Adult Neurology Rotations for Child Neurology Residents

Abstract

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.

A half‐century check‐up for child neurology training

“…A decade or so ago, the Child Neurology Society's (CNS) leadership and the society's representatives on the Neurology Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) initiated a discussion about the child neurology training requirements that culminated in a series of curriculum modifications in 2014. 4 Before then, the focus of the adult neurology training for child neurology residents was largely at the discretion of the individual programs, and some child neurology residents spent most of the time on inpatient rotations. To complicate things further, adult-focused rotations such as adult neurophysiology, neuroradiology, and neuropathology could not be used to satisfy part of the adult neurology requirement because the activities did not include direct care of the patients.…”

“…In most programs, child neurology residents share the night and weekend adult neurology call duties during adult neurology rotations, including the non-clinical rotations in many programs. 4 Neither the ACGME nor the ABPN specifically requires child neurology residents to participate in adult neurology night call, and a few programs, including my own, do not require their residents to do so. Is adult night call an essential part of child neurology training?…”

Recognizing and Responding to the Needs of Future Child and Adult Neurology Care Through the Evolution of Residency Training

“…Most of the revisionary focus related to child neurology residency training requirements has been on the mandatory 12 months of adult neurology rotations and potentially reducing or even eliminating these rotations. There has been less discussion of how that time is spent, 5 and how the curriculum for neurological training should be modernized for all learners to better represent not only the increasingly significant lifespan demands described above, but also 21st century neurological therapeutics particularly disease‐modifiying therapies, genetic therapies, and precision or individualized therapeutics. Both child and adult neurology residents must learn the steps required for transitioning from pediatric to adult care which can be challenging, creating vulnerabilities in care continuity, and potentially safety concerns.…”