Prepare for the Annual Meeting in Austin

By Philip L. Pearl, MD

Phillip Pearl, MD

As we prepare for the annual meeting in Austin, it is a good time to reflect on PCN progress over the past year. There has been a flurry of activity related to ACGME Program Requirement Revisions, development of a Milestones Curriculum, Universal Curriculum for Child Neurology Training Programs, and a look at Pediatric vs Neurology “Home Base” for Child Neurology Programs. We joined forces with the CNS in designating combined committees to address the Match and the newly minted Blue Bird Circle Award for Outstanding Child Neurology Program Directors, generously funded by the Texas Children’s Hospital program in the lone star state hosting our meeting.

Program Requirement Revision Highlights:

Following many years of debate at meetings of the PCN, CNPD, and other forums, the Residency Review Committee (RRC) prepared recommended program requirement revisions which were posted for public comment January through May, followed by revisions during the May meeting of the RRC in Chicago at the ACGME offices. While these edits remain under review of the Committee on Revisions, there are substantive revisions applicable to the sponsoring institutions, roles and responsibilities of program directors, faculty, curriculum, and evaluation of both the trainees and the programs. These can be summarized as follows:

The sponsoring institution must provide at least 20 percent FTE support (time and funding) for the program director (PD) and an additional 1% per resident (bringing this into line with the adult neurology programs), and must support a program coordinator to assist the PD.

The PD must monitor resident stress (including mental and emotional), resolve situations that demand excess resident service or produce excessive stress, approve the 12 months of adult neurology education, and (should) attend at least one national PD meeting per year
(PCN or CNPD).

The curriculum for adult neurology must be at least 12 months (which do not need to be contiguous) and are specified as: 1) six inpatient months, 2) three months of outpatient clinical adult neurology, and 3) three elective months. Rotations in neuroradiology, neurophysiology, and neuropathology would count toward the last requirement, as well as neuropsychology, genetics, or other areas related to neuroscience. The RRC interprets this requirement broadly, with the stipulation being they are adult- and clinically-based.

The resident evaluation requirement now includes five first-time patient encounters under direct supervision with the criteria as set forth by the ABPN (neuromuscular, neurocritical care, neurodegenerative, outpatient, and adult patients; one patient must be under two years of age); two must be successfully completed by the end of the second year of neurology training and all must be completed before the final month of the 36-month training period.

The program evaluation mandates that at least 75% of graduates taking the ABPN board certification examination pass and, in programs with fewer than five graduates in the past five years, at least 75% of the last five graduates to have taken the examination must pass.

Curriculum Development

A committee chaired by Pat Crumrine has established a working document of a milestones-based approach for child neurology training following a meeting convened in August. The milestones use a taxonomic approach progressing from basic to intermediate to advanced levels of proficiency and entrustable professional activities. The adult neurology milestones curriculum served as a template and the child neurology document looks extremely well done and will be presented by Drs. Crumrine and Urion at the PCN meeting. Along similar lines, we have been collecting content-based goals from the contributors to Dr. Rust’s special edition of the Seminars in Pediatric Neurology covering “Training of the Child Neurologist in the 21st Century” and plan to edit these as a foundation of what a child neurology resident is expected to know by the end of training. We anticipate linking these areas to cases that have been presented on the CNS Case Sharing Website and future cases to be developed.

Department “Home Base” for Child Neurology Programs

A question raised this year by at least two programs was related to the optimal placement of child neurology programs in pediatric versus neurology departments. It is likely that each institution has its own unique situation, as “all politics are local,” but the Executive Committee decided to pursue this investigation via an e-survey to assess the status of child neurology programs in terms of academic and financial lines of authority, and to solicit input and opinions from members suggesting what would be ideal.
Amy Brooks-Kayal spearheaded this project
and we anticipate presenting these results at the fall meeting.

Blue Bird Circle Award

Gary Clark and the Baylor group led the effort to create and fund a Blue Bird Circle Award to recognize outstanding educators in child neurology. The criteria for the award were drafted jointly between the PCN and CNS
and were:

  • Nominees should be a current or former child neurology residency program director.
  • The award recipient should have demonstrated leadership and vision in local program development, curriculum development, innovation in teaching methods, or training requirements.
  • The awardee should inspire in trainees and colleagues alike a passion for the practice of child neurology. Nominees must be living at the time of selection.

I thank Bruce Cohen for agreeing to chair this year’s selection committee, and the very able committee members (Amy Brooks-Kayal, Leon Dure, Barry Kosofsky, and Suresh Kotagal) who carefully reviewed truly comprehensive and formidable nomination packages for six excellent nominees. The inaugural awardee chosen is Harvey Singer. In selecting Dr. Singer, the committee took particular note of his 23-year tenure as Chair of the Division of Child Neurology at Johns Hopkins Hospital where, in addition to training over 50 child neurologists, he has distinguished himself as a leading expert on Tourette syndrome and other movement disorders. Dr. Singer is a past-President of the Professors of Child Neurology, and currently serves on the CNS Executive Committee as Secretary-treasurer. He was the driving force behind implementation of the San Francisco Match and, in the past year, the successful transfer to the National Resident Matching Program.