphasis on cerebral palsy training as program directors more interested in cerebral palsy may have been more likely to respond. Furthermore, it is not clear how accurate program directors’ perceptions are with regard to the adequacy of training.…”

Section: Discussionmentioning

confidence: 99%

“…In an earlier survey, more than 80% of recently graduated child neurology residents reported that a training program with fewer or no adult neurology months would have better prepared them to diagnose and manage cerebral palsy. 10 Furthermore, children with cerebral palsy become adults with cerebral palsy, who continue to have very specialized needs, although it can be quite difficult to find adult neurology providers with cerebral palsy expertise. 11 These gaps could be addressed in training, as adult neurology trainees rotate through pediatric neurology experiences.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Palsy in Child Neurology and Neurodevelopmental Disabilities Training: An Unmet Need

et al. 2022

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Background Cerebral palsy (CP) is the most common cause of childhood motor disability. However, there is limited guidance on training of child neurologists and neurodevelopmental disability specialists in the care of individuals with cerebral palsy. We sought to determine training program directors’ impressions of the importance and adequacy of training in the diagnosis and management of cerebral palsy. Methods In this cross-sectional study, all 82 child neurology and neurodevelopmental disability program directors were asked to complete a survey querying program characteristics, aspects of training in cerebral palsy, importance of cerebral palsy training, and perceived competence at graduation in cerebral palsy care. Results There were 35 responses (43% response rate). Nearly all program directors (91%) reported “learning to diagnose cerebral palsy” as very important, and most (71%) felt that “learning to manage cerebral palsy” was very important. Although most program directors reported trainees to be very or extremely competent in cerebral palsy diagnosis (77%), only 43% of program directors felt that trainees were very or extremely competent in cerebral palsy management. Time spent with cerebral palsy faculty was associated with higher reported competence in cerebral palsy diagnosis ( P = .03) and management ( P < .01). The presence of a cerebral palsy clinic was associated with higher reported competence in cerebral palsy management ( P = .03). Conclusions Child neurology and neurodevelopmental disability program directors reported that training in cerebral palsy is important for residents; however, a significant proportion felt that residents were not very well prepared to manage cerebral palsy. The development of cerebral palsy curricula and exposure to cerebral palsy clinics may improve training, translating to better care of individuals with cerebral palsy.

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“…16 One advantage of this proposed change is that it would give child neurology residents more time to explore subspecialties such as genetics and developmental neurology earlier in residency. 17…”

Section: Other Methods To Support Residents In the Fellowship Applica...mentioning

confidence: 99%

The Neurology Fellowship Application Conundrum

et al. 2022

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For many neurologic subspecialties, the fellowship application process begins early in the first half of the second year of neurology-specific training (PGY3 for adult neurology residents and PGY4 for child neurology residents). In 2019, the American Academy of Neurology (AAN) published a position statement recommending communication between fellowship candidates and training programs begin no sooner than March 1 of the penultimate year of training and that programs offer fellowship positions no sooner than August 1 of the final year of training. A few pilot subspecialties adopted this timeline for 2021 recruitment for positions beginning in 2022. All US-based AAN affiliated neurology and child neurology residents who recently completed the fellowship application process received a survey about their fellowship application experience. Of the 291 residents who responded to the survey, 96% agree that applications should not be submitted before March 1 of the penultimate year of training and 72% feel that August 1 of the final year is a reasonable time to begin offering positions. Nearly half (49%) of residents feel that there is too little time for subspecialty/clinical exposure prior to applying for fellowship and 88% feel the current process and timeline are stressful. Residents who applied to programs in pilot subspecialties report more time to choose, less stress, and a lower number of time-pressured offers. A vast majority of residents (89%) prefer to submit a single application through a centralized system. The survey results suggest that residents who just completed the fellowship application process agree with the AAN recommended timeline for all subspecialties, and that all neurology subspecialties should consider adopting a fellowship match. Programs can help facilitate a better fellowship application experience by providing earlier exposure to a broad range of neurologic subspecialties and ensure that residents are given opportunities to attend national meetings and participate in appropriately scoped scholarly endeavors.

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Views of Recently First-Certified US Child Neurologists on Their Residency Training

Cited by 9 publications

References 10 publications

Adult Neurology Rotations for Child Neurology Residents

Adult Neurology Rotations for Child Neurology Residents

Cerebral Palsy in Child Neurology and Neurodevelopmental Disabilities Training: An Unmet Need

The Neurology Fellowship Application Conundrum

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