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Program Overview

The Pediatric Neurology residency at Johns Hopkins is designed to train a physician in both academic and clinical pediatric neurology. There are 3 residents per year. The program stresses the development of competence in several areas including clinical neurology (with inpatient, outpatient and consultative experiences), neurosurgical problems and the scientific basis of neurology. Ours was one of the first programs to have pediatric neurology residents serve as senior residents on the Adult service, which has led to a highly integrated training experience over the years. Furthermore, the program allows pediatricians with diverse backgrounds and interests the opportunity to develop areas of special competence in specific clinical or research areas. All residents are required to participate in at least one research project under the mentorship of a full-time member of the faculty, to be completed by and presented in June of their graduating year.

The Inpatient Service
The inpatient service team is responsible for providing primary and consultative care for children with neurological and neurosurgical problems through the Johns Hopkins Children's Center which is divided into age-appropriate wards. The inpatient team is composed of a pediatric neurology attending physician, 1-2 pediatric neurology senior residents and at least one junior resident from pediatric neurology, adult neurology or the Kennedy Krieger Institute (NDD fellow).  Often there are 1-2 Johns Hopkins or visiting medical students as well.  There are approximately 600 clinical neuroscience admissions to the Johns Hopkins inpatient service per year. An additional 5 to 10 pediatric patients are followed in consultation each day.  Children admitted for epilepsy surgery are also closely followed.  Inpatient admissions are managed by the Pediatric Neurology team during the day but overnight inpatient coverage is provided by the Pediatrics team. A Pediatrics resident is a member of the Neurology team during the day, as well.

The Outpatient Service
We provide strong outpatient experience in child neurology, as the national trend in training programs is to increase this experience to match the growing outpatient treatments of the majority of patients.  The pediatric neurology outpatient clinics at Johns Hopkins include those for general child neurology problems and specialty clinics in epilepsy, migraine, movement disorders, stroke, neurofibromatosis, and neuromuscular diseases.  Clinics at Kennedy Krieger Institute also include autism, developmental disabilities, rehabilitation, and neurogenetics.

In each clinic, the resident is assigned to an attending for whom a panel of patient has been scheduled. A mixture of new and follow-up patients are interviewed, examined, and discussed with the attending. All pediatric neurology residents have a weekly continuity clinic, staffed by a faculty member, which they attend year-round for all three years of the residency.

During the three-year program, approximately one year is spent in clinical pediatric neurology, one year in adult neurology and one year in electives. Time spent in each of these areas is distributed over the duration of the training program in order to provide a continuum of exposure to clinical neurological problems. Adult neurology training is divided equally between consultative and ward services as per ACGME requirements, with very strong outpatient adult neurology clinic rotations.   Elective time may be spent either learning clinical subspecialties or developing a more in-depth knowledge of a clinical or research area. Away electives are allowed with residency director approval.

The First Year:
During the first year, the resident develops clinical skills in adult and pediatric neurology. The physician will spend 4 months as a junior resident on the adult neurology wards, which includes the stroke, general, and NCCU (Neurology Critical Care Unit) at The Johns Hopkins Hospital (JHH) and The Johns Hopkins Bayview Medical Center (JHBMC), 3 months on the pediatric neurology service at JHH as the junior resident, and 1.5 months of adult outpatient neurology clinic, 1 month of pediatric neurology outpatient clinic, 2 weeks of EEG and 2 weeks of neuroradiology.  Call averages every 4th evening on adult neurology months; pediatric neurology months are call-free.

The Second Year:
The second year of the program involves subspecialty electives and rotations in both pediatric and adult neurology.  During this year, the resident transitions into more supervisory responsibilities.  A resident spends 1.5 months as the adult neurology senior resident (at JHH), 2 months as the senior resident on pediatric neurology, 1.5 months of adult neurology outpatient clinic, 1 month on pediatric epilepsy/EEG, 1 month on neuromuscular, 2 weeks in the neurology intensive care nursery (NICN), 2 weeks of neuropathology, 2 weeks at the Kennedy Krieger Institute, and 2.5 months in other electives. Months with in-house call are those as the adult neurology senior; as the pediatric neurology senior all call is from home during evenings.  

The Third Year:
In the third and final year, the "chief" resident supervises the pediatric neurology inpatient service as the primary senior resident for 2.5 months, and spends 1 month each on child psychiatry, clinical neurophysiology, outpatient pediatric neurology clinics.  Two months are spent at the Kennedy Krieger Institute.  The remaining 3.5 months are spent on elective rotations.

Research Opportunities
An important part of the program is exposure to and participation in clinical or basic neuroscience research efforts. All residents become involved in a project during their three years of training. In the third year, results of the resident's efforts are presented at a special neurology Grand Rounds. Our residents have consistently presented outstanding projects and have frequently won the Slotkin Award (department-wide prize for best research presentation).  Research seminars are held on a regular basis under the auspices of the Departments of Neurology, Neurosurgery, Neuroscience, and Pediatrics. In order to improve the resident's neuroscience background, trainees are urged to participate as teaching assistants in the School of Medicine's neuropathology and neuroscience courses.

Conferences
All residents are encouraged to attend conferences that have been designed to keep them informed of major developments in both the basic and clinical neurosciences. A wide variety of conferences, lectures, courses and seminars are available through the Department of Neurology, Neurosurgery, Neuroscience, Pediatrics and Psychiatry. Ward attending rounds are held daily with didactic sessions at least three times weekly on both the adult and pediatric neurology services. Noontime conferences on clinical and research topics are held daily throughout the year.  Child Neurology Grand Rounds are held every Wednesday at 8am.

For the first two months of the residency (July and August of each academic year), major topics of clinical interest to the first-year neurology resident are discussed, including a series on “neurologic emergencies” residents may encounter. During the remainder of the year, these conferences include regular discussion of movement disorders, cerebrovascular disease, seizures, neuromuscular disorders, cognitive neurology, neuropathology (clinical-pathological conference), and neuroradiology. Other regular weekly conferences are devoted to pediatric neurology, pediatric neuro-oncology, adult neurology, neuroradiology, neuro-ophthalmology, neurovirology, epilepsy, nerve and muscle, vascular disease and neuro-vestibular issues. Topics of conferences at Bayview include sleep disorders, clinical neurophysiology, neuroradiology, neurotoxicology and aging. Conferences in many other areas are held under the auspices of psychiatry, neurosurgery, pediatrics and other clinical and basic science departments.

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