Reflections on the state of child neurology

The effectiveness of pediatric residency education in preparing graduates to manage neurological and neurobehavioral issues in practice

PURPOSE

Pediatricians are required to manage a variety of neurodevelopmental conditions. In this study, the authors surveyed self-assessment of competency by recent graduates of the University of British Columbia (UBC) pediatric residency training program in various areas of pediatric neurology, from acute care to behavioral assessments.

METHOD

Forty-six questionnaires were mailed or e-mailed between October 2002 and September 2004 to UBC pediatrics program graduates of 1998-2004. The 29-item questionnaire consisted of 26 questions on a six-point scale and asked respondents to rate their ability to manage specific neurological and developmental symptoms and conditions. Also, three open-ended questions asked respondents which topics required less emphasis or more emphasis and which were appropriate for continuing medical education (CME). Descriptive statistical analyses were performed.

RESULTS

A total of 39 questionnaires (85% response rate) were completed and returned. The results indicate that 74% of pediatric graduates feel that more of the neurology portion of residency training should be spent on general pediatric behavioral and neurological conditions (e.g., attention-deficit/hyperactivity disorder or developmental delay) and would choose to attend CME on these areas, and 28% of respondents would prefer to receive less training on complex neurological problems that are managed at a subspecialty level (e.g., chronic refractory seizures).

CONCLUSIONS

Pediatric residents need sufficient, specific training to enable them to competently investigate and manage the neurobehavioral complaints and conditions commonly encountered by general pediatricians in both their office and hospital practice.

[Neuropediatric practice in Spanish hospitals: supply and demand]

BACKGROUND

No reports have been published of country-wide neuropediatric practice.

OBJECTIVE

To determine neuropediatric practice in Spanish hospitals by studying supply and demand throughout the country.

MATERIALS AND METHODS

A survey was performed of Spanish hospitals in 2001. Private hospitals with no state funding and hospitals without a pediatric unit were excluded. The parameter used to study supply was the existence of neuropediatric beds and that used to study demand was the annual consultation rate per 1000 inhabitants aged from 0 to 14 years.

RESULTS

A questionnaire was sent to 277 hospitals and 106 (38.27 %) responded. Sixty percent of Spanish hospitals had neuropediatric beds. The mean neuropediatric consultation rate was 31 consultations per 1000 inhabitants aged from 0 to 14 years.

CONCLUSIONS

In Spain, the supply of neuropediatric services is fairly widespread. The greater the number of pediatric beds, the higher the probability of neuropediatric beds. However, 42 % of small hospitals provides this service. In contrast with previously reported results on morbidity in primary care, our results show that most children with neurological processes are referred to hospital.

Pediatric neurology services in Canada: demand versus supply

As the practice of pediatric neurology has continued to evolve and expand, concerns have emerged regarding a perceived trend toward increasing clinical demand and decreasing manpower. Quantitative data are lacking, however. To address this, a questionnaire was sent to hospital-based pediatric neurology units in Canada, with all 18 centers responding. A total of 63 full-time-equivalent pediatric neurologists were disproportionately spread across the country, giving an overall ratio of 2.1 per million population (or 1.1 per 100,000 children). Waiting times for nonurgent consultations showed a median of 12.5 weeks. The number of weekly clinics per population was not proportional to either the number of specialists per center or to the waiting times. The regional variations in the level of service do not correlate with the regional manpower figures, reflecting different individual profiles of clinical and academic activities.