British Paediatric Neurology Association
Higher Specialist Training Syllabus
Paediatric Neurology Revised January 2001

Read in conjunction with the sections on Neurology, Learning Difficulties and Development in the General Professional Training Syllabus.

Y1 KNOWLEDGE

Y1A Knowledge of Paediatric Neurology

1. Wide range of normal and abnormal patterns of development.

2. Neonatal neurology with an understanding of the principles of ante-natal brain development, brain injury and its investigation.

3. Epidemiology, aetiology, pathogenesis, pathology, clinical features, treatment and outcome measures for:

   a) neurological diseases in childhood.

   b) the common paroxysmal disorders, including epilepsy, sleep disorders and headache.

   c) the causes of developmental delay, learning disability and specific learning difficulties - to include an understanding of language and complex communication disorders (autistic spectrum).

4. Neurological emergencies in childhood, eg, presenting with coma, status epilepticus, raised intracranial pressure and paediatric emergencies presenting with neurological features eg, metabolic disorders, non-accidental injury.

5. lnter-relationship of neurological diseases with other body systems including growth and nutrition: feeding difficulties, reflux and aspiration.

6. Orthopaedics, orthotics and bioengineering in the clinical setting.

7. Genetic issues including recurrence risk, prenatal diagnosis, gene localisation and imprinting.

Y1B Diagnostic Methods

1. Prenatal diagnosis as it relates to neurological disorder.

2. Biochemical changes in blood and CSF and haematological changes that may accompany neurological disorder in children.

3. Genetic and immunological basis of some neurological disorders: methodology of investigations.

4. Use of tissue biopsy: interpretation of histological abnormalities.

5. Appropriate use of neuroradiology and other screening modalities.

6. Clinical neurophysiology including EEG, EMG and nerve conduction studies. As with other technical procedures (see below) trainees are not expected to become proficient in all aspects of clinical neurophysiology, though a good working knowledge of standard procedures is required. If a consultant appointment requires reporting skills then a further period of training should be arranged if appropriate. A few trainees will wish to become a paediatric clinical neurophysiologist; a training programme following two years in paediatric neurology has been agreed.

7. Assessment of hearing and vision including behavioural, brainstem, auditory evoked potentials, electroretinography and visual evoked potentials.

8. Neurometabolic investigations.

9. Principles of gait analysis.

Y1C Therapy

1. Familiarity with current standard treatment plans for all forms of neurological disorder.

2. Thorough knowledge of drugs used in treatment, especially antiepileptic drugs, steroids and other immunosuppressants, muscle relaxants, analgesics, gastro-protective drugs, anti-bacterial and anti-viral agents and behaviour modifying drugs.

3. Principles underlying rehabilitation.

4. Principles of management of behaviour disorders including pharmacotherapy, counselling and psychotherapy (this knowledge will be gained in a module in child and adolescent psychiatry).

5. Aids to treatment and rehabilitation, hearing and vision aids, seating, mobility aids, orthoses, communication,aids, computers etc.

6. Awareness of range and potential consequences of unconventional and alternative therapies.

Y1D Multidisciplinary Care

1. Use a team approach to management of neurological disorders and understand its advantages and limitations.

2. Understand methods used by occupational, speech and physiotherapists, nurses, specialist health visitors, play therapists, dieticians, clinical, neuro- and educational psychologists, teachers and social workers in assessment ( with a knowledge of the basis and strengths of neuro-psychometric assessment ), treatment and rehabilitation.

3. Knowledge of methods used by other medical specialists including the ophthalmologist, ENT surgeon, community paediatrician, child and adolescent psychiatrist, neurosurgeon.

4. Community Child Health Services.

5. Function of the Child Development Service including outreach child development teams.

6. Special Needs Registers.

7. Transition of care from children's to adult services.

Y1E Integrated Care - Work with other Agencies

1. Statement of educational needs - Education Acts 1981 and 1993 or separate Scottish legislation; interface with the Education Department: learning disability teams mainstream and special schools.

2. Child protection - the 1989 Children Act or separate Scottish legislation. Social Service provision including respite care, care support and benefits.

3. Self help and parent support groups.

Y1F Ethical Issues

1. Ethics of research in children.

2. Process of informed consent.

3. Knowledge of issues governing ethics and consent for clinical trials.

4. United Nations Convention of the Rights of a Child and other relevant proclamations and judgements set down in law.

Y1G Management

1. Understanding of the management skills required for the development and use of resources in the neurology unit, including budget control, contracting, strategic planning and writing a business plan.

2. Experience the day-to-day running of a paediatric neurology service within the medical directorate system.

3. Knowledge of and involvement in clinical audit.

4. The structure and function of local, regional and national NHS organisation.

5. Knowledge of research funding - grants, charities and NHS R&D support.

Y2 SKILLS

Y2A Clinical

1. Developmental assessment.

2. Detailed neurological examination.

3. Interpret results of investigations including EEG, EMG, nerve conduction, CT and MRI scans.

4. Draw up a management plan taking into account continuing medical problems and attendant social, educational and psychological factors.

5. Co-ordination of care for the critically ill child: the management of neurological emergencies.

Y2B Technical

1. EMG

2. Nerve conduction studies

3. Skin biopsy

4. Muscle biopsy

5. Cerebral pressure monitoring line care

6. Perform tests to determine brain death

7. Neonatal cranial ultrasound

8. Muscle ultrasound

9. Cerebral function monitoring

Y2C Academic

1. Critical evaluation of clinical results from literature review and audit.

2. Manuscript preparation.

3. Oral presentation skills.

Y2D Organisational

1. Routine departmental tasks including duty rotas, teaching programmes, Postgraduate meetings.

Y2E Teaching

1. Formal and informal teaching skills at undergraduate and postgraduate level.

2. Development of a core teaching material to enable participation in teaching programmes on a regular basis.

Y3 ATTITUDES

Y3A Leadership

1. Understanding and implementing a leadership role in a multidisciplinary team.

Y3B Communication

1. Effective and appropriate approach to parents and children in the consultation setting with particular reference to giving them the news that they will have a continuing or disabling condition and to be able to give guidance in broad terms on prognosis; to have a good working knowledge of other information available - written, audio, video or CD-ROM, and the internet - to complement what was said in the consultation and to have knowledge of family support groups (especially Contact-a Family).

2. Effective and appropriate approach to colleagues, GPs, community health care staff, research and laboratory staff and managers.

Y3C Education

1. Commitment to continuing self-education and the teaching of others.

2. Maintenance of a training experience portfolio.

Y3D Support

1. Maintenance of a training experience portfolio.

2. Understanding and positive approach to the supervision of junior medical staff.

3. Recognition of and coping with stress in self and others.

Y3E Academic/Research

1. Recognition of and coping with stress in self and others.

2. Support to/active in research.

3. Collaborative attitude to local and national colleagues.

Y3F Managerial

1. Interest in the overall organisation of departmental activities and in particular its function as an effective Regional/tertiary centre with its outreach clinics.

2. Understanding approach to local management structure.

3. Constructive attitude to the processes of decision making.

4. Acceptance of shared responsibility for use of resources.

5. Ability to understand clinical complaints procedures and to respond effectively to them.

BPNA Training Committee
January 2000