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C.S. Mott Children's Hospital

Curriculum

I.  PEDIATRIC NEUROLOGY CURRICULUM ORGANIZATION / STRUCTURE

The curriculum is designed to meet RRC guidelines for training in Child Neurology and the Goals and Objectives of our training program.

Requirements include 12 months of clinical adult neurology, 12 months of clinical child neurology, and 12 months referred to as the flexible year.

Organization of the curriculum:

Year 1:  

GME and Neurology orientation to review all relevant house officer policies and institutional mandates and resources

Receive and review program curriculum

Complete UMHS Mandatory education programs (on-line)

Rotations: one -two month of Pediatric Neurology; 10-11 months (including vacation) of Adult Neurology. 

Weekly Pediatric Neurology continuity clinic (1/2 day).

Year 2 :

One-two months of Adult Neurology; 1-2 months of electives (one month of EEG is recommended);

8-9 months of general Child Neurology (including vacation).

Weekly Pediatric Neurology continuity clinic.

Year 3:

One-two months of general Child Neurology.  10-11 months of the following obligatory and elective components (including vacation).

Weekly Pediatric Neurology continuity clinic.

The obligatory components are formulated to meet RRC requirements for training in Child Neurology.

Obligatory components include:

The remainder of Year 3 is devoted to elective rotations, described below.

In Years 2 and 3, on all Pediatric neurology general and elective rotations, residents take call a maximum of one in three nights from home for Pediatric Neurology.

As long as all requirements are met over the three year period, the chronology of each Year of training may be modified.

A. Adult Neurology: Year 1

The pediatric neurology resident will function as  junior resident in Neurology.

Residents will be included in the Dept. of Neurology orientation program, and receive the Dept. of Neurology Resident Orientation Guide.

While caring for patients, the trainee should also be exposed to all pertinent ancillary diagnostic procedures, including lumbar puncture, EEG/evoked potentials, EMG/NCS, neuro-CT/MRI/angiography/ultrasonography.

Trainees will attend regular conferences including clinical case discussions, basic science conferences, grand rounds, and other didactic conferences.

B. Clinical child neurology: Year 2

  • Emergency department consultations throughout the year

  • Child neurology continuity clinic – ½ day per week

  • New patient clinics general Pediatric neurology clinics: two ½ days/week

Trainees will attend regular conferences including clinical case discussions, basic science conferences, grand rounds, and other didactic conferences.

Over Years 2 and 3, trainee will be responsible for at least 4 Morbidity and Mortality conference presentations.

Over Years 2 and 3, trainee will be responsible for at least 6 Journal Club presentations.

C. Clinical child neurology: Year 3. 

In addition to the required rotations described above, additional optional rotations in year 3 include:

a.            Neuro-ophthalmology

b.            Neuroradiology

c.             Developmental / Behavioral neurology

g.             Additional electrophysiology

h.             EMG/neuromuscular (1 month: clinic/lab observation; 3 month minimum if individual wants to perform EMG’s)

i.              Sleep medicine

j.              Neuroanatomy review

k.            Pediatric neurology sub-specialty clinic rotation - this one month rotation provides the resident with opportunities to participate in a broad range of Pediatric sub-specialty clinics staffed by members of the division and other pediatric sub-specialists with relevant expertise

l.              Academic experience options.

Research project. Residents can participate in a broad range of clinical and basic research projects with any member of the University of Michigan faculty. Criteria will include matching of skills and experience of candidate with proposed elective experience, availability of an appropriate mentor, and delineation of a well-defined and feasible project.

Statistics. Residents are expected to read: Statistics at Square One.

If a resident does not participate in a research project, he/she will be expected to prepare a case report or review article for publication with a member of the faculty.

m.           Teaching experiences. Residents will prepare and present at least 3 formal one hour lectures, including a Pediatric noon conference on a required topic,  a Neonatal Neurology lecture on an assigned topic, and Neurology Grand Rounds. These lectures will each be reviewed with a faculty member, who will provide constructive comments, to enhance teaching skills, prior to the presentation

n.             Trainee will attend a national clinical or scientific meeting relevant to Child Neurology

o.             Other elective rotations may be included to meet specific trainee interests.

II. B. Curriculum to address other aspects of Core Competencies.

Inter-personal Skills and Communication. Our major focus is on teaching communication with other health professionals. The major venues include the out-patient clinic (where all referral letters written by trainees are reviewed by attending MD’s), and the in-patient consultation service (where attending MD’s supervise and provide feedback to trainees) regarding interactions with primary teams, communication of recommendations, and written consultations - which are all reviewed and edited electronically.

Formal guidance in preparation of dictations is provided in the Pediatric Neurology orientation manual.

In addition, we request regular feedback from our division nurses, regarding the trainees ability to effectively communicate both with them and with patients. All patient contacts are documented in the electronic medical record, and reviewed and signed by an attending MD.

Professionalism. All new trainees are required  to complete UMHS institutional mandatories at the onset of training. These web-based instructional programs include “self-tests” to verify understanding of principles. HIPAA-related issues are regularly reviewed in the context of patient care. If specific deficits are identified during monthly evaluations, the faculty will address and attempt to remediate these deficits.

Quality Assurance activities. An integral component of the monthly Pediatric Neurology/Neuroradiology conference is to ensure that physicians from both services have the opportunity to review abnormal studies, in particular those cases in which the interpretation is complex. This conference serves as a Quality Assurance activity, and residents are expected to participate throughout Years 2 and 3 of training.

Trainees are responsible for quarterly Morbidity and Morality conferences.

Bioethics. Residents are required to attend at least 8 Bioethics Rounds and/or Pediatric Ethics committee meetings during their training..

Formal didactic sessions in pediatric pain management and end-of-life care, monitoring alertness and fatigue

Residents as teachers. In Year 3, residents are expected to prepare and present at least 3 didactic lectures, geared to pediatric or neurology residents. The resident will select a faculty mentor, and review the  presentation at least one week prior to the scheduled presentation date.

Practice-Based Learning. Continued emphasis on scholarship and learning is essential to the development and maturation of a child neurologist in training. Continued attendance and participation in teaching conferences, case discussions, grand rounds, and basic science seminars is important throughout the entire training period.

Trainees are expected to learn how to use Internet resources to enhance learning and communications throughout their training. A major focus for our program is to ensure that all trainees are aware of and are able to utilize electronic resources (PubMed, Child-Neuro list-server, electronic journals) to keep abreast of advances in the field, and to obtain patient-specific information.

Participation in journal club enhances resident awareness of topical publications, and enables them to learn how to critically review publications. Dr. Joshi  serves as the statistics consultant.

System-Based Learning. Trainees received a manual and are expected to complete a test regarding Risk Prevention Skills, prepared by UMHS Risk Management Office.

Billing issues, and determination of appropriate billing levels, are an integral component of patient evaluations.

In the clinic, issues related to insurance coverage for testing and for referrals are addressed for every patient.

Trainees are encouraged to join the Child Neurology Society; the division pays junior membership fees.

Trainees should gain familiarity with American Academy of Neurology practice guidelines relevant to Child Neurology.