We feel strongly that the best way to learn pediatric neurology is to do it. Pediatric neurology residents have the opportunity to develop their skill managing an extensive variety of patients in both the outpatient and inpatient settings.
Outpatient
PGY1 and PGY2s have the option to engage in a weekly child neurology continuity clinic as part of a Child Neurology Early Start Pathway. Residents who choose this pathway work closely with neurology faculty during these clinic weeks and are able to longitudinally follow patients they meet while rotating on the neurology inpatient floor service. They also have the opportunity to complete additional selectives in genetics, neurogenetics and neurology subspecialty clinics. Residents who complete this pathway are eligible for the American Board of Psychiatry and Neurology (ABPN) certification after completion of their neurology training.
Alternatively, PGY1 and PGY2s can also choose to participate in the Dual Board Eligibility Pathway. Residents who choose this pathway engage in weekly outpatient clinics in general pediatrics and complete all required training blocks for the American Board of Pediatrics (ABP) certification. These residents will be eligible for ABP and ABPH certification after completion of their five years of pediatrics and neurology training.
During the PGY3 year (i.e., the initial neurology year spent primarily on the adult neurology service) the weekly resident continuity clinic is a critical element of the pediatric neurology training program. Residents see pediatric patients specifically assigned to them and follow them longitudinally through their three years of training. The residents also handle outpatient management issues for their patients over the phone between visits. The goal is for them to essentially have their own “practice” during those 3 years of training.
During the PGY4 and PGY5 years residents spend 4 months of the year working in the outpatient pediatric neurology clinics. Residents see patients in sub-specialty clinics such as epilepsy, movement disorders, cerebral palsy, neurorehabilitation, neuromuscle, neurofibromatosis, tuberous sclerosis, Rett syndrome, neuroimmunology, neonatal neurology, and headache. During the PGY4 and PGY5 year residents can spend dedicated elective time in any of the subspecialty clinics listed above or other clinics such as neuro-ophthalmology, neuro-otology, neuro-oncology, neurocritical care follow-up, genetics, sleep medicine and others.
Inpatient
On inpatient rotations, residents supervise the care of patients on the neurology ward service and consult on patients with neurological problems on other floors of the hospital and in the emergency department. St. Louis Children’s Hospital provides tertiary and quaternary care for the city of St. Louis, the surrounding region, the Midwest, the US, and international patients. Thus, the variety of patients our residents see is outstanding. We also have strong relationships with the intensive care units in the hospital which include the Pediatric Intensive Care Unit, Neonatal Intensive Care Unit, and Cardiac Intensive Care Unit. Our frequent consults there give our residents the chance to further develop their skills in critical care neurology. Our division policy is that generally any patient admitted to the hospital who does not have a neurologist will follow-up with the resident that cares for them if out-patient follow-up is needed.
Call is no longer taken during the PGY3 adult neurology year. At home call is taken during the PGY4 and PGY5 years. During these years, the on-call resident overnight night takes the first-call responsibility for out-patient issues for all faculty and resident patients, phone consultation for outside emergency departments generally in the Missouri/Illinois area, and calls from the St. Louis Children’s emergency department and in-patient services. At night there is always attending backup for any issue that the resident needs assistance in managing. Our attendings encourage residents to call with any questions.
Electrophysiology
Electrophysiological tests are a common tool in pediatric neurology. Residents gain experience in EMG and EEG during dedicated weeks during their adult PGY3 year. During in-patient rotations, residents get extensive experience with EEG and video EEG monitoring. Residents can spend additional time learning these modalities during the elective portion of their PGY4 and PGY5 year.
Rotations
PGY3 year
Six months of the PGY3 year are spent on the inpatient adult neurology services at Barnes-Jewish Hospital. The residents share rotation schedules and inpatient responsibilities with the PGY2 adult neurology residents for that year. Rotations include the consults, acute stroke team (including exposure to telemedicine), stroke ward service, general neurology ward service, night float consults and time in the neurological/neurosurgical ICU (one of the largest in the country). An additional 2-3 months are spent on the inpatient consult and inpatient neurology ward services at St. Louis Children’s Hospital. The remaining 2-3 months include adult outpatient sub-specialty clinics, EEG, EMG, electives and career development.
PGY4 year
Several months of the PGY4 year are divided between three different neurology consulting services, including the pediatric intensive care unit consult service, the neonatal intensive care unit consult service, and a consulting service for the emergency department and other hospital floors at St. Louis Children’s Hospital.
Consult service: The neurology consult service handles consults from the PICU, CICU, emergency department, and hospital floors. Residents covering the consult services also take calls from community pediatricians, outside hospital critical care physicians, emergency medicine doctors and neurologists.
The neonatal neurology consult service handles consults in the NICU (one of the largest in the country) and infants in the CICU.
12th floor neurology ward service: Two months during PGY4 year are spent as the supervising fellow of the 12th floor neurosciences service of St. Louis Children’s Hospital. This floor is largely dedicated to the care of general neurology, neurosurgery, neurorehabilitation and epilepsy monitoring patients. The pediatric neurology resident supervises the floor team of pediatric residents in the care of neurology patients. The 12th floor fellow also assists our epileptologists in the care of the epilepsy monitoring unit (EMU) patients with the help of nurse practitioners.
Outpatient: Three months of the PGY4 year are spent on the outpatient clinic rotation at St. Louis Children’s Hospital. The resident rotates through the various faculty sub-specialty clinics including epilepsy, movement disorders, cerebral palsy, headache, tuberous sclerosis, neurofibromatosis, neurorehabilitation, Rett syndrome, neuroimmunology, neonatal neurology, and neuromuscle.
PGY4 residents also have over two months for research, career development, required electives or subspecialty electives of residents’ interest.
PGY5 year
Each PGY5 spends 11 weeks of service time as the 12th floor neurology fellow or consulting fellow, as described above. This supervising and teaching role prepares trainees for independent practice and supervision.
The PGY5 year contains at least 6 months of elective time that may be used for basic science or clinical research and resident-designed electives both within neurology or interfacing subspecialties. Our residents have applied for and participated in the national R25 research mentorship and funding program. Recently, our residents have designed their own electives in global health, neurogenetics, neurocritical care, neuroimmunology, neuro-oncology, stroke, psychiatry, and ethics.
The remainder of the PGY5 year is spent completing requirements in adult neurology specialty clinics, as well as opportunities in neuroradiology, neuropathology, neuro-oncology, sleep medicine, neuro-ophthalmology, neuro-otology, and additional training in EEG, EMG, etc.
Call
PGY3 year
Residents spend six months on inpatient adult neurology services, including the inpatient general neurology and inpatient stroke services, the consult service, the acute stroke response service, night float and the neurological/neurosurgical ICU service. In 2021, the program changed its ward service schedule from an every fourth night 24 hour call system to a day shift/night shift schedule, which has been well received by the residents. Thus, residents spend 6 weeks on night shift through the course of the year and only occasionally take 24 hour call during weekends on wards and during neuro-ICU.
PGY4 year
During the PGY4 year, the residents take at home call. The on-call resident takes all neurology calls from St. Louis Children’s Hospital and all telephone consult calls from outside hospitals. The resident also takes parent phone calls for neurology patients.
PGY5 year
During the PGY5 year, the residents take at home call one Sunday per month with 2-3 occasional other calls per year.
Continuity clinic
PGY1 and PGY2 residents have the option to engage in a neurology specific continuity clinic through the Child Neurology Early Start Pathway as outlined above. Residents who engage in these clinics spend one half day each week working closely with neurology faculty seeing new referrals and follow up patients. Residents will not be held responsible for handling outpatient phone calls during these years.
During the PGY3 years, continuity clinic continues for those in the Child Neurology Early Start Pathway and starts for those in the Dual Board Eligibility Pathway. Residents spend one half-day each week in clinic and typically see 3-7 patients per clinic. Patients are assigned to a specific resident’s schedule and follow-up with that resident during their entire three years of training. The clinic is typically staffed by three attending physicians. Generally, all inpatients who do not have a neurologist at the time of admission are followed in clinic by the resident that cared for them during their hospitalization if they need on-going care. Residents handle all outpatient calls on their own patients during office hours. PGY4 residents receive nursing staff assistance during their busy in-patient rotations.