Over the next several months, the Accreditation Council for Graduate Medical Education is scheduled to consider a proposal that would decrease the amount of time that child neurology residents spend on inpatient adult neurology training.
The proposal is currently being considered by the ACGME’s Neurology Residency Review Committee and could move to the Committee on Requirements next year.
Currently, residents spend 12 months in adult neurology training, with as much as 9 months working in an inpatient setting in some cases. The proposal would limit adult inpatient work to 6 months, and mandate that residents spend a certain amount of their adult training time working in outpatient clinics. The proposal would also offer more elective options for residents during the adult neurology year, giving them the chance to train in virtually any part of the specialty from neuroradiology to neuropathology.
If the ACGME approves the proposal in early 2013, the soonest it could go into effect would be July 2013, said Dr. Phillip L. Pearl, chief of neurology at Children’s National Medical Center in Washington and a member of the Neurology Residency Review Committee.
The proposal emerged in large part because of concerns that child neurology residents were spending too much of the adult training year functioning as interns on adult stroke services, Dr. Pearl said.
"I think we’ve come to agreement that we see the value of maintaining strong adult neurology training, but opening it up and diversifying it," said Dr. Pearl, who is also the president of the Professors of Child Neurology.
Keeping the year of adult neurology training intact is important, Dr. Pearl said, because it provides a foundation to create "child neurologists and not neurological pediatricians."
"Neurologists think differently than pediatricians," he said. "The child neurologist does need to be able to take care of strokes, and movement disorders, and multiple sclerosis in children, and be able to localize neurological deficits in children. The best way to learn that process is in adults, where the disorders and localizable deficits are much more common."
Maintaining the connection to adult neurology training is also critical because it allows child neurologists to remain boarded in both adult and child neurology, Dr. Pearl said.
But continuing with the full 12 months of training in adult neurology is controversial, even with the increased emphasis on outpatient work.
Courtesy Cincinnati Children's Hospital Medical Center
Dr. Donald L. Gilbert
Dr. Donald L. Gilbert, the child neurology residency program director at Cincinnati Children’s Hospital Medical Center in Ohio, said the proposal under review by the Residency Review Committee is "inadequate." Instead, he wants to see the requirement for adult training reduced to 3 months, followed by an additional 3 months of electives.
"Flexibility is the way to go," he said.
The reasons for ratcheting down the adult requirement are practical, Dr. Gilbert said. Today’s child neurologist doesn’t see that many adult patients. Dr. Gilbert and his colleagues recently conducted a survey of 437 child neurologists who were certified between 2001 and 2010. Of the 179 who responded, only about 3% reported that they provided general adult neurology services in their practices. About two-thirds of those who responded said they provided no adult neurology services.
"We need to train people to take care of whom they are going to take care of," he said.