Higher Specialist Training Syllabus in Paediatric Neurology

Revised January 2000

This should be read in conjunction with the sections on Neurology, Learning Difficulties and Development in the RCPCH general professional training syllabus

1. Knowledge

1.A Knowledge of Paediatric Neurology

i) Wide range of normal and abnormal patterns of development

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

iii) Epidemiology, aetiology. pathogenesis, pathology, clinical features, treatment and outcome measures for: a) neurological diseases in childhood b)the causes of developmental delay, learning disability, and specific learning difficulties - to include an understanding of language and complex communication disorders (autistic spectrum)

iv) 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

v) Inter relationship of neurological diseases with other body systems including growth and nutrition: feeding difficulties, reflux and aspiration

vi) Orthopaedics, orthotics and bioengineering in the clinical setting

vii) Genetic issues including recurrence risk, prenatal diagnosis, gene localisation and imprinting

1.B Diagnostic methods

i) Prental diagnosis as it relates to neurological disorder

ii) Biochemical changes in blood and CSF and haematological changes that may accompany neurological disorder in children

iii) Genetic and immunological basis of some neurological disorders: methodology of investigations

iv) Use of tissue biopsy: interpretation of histological abnormalities

v) Appropriate use of neuroradiology and other screening modalities

vi) 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 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

vii) Assessment of hearing and vision including behavioural, brainstem auditory evoked potentials, electroretinography and visual evoked potentials

viii) Neurometabolic investigations

ix) Principles of gait analysis

1.C Therapy

i) Familiarity with current standard treatment plans for all forms of neurological disorder

ii) 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

iii) Principles underlying rehabilitation

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

v) Aids to treatment and rehabilitation, hearing and vision aids, seating, mobility aids, orthoses, communication aids, computers etc

vi) Awareness of range and potential consequences of unconventional and alternative therapies

1.D Multidisciplinary care

i) Use a team approach to management of neurological disorders and understand its advantages and limitations

ii) 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 neuropsychometric assessment), treatment and rehabilitation

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

iv) Community child health services

v) Function of the child development service including outreach child development teams

vI Special needs registers

vii) Transition of care from children's to adult services

1.E Integrated care - work with other agencies

i) 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

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

iii) Self-help and parent support groups

1.F Ethical issues

i) Ethics of research in children

ii) Process of informed consent

iii) Knowledge of issues governing ethics and consent for clinical trials

iv) United Nations Convention on the rights of the child and other relevant proclamations and judgements set down in law

1.G Management

i) 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

ii) Experience the day-to-day running of a paediatric neurology service within the medical directorate system

iii) Knowledge of an involvement in clinical audit

iv) The structure and function of local, regional and national NHS organisation

v) Knowledge of research funding - grants, charities and NHS R&D support

2. Skills

2.A Clinical

i) Developmental assessment

ii) Detailed neurological examination

iii) Interpret results of investigations including EEG, EMG, nerve conduction, CT and MRI scans

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

v) Co-ordination of care for the critically ill child: the management of neurological emergencies

2.B Technical

Trainees are not asked to be proficient with all these investigation but rather to be familiar with them and to understand their strengths and weaknesses.   Trainees should be competent at performing tests to determine brain death

i) EMG

ii) Nerve conduction studies

iii) Skin Biopsy

iv) Muscle biopsy

v) Cerebral pressure monitoring line care

vi) Perform tests to determine brain death

vii) Neonatal cranial ultrasound

viii) Muscle ultrasound

ix) Cerebral function monitoring

2.C Academic

i) Critical evaluation of clinical results from literature review and audit

ii) Manuscript preparation

iii) Oral presentation skills

2.D Organisational

i) Routine departmental tasks including duty rotas, teaching programmes, postgraduate meetings

2.E Teaching

i) Formal and informal teaching skills at undergraduate and postgraduate level

ii) Development of a core teaching material to enable participation in teaching programmes on a regular basis

3. Attitudes

3.A Leadership

i) Understanding and implementing a leadership role in a multidisciplinary team

3.B Communication

i) 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 a knowledge of family support groups (especially Contact-a-Family)

ii) Effective and appropriate approach to colleagues, GPs, community health care staff, research and laboratory staff and managers

3.C Education

i) Commitment to continuing self-education and the teaching of others

ii) Maintenance of a training experience portfolio

3.D Support

i) Supportive and sympathetic approach to handling families which can be maintained under difficult circumstances

ii) Understanding and positive approach to the supervision of junior medical staff

iii) Recognition of and coping with stress in self and others

3.E Academic/Research

i) Innovative attitude to clinical problems

ii) Support of / active in research

iii) Collaborative attitude to local and national colleagues

3.F Managerial

i) Interest in the overall organisation of departmental activities and in particular its function as an effective regional / tertiary centre with its outreach clinics

ii) Understanding approach to local management structure

iii) Constructive attitude to the process of decision making

iv) Acceptance of shared responsibility for use of resources