Most of our trainees complete two years of pediatrics at St. Christopher’s Hospital for Children before beginning their child neurology training. The three-year Child Neurology Residency meets the training requirements established by the American Board of Psychiatry and Neurology (ABPN) and the Accreditation Council for Graduate Medical Education (ACGME).
The first year of the Child Neurology Residency is spent at Temple University Hospital doing adult neurology. The year is divided into 13 blocks with the following schedule: six blocks of inpatient adult neurology (three blocks on primary neurology floors and three blocks on neurology consults), one block in the epilepsy monitoring unit (EMU), two blocks of outpatient adult neurology clinic, and three blocks of electives (one can be done at St. Christopher’s). Residents take in-hospital call on average once per week. Residents get three weeks of vacation plus one major holiday off during the adult neurology year.
The second and third years of the Child Neurology Residency are spent at St. Christopher’s Hospital for Children. Both years have the following structure: three months of inpatient child neurology (combined primary neurology service and consult service), three months of outpatient child neurology, and six months of electives. Electives include required rotations (psychiatry and neurosurgery) as well as optional electives such as neuromuscular, neuroradiology, EEG, metabolism, genetics, physical medicine and rehabilitation, and research. In addition to many elective opportunities at St. Christopher’s, our residents have the opportunity to do some of their electives at Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE and the Children’s Hospital of Philadelphia (CHOP). There is no in-hospital call during the two child neurology years. Residents take call from home on average once per week in addition to one weekend per month. Residents get four weeks of vacation per year.
Residents will have their own once-weekly child neurology continuity clinic at St. Christopher’s Hospital for Children throughout the three years of training.
Inpatient Child Neurology
St. Christopher’s Hospital for Children is a 188-bed nonprofit tertiary care center. We have a level 1 trauma center and the only pediatric burn center in the city of Philadelphia. SCHC has an active pediatric intensive care unit and neonatal intensive care unit that receive referrals from the greater Philadelphia area. The inpatient neurology team is composed of the inpatient attending, inpatient child neurology resident, and a variety of other rotators. Primary neurology patients are housed on an inpatient team staffed by pediatrics residents but run by the neurology team. Additionally, the inpatient team performs consults in the emergency room, inpatient general pediatrics units, PICU, and NICU. Inpatient video EEGs are performed on an elective and emergent basis throughout the hospital. Average inpatient neurology census is two to four patients on service, one to three new consults per day, and one to three follow-up consults per day.
The section of child neurology has a duty to provide the best possible care for the patients that we serve on the inpatient units at St. Christopher’s Hospital for Children. Patients admitted for evaluation and treatment of child neurologic problems require inpatient care that is comprehensive, cost-effective, and compassionate. To this end, the child neurology resident on the inpatient service will develop competence at inpatient management of a variety of acute pediatric neurological conditions through development of their neurologic fund of knowledge, neurologic exam skills, and clinical judgement. During the last year of training, the child neurology resident is expected to assume a more supervisory role of the inpatient medical team composed of junior residents and medical students with a focus on independence in medical decision making, management of complex conditions, and development of communication skills necessary for team leadership and difficult family conversations.
Outpatient Child Neurology
The Section of Child Neurology has a number of subspecialty clinics in addition to general neurology clinics that allow the child neurology resident to broaden their exposure to the breadth of outpatient child neurological conditions. The resident will see common and uncommon diagnoses concentrated within our tertiary care subspecialty clinics and will experience the entire spectrum of a disease via interactions with multiple patients at different time points in the same disease. Currently available subspecialty clinics include intractable epilepsy, sleep, metabolic, neuromuscular, and PKU. We also work closely with Tower Health pediatric neuropsychologists, one of which has her office within our section.
The outpatient child neurology resident will be assigned to work with one attending physician in their clinic during each half day of this rotation. The attending may wish the resident to observe clinical interactions or may ask the resident to first see patients independently and then discuss with the attending thereafter. The degree of independence allowed to each resident will be determined by the attending depending on the patient, although it is expected that the degree of independence will increase with increasing seniority in the residency program.
Our clinic space includes 8 examination rooms, two testing rooms for neuropsychological evaluations, and an EEG reading room. The Neurodiagnostic lab has 6 exam rooms, performing EEGs and evoked potentials during the day and sleep studies overnight. Offices and conference space are adjacent to the clinic space.