British Paediatric Neurology Association
UK Training in Paediatric Neurology


Printer friendly document
Back to Training

Background

Since the previous paediatric neurology training guidelines were produced in 1982, there have been many changes in both paediatric neurology and professional training in general. There is a general aim of harmonising the training throughout Europe or at the very least understanding the training in each country so that it is easy for people to move between European countries. The Calman report has also lead to a shortening of professional training in the UK. The programme described is regarded as a minimum and many doctors may benefit from at least one further year in training.

Obligatory Training

  1. Two years of general paediatrics including experience of neonates.

  2. Those accepted for higher training would be expected to have obtained MRCP or an equivalent qualification.

  3. Two years clinical paediatric neurology involving direct patient care, fully supervised, in a department with access to the full range of neuroscience investigations. This acute neurological training should include neurosurgical and intensive care work.

  4. One year paediatric neurodisability which should include some secondary community as well as tertiary level work.

The paediatric neurology training could start at SHO level but would be mainly at the Specialist Registrar grade.

The general acute and disability paediatric neurology experience can be integrated.

  1. Six months adult neurology. The previous recommendation was one year but many people have done only 6 months. In general they have found this valuable experience in the clinical examination of the nervous system, experience of a range of pathologies that are less common in childhood and in understanding the discipline with which they are in continuity from the point of view of patient care. Ideally this should be built into a neurosceinces rotation. Many have found that SHO level is the most useful for gaining this experience.

  2. Child Psychiatry: because of the high rate of psychiatric illness in children with brain disease, child psychiatry either as a separate appointment or more appropriately as a module within the paediatric neurology training is essential with the minimum being one day per week for a year. This should include some academic teaching in this subject.

  3. Paediatric neurology is a broad subject and it is recognised that trainees will often take a special interest in one area, eg neuromuscular disease, metabolic disease, neuropsychiatry, intensive care etc but narrow specialisation is not encouraged at the training stage.

  4. Those in training should have a named tutor who would transfer supervisory responsibility when necessary, eg as with two site training schemes.

  5. Major neurosciences units and collaborative services on several sites should aim to take people for training in paediatric neurology by providing a three and a half year co-ordinated package.

  6. An organised clinical skills and a teaching programme with completely protected time should be available. The latter should occupy at least half a day a week for neuroanatomy, genetics, biochemistry, neurophysiology, neuroradiology and neuropsychology over a period of probably 6 terms though some circumstances may require equivalent training time in blocks. Research methodology should be included within that training. One aim of this training is to develop the trainees' teaching skills.

    We recommend however that a taught MSc in paediatric neurosciences should be rapidly developed to provide this combination of clinical and academic training. The provision of a senior staff member, paid study leave and funding to cover the course fees is essential.

  7. Research during training: we would retain the view that a period of research is desirable but not obligatory. We should insist that there should be a minimum of 4-6 months total equivalent which provides the opportunity to either work on a pilot research project or explore one particular area of paediatric neuroscience. This again requires a supervisor who may not be the clinical tutor. With that in mind, funded clinical research fellow or lecturer appointments in paediatric neurology are required to allow more extended time in research and the opportunity to obtain longer time funding.

Since PhD research projects require 3 years and training in research, this could greatly lengthen the training time for academic paediatric neurologists as distinct from those who are taking mainly clinical training. Therefore a programme for training in academic paediatric neurology could be constructed in which the general paediatric 2 years remained, 2 years of clinical neurology including disability are required and 3 years of research work. PhD sutdents could take modules from an MSc course when it becomes available within the 3 year period. We recognise that an academic paediatric neurologist training may not cover all aspects of clinical neurology and this makes the selection of PhD students on academic potential very important. The training outlined is the minimum and some additional training may be required to fulfil a comprehensive regional appointment but this should be dealt with on an individual basis.

  1. In order to provide the required level of experience, the requirements for the clinical service of the training department are that there should be at least two whole time equivalent paediatric neurologists. Departments staffed by one paediatric neurologist should link with another centre fulfilling this minimum criterion. There should be a close relationship with a general neurosciences centre. There should be an agreed training programme.

The on call commitment should allow experience of a wide range of acute neurology both primary neurological disease and neurological aspects of major non-neurological disease.

Entry from Adult Neurology

  1. Following 2 years or more adult neurology training, doctors may enter paediatric neurology. They will be required to have a minimum of one year general paediatric training at SHO level, and their paediatric competence approved and 2 years paediatric neurology including the taught training programme.

Continuing Education

  1. Consultants in post should attend regular clinical practice update sessions as organised by the BPNA.

District Based Paediatric Neurology

  1. There have been proposals for district based consultant posts in paediatric neurology but at the time of preparing this report the BPNA feels that there is insufficient information about the effectiveness of this innovation and that its first priority is to achieve full tertiary level staffing. If, however, such an appointment is made, it should be for a fully trained paediatric neurologist and have at least 2 sessions in the tertiary unit.

Training Pathway

Full registration is likely to be by 24 years of age. A further 2 years of paediatrics (gaining MRCP) would be achieved by 26-27 years. Thereafter either of the following will be expected:

Clinical track 3.5 years clinical
1 year MSc / flexible
Academic track 2 years clinical
3 years research
The anticipated age for completion of minimum training by either clinical or academic track will be 31-32 years.

Training in Paediatric Neurology should include those subjects listed in the Appendix.
A training record will be kept and the subject list should be reviewed by both the trainee and the supervisor at regular intervals during training to ensure adequate coverage.

Updated by BPNA Training Committee
June 1999