Karen Ballaban-Gil, MD, the recipient of the 2019 CNS-PCN Outstanding Training Director Award has been the leader (and poster child) of the Child Neurology residency program at the Albert Einstein College of Medicine/Montefiore Medical Center since 2001. Upon assuming the role of director, Karen modified the training program, restructuring it to reflect the changing nature of child neurology. She added many outpatient experiences, including outpatient rotations in developmental pediatrics, rehabilitation medicine, and subspecialty outpatient clinics, including epilepsy clinic, and autism clinics. She also added a monthly continuity clinic for residents to follow up patients in the outpatient setting whom they initially consulted on as inpatients, allowing them to have more of a “private practice” experience in addition to their weekly teaching pediatric neurology clinic. In recognition of her excellence, Karen was appointed as Associated Director of the Isabelle Rapin Division of Child Neurology at the Albert Einstein College of Medicine/Montefiore Medical Center. Isabelle must be smiling, indeed, as she was the proud mentor and guiding light in Karen’s career in child neurology.
Karen developed a core curriculum for the pediatric neurology trainees and organized lectures on this curriculum. Together with the training director of the child psychiatry program, she organized bimonthly joint conferences with the child psychiatry team. She was instrumental in organizing a weekly teaching conference with the pediatric neurosurgery team, to improve the educational experience and patient care of patients with pediatric neurosurgical/ neurological disorders.
As the demands of the ever increasing numbers of inpatient consultations began to impinge on the teaching time (and therefore learning experiences) of the residency program, Karen reorganized the service to have two attendings: one with primary teaching responsibilities, the other, the hospitalist, to manage the clinical responsibilities of the inpatient service. Karen also reached out to other institutions in the New York area to develop relationships and coordinate new rotations for residents in subspecialty areas where Montefiore’s program did not have the depth of knowledge to give the residents sufficient experiences, including in neurooncology, neurogenetics and neuroimmunology. Karen has been instrumental in setting up centers of excellence for pediatric neurology care at Montefiore Medical Center/Albert Einstein College of Medicine, helping to coordinate multidisciplinary clinics that care for children with complex neurological disorders, such as the Tuberous Sclerosis and Neuro-Cutaneous clinic, the Tristate Rett Center, and the Multiple Disciplinary Muscular Dystrophy Association (MDA) clinic.
Karen worked with the pediatric emergency department (ED), hospitalists and other pediatric subspecialists to develop treatment protocols and guidelines in order to decrease the reliance on our house staff to do inpatient consultations and improve the quality and timeliness of care that our patients receive, both inpatient and outpatient. Examples of these protocols include development of an evaluation, treatment and referral pathway for infants with suspected brachial plexus injuries in our newborn nurseries,; development of an evaluation and referral pathway for children referred to our ED or outpatient offices for evaluation of (suspected) papilledema; development of an evaluation and rapid referral pathway for children with new onset seizures; and, most recently, the development of a pediatric stroke pathway for the Children’s Hospital at Montefiore. This last endeavor involves coordination of multidisciplinary care, including neuroradiology, pediatric interventional neuroradiology, neurosurgery, pediatric intensive care, pediatric hematology and our adult stroke service, as well as championing the development of the pediatric stroke pathway (order sets, pediatric NIH stroke scale, etc.) in the EPIC medical records system.
Karen has been responsible for overseeing the development and implementation of all of our electronic medical records systems for the Division of Child Neurology. In this role, she has worked together with the IT division of Montefiore to develop pediatric neurology specific content and templates for each of the five different iterations of electronic medical records that we have used since the inception of EMRs. In creating these templates, Karen has developed age and diagnosis specific templates that help guide the residents through the appropriate history-taking and physical examination of pediatric neurology patients, based on their presenting complaints. These templates serve not only as an efficient means of gathering the appropriate medical information necessary to best care for our patients, but also teaches our residents – including child neurology, adult neurology, general pediatrics and child psychiatry residents – what information is essential in the evaluation of children with specific neurologic illnesses. Karen serves as a mentor for premedical students, medical students, residents and junior faculty. She spends many hours with medical students interested in neurology and child neurology, having them spend time and shadow in her office to expose them to the field of child neurology. Additionally, she counsels aspiring medical students about residency decisions, regardless of whether they are planning to come to our program or prefer to go elsewhere. She has had a number of premedical students shadow her, as well, hoping to instill in them the same love of child neurology that she has. In addition, for many years, Einstein had a program for minority high school students interested in pursuing careers in health care fields. For many years, Karen would have one of these students spend time with her for six weeks each summer and lectured to the group of high school students during the school year, as well. Karen only ended her participation in this program when the program itself ended. Both adult and child neurology residents know that Karen’s door is always open to speak to her about residency issues, seek guidance in making career decisions, or ask for help in figuring out how to balance family and career. Junior attendings know they can turn to Karen for guidance in these areas, as well.
Karen mentors our child neurology residents in their scholarly activities, as well. A number of years ago, we began requiring all residents to participate in a scholarly project prior to graduation; the project can range from a case presentation with review of the literature to a research project. Throughout the course of their residency, Karen meets regularly with each resident to help them formulate research questions and projects and helps guide them to appropriate mentors for those projects. When those projects are within the scope of her expertise, she has often mentored the projects herself.
Karen has made a difference in our training program as she provides effective guidance together with “tender” discipline and support as needed for physicians during their formative years. Her influence goes beyond our institution, extending to all child neurology programs. Receiving this prestigious award from the Child Neurology Society is a well- deserved recognition of her many achievements as a physician educator. We are lucky in our Society to have such an inspirational leader and wonderful human being training our “young ones.”