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Inpatient Pediatric Neurology
The inpatient pediatric neurology services are divided into three teams: general hospital, ICU, and Epilepsy long-term monitoring. Residents spend time primarily on the general and ICU services.
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General Neurology Team
- 1 Child Neuro resident
- 1 Adult Neuro resident
- Med Student-3/Med Student-4
- General Neuro attending
ICU Neurology team
- 1 Child Neuro Resident
- 1 Adult Neuro Resident
- 1 NP (Mon/Tues/Fri)
- No MS-3s, sometimes MS-4
- ICU Neuro attending
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General Neurology Team
Primary Patients
- Pediatric Interns The pediatric intern is responsible for presenting patients, writing notes, and entering orders.
- Pediatric Seniors: Assists the pediatric interns and serves as a key resource for general pediatrics issues and logistical matters.
- Neurology Resident: Functions as a fellow, with responsibilities including prerounding, examining patients, and adjusting notes as needed when managing these patients.
Consults: Cover the following areas:
- Hospital Floor
- Emergency Room
- Rapid Treatment Unit (RTU)
- Well Baby Nursery
ICU Neurology Team
Coverage: Manages consultations in the following areas:
- PICU (Pediatric Intensive Care Unit)
- CICU (Cardiac Intensive Care Unit)
- UNICU (Neuro Intensive Care Unit)
- PNICU (Neonatal Intensive Care Unit)
- Intermediate Care Nursery
Epilepsy Team (Long-Term Monitoring Team)
- Admissions and Staffing: Nurse Practitioners (NPs) handle admissions and work closely with the Epilepsy Attending.
- Child Neurology Residents: Manage patients overnight and on weekends only.
This structure ensures comprehensive coverage and effective patient management across various settings in our inpatient pediatric neurology services.
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Rounding
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Round 9:00 AM Monday, Tuesday, Thursday, Friday
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Table Round 8:00 AM - Wednesday
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Neuro-Radiology Rounds 8:00 AM - Friday
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Osborn Team Rounds 9:00 AM
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Family Centered Rounds with Pediatric Teams
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Pediatric Neurology Outpatient Clinics
The Pediatric Neurology Outpatient rotation is a core clinical training component for child neurology residents, occurring as a required rotation during one of the three years of neurology training. This rotation provides comprehensive exposure to pediatric neurology in an outpatient setting, focusing on diagnosing and managing various neurological conditions in children. Residents will understand and identify normal neurological development milestones in infants, children, and adolescents, recognizing deviations from normal development. They will specify the clinical features and management strategies for conditions specific to infancy, childhood, and adolescence, and recognize patterns indicative of specific neurological disorders, such as epilepsy syndromes, metabolic disorders, and genetic or acquired conditions. Residents will apply age-appropriate neurological examination skills for thorough and effective evaluations, demonstrate knowledge and utility of neurodiagnostic procedures including EEG, CT, MRI, spinal fluid examination, and various electrophysiologic studies. They will employ cost-effective and appropriate approaches to neurodiagnosis based on a well-developed differential diagnosis and develop suitable management and treatment plans, revising them as needed based on patient responses. Furthermore, the rotation instills lifelong learning habits and practices to continuously improve knowledge and skills in pediatric neurology, preparing residents to diagnose and manage a wide range of pediatric neurological disorders effectively and compassionately.
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Outpatient Pediatric Neurology Rotation
WEEK
Monday
Tuesday Wednesday Thursday Friday AM
Pediatric Epilepsy Management Conference
General Neurology Clinic AM
Telehealth Clinic AM Epilepsy Surgery AM Neuromuscular Clinic AM Fast Track Clinic NOON Pediatric Neurology Grand Rounds Pediatric Neurology Sign-Out Conference
PM General Neurology Clinic PM Complex Epilepsy Clinic PM Headache Clinic PM Thursday Evening Clinic Reading Time
Pediatric Epilepsy
The Pediatric Epilepsy Rotation offers residents a comprehensive clinical experience in managing epilepsy and seizure-related disorders. Residents will engage in both in-depth clinical management and practical skills development. In the Epilepsy Monitoring Unit (EMU), responsibilities include overseeing all studies, reviewing data multiple times daily, generating preliminary reports, and resolving technical issues, with a focus on integrating findings into patient care and communicating with patients and referring physicians. The Long-Term Monitoring (LTM) component emphasizes bedside monitoring of epilepsy and seizure disorders in pediatric and adult patients, involving frequent data review, report generation, and advising on EEG evolution and management.
Residents will gain essential skills in evaluating and managing pediatric epilepsy cases while developing proficiency in electroencephalography (EEG). Key objectives include mastering patient history relevant to epilepsy, conducting thorough physical and neurological examinations, expanding knowledge of epilepsies and related disorders, and understanding anticonvulsant pharmacology. Responsibilities also encompass observing EEGs with technicians, performing EEG electrode applications, and pre-reading neonatal and pediatric EEGs. This rotation ensures residents meet ACGME exposure requirements, collaborate closely with care teams, and stay updated on emerging treatments and advancements in pediatric epilepsy management.
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Pediatric Epilepsy Rotation
Monday
Tuesday Wednesday Thursday Friday AM Pediatric Epilepsy Management Conference LTM EMU LTM EMU NOON Pediatric Neurology Grand Rounds Epilepsy Journal Club Clinical
Neurophysiology
Course
PM EMU LTM Continuity Clinic LTM EMU Monday
Tuesday Wednesday Thursday Friday AM Pediatric Epilepsy Management Conference Routine EEG Reading LTM EEG Reading LTM LTM EEG Reading NOON Pediatric Neurology Grand Rounds EEG Review Conference Clinical
Neurophysiology
Course
PM Seizure Fast-Track
ClinicRoutine EEG Reading Continuity Clinic Routine EEG Reading LTM EEG Reading
Neuroradiology
The Neuroradiology rotation is designed for child neurology residents at all levels. During this rotation, residents will engage in reading and interpreting radiology studies in a one-on-one setting with neuroradiology fellows at Primary Children's Hospital. The rotation aims to develop essential radiographic interpretation skills necessary for both pediatric residents and practicing general pediatricians. Residents will learn to evaluate various radiographs, including those of the chest, abdomen, extremities, and line placements. Residents will also understand the procedures involved in obtaining and performing medical imaging, including patient experiences, risks and benefits (such as radiation exposure), and the need for sedation. To achieve these goals, residents will spend time observing and learning from radiologists in the reading room, engaging in individual study, and observing technologists and nurses in the Department of Medical Imaging.
Child and Adolescent Psychiatry
The Child Psychiatry rotation for Child Neurology residents, typically occurring in the second year of the training program, spans at least one month and aims to equip residents with essential knowledge and skills to recognize, diagnose, and manage psychological and psychiatric diseases in children, particularly those with neurological disorders. The rotation focuses on common childhood psychiatric diagnoses, while fostering empathy and effective communication with affected families. Residents will develop comfort in addressing emotional responses to neurological conditions, collaborate with mental health experts, and stay updated with ongoing psychopharmacological treatments. Key skills include information gathering through comprehensive psychiatric histories and mental status examinations, crisis management for aggression and suicide risk, prioritizing case information, and assessing comorbid conditions.
Medical Genetics
The Medical Genetics rotation aims to provide child neurology residents with a firm foundation in the genetic aspects of human disease. This rotation equips residents with the knowledge and skills necessary to recognize and care for patients with genetic dysfunction, dysmorphology, biochemical genetics, and metabolic diseases. Residents will become aware of how genetic dysfunction can lead to human disease and will acquire the skills to evaluate children with multiple congenital anomalies. They will understand the principles of diagnosing and caring for children with inborn errors of metabolism and will learn about clinical teratology. The rotation also focuses on the knowledge and skills needed to discuss genetic aspects of human diseases with families, principles and methods of genetic counseling, and the laboratory basis for genetic screening and testing. Residents will learn to request and interpret genetic tests in diagnosing neurological diseases in children. By acquiring this knowledge and skill set, graduating child neurology residents will be able to properly recognize and evaluate children with potential neurogenetic diseases, whether congenital, autosomal, X-linked, mitochondrial, metabolic, or polygenic. Additionally, they will develop lifelong learning skills to keep up with advances in human molecular diagnostics and new developments in molecular biology, molecular genetics, clinical genetics, and epigenetics.
Physical Medicine and Rehabilitation
The Physical Medicine and Rehabilitation (PMR) elective rotation provides child neurology residents with both inpatient and outpatient experiences in pediatric physical medicine and rehabilitation. This rotation focuses on understanding the role of rehabilitation in enhancing patient and family quality of life by promoting functional independence and societal integration for children with disabilities. Residents will explore comprehensive treatment approaches for children with conditions such as cerebral palsy, traumatic brain injury, and other pediatric acquired disabilities, addressing medical, functional, and psychosocial needs.
During the rotation, residents will gain insight into how rehabilitation aims to improve quality of life through functional independence and societal integration. They will learn to describe the comprehensive needs of children with cerebral palsy and traumatic brain injury, addressing medical, functional, and psychosocial aspects. Residents will discuss the management of common medical rehabilitation problems, techniques for managing spasticity, and the indications for various techniques. They will also identify functional areas commonly targeted by the rehabilitation team, including mobility, daily living activities, fine motor skills, cognition, communication, and feeding. The rotation covers issues related to reintegration into home, community, and school settings following a disabling event and the roles of different team members in addressing functional deficits. Residents will differentiate which rehabilitation settings—intensive inpatient, outpatient, or home and community—are suitable for various patients and will strengthen their neurological and musculoskeletal examination skills, relating impairments to functional disabilities.
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Adult Inpatient Wards
Neuropathology
The Neuropathology rotation is designed to develop residents' skills in diagnosing and interpreting neuropathological specimens. Residents will learn to perform and interpret frozen sections and squash preparations during surgeries, communicate results to neurosurgeons, and analyze permanent sections with appropriate special stains and immunostains. They will also participate in quality assurance meetings and treatment-planning conferences, improving their diagnostic skills for conditions like gliomas and meningiomas. Residents will attend brain cutting conferences, perform brain sectioning, and evaluate autopsy brains. They will gain experience in diagnosing common brain lesions, understanding clinicopathologic correlations, and answering clinicians' questions effectively.
Neuro-Ophthalmology
The Neuro-Ophthalmology rotation is a clinical experience designed to introduce residents to the field of Neuro-Ophthalmology. The goal is to develop proficiency in examining the optic nerves, pupils, and cranial nerves, and in evaluating conditions such as diplopia, papilledema, anisocoria, and visual loss. Residents will learn to accurately assess visual acuity, color vision, pupillary reactions, visual fields, eye movements, and the optic disc. They will gain the skills to differentiate between disorders like acute ischemic optic neuropathy, optic neuritis, and papilledema, and systematically evaluate anisocoria and double vision. Additionally, residents will understand the utility of various diagnostic tests, including visual field testing, visual evoked potentials, and optical coherence tomography. By the end of the rotation, residents will be equipped to expertly evaluate eye movement abnormalities and optic nerve pathologies, integrating these skills into their clinical practice and fostering lifelong learning habits.
