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Pediatric Neurology?

Discussion in 'Neurology' started by omores, Nov 22, 2002.

  1. omores

    omores sleep deprived
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    I was all set on regular ol' neurology, and then my pediatrics rotation came along and spun my head a bit. Now I'm seriously considering pediatric neurology, but I'm having a hard time getting any objective information about the field. The standard neurologists I talk to don't know much about it, and the pediatric neurologists are all so rabidly enthusiastic that I'm almost afraid to continue the conversation.

    Do any of you out there have an opinion?

    And does anybody know how hard it is to secure the two years of pediatric training that is the prerequisite for peds neuro programs? I've heard that pediatric residency programs look askance at applicants who are planning to bail out early...
     
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  3. dcw135

    dcw135 Member
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    Hi, I debated between adult and peds neuro while a 4th year, went with adult and although I'm a miserable resident, I have not had occasion to believe I made a mistake.

    First of all, I really liked ped neuro, which I did at CHOP. Saw some great cases, I liked the people in the field, and there is certainly a need for you in pediatric neurology aside from seeing ADHD kids.

    But I simply couldn't handle parents of the kids who were going to die or, even worse, live. I had a hard time actaully going into the rooms of some of the kids (I still recall a locked-in 12 year old with vasculitis with particular horror - she just would not die). So emotionally, I thought I didn't want to do that for the rest of my life, ie, deal with emotionally devastated people who were stupid either as a reaction to the recent events, or naturally so.

    Also, the 2 years of general peds turned me off. I'm a PGY-3 now, and I'd just be entering my neurology training for the last 5 months. That sucks. I didn't want to do general peds at all.

    And last of all, the field is less clinical than adult neuro. Every kid gets the same workup: MRI, EEG because they all present with seizures. There's less room for a good clinical head.

    So now that I'm not very enthusiastic about the clinical side of neurology - or any of medicine in general - I still get some pleasure out of correctly diagnosing some cases. I don't think that would be the case if what was the case was Batten's or Tay Sack's.

    But you should feel both of them out. They are very different in terms of personalities and life - and both beat anything else in the medical field for me - so its a choice between two good options, thus difficult.
     
  4. omores

    omores sleep deprived
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    Yikes -- I disappeared into the black hole of my surgery rotation for awhile and came back to find this poor wee thread had already filed itself away in the archives...

    Thanks, dcw135, for your articulate response. I'm still vacillating between peds and adult neuro and likely won't be able to gain any more insight this year, other than reaffirming that I'd find either version much more interesting than, say, surgery. That peds neuro requires less of a clinical head gives me something to ponder. That's the part of neurology I like best.

    Peds neuro is often said to invovle a greater variety of conditions, whereas adult neuro is dominated by strokes. This wasn't really the case over the course of my very brief exposure to the two fields, but I may just be a victim of sampling error. Futher opinions, from you or anyone else?

    Thanks!
     
  5. panch

    panch Member
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    glad to hear you survived the black hole of surgery omores (whoever you are)

    anywho, a few technical notes:
    1.) you can apply directly to places for peds neuro as a senior medical student. you'd do your two years of peds at the same place as where you'd do pedi neuro. as you prolly know, there is no centralized application system (sucks); but the competition for pedi neuro spots is very different (b/c so few ppl end up going into it). of course, you can also apply as a peds intern and land a great spot (e.g. last year an intern at the middle of the road peds program at my school applied and landed a spot at Hopkins, this person wasn't a mud/phud or superstar)

    2.) you might not have to do two years of peds. the ABPN (American Board of Psychiatry and Neurology) requires one of the following: a. two years of peds residency; b. an intern year of IM and an intern year of Peds; c. an intern year of peds and one year of basic neuroscience research. [Note: not all programs may accept b or c, depends on the PD and department. also, you may be able to swing just doing one year of peds if you're a MD/PhD and your research was in the basic neurosciences... that would have to be negotiated and approved before starting residency]
    link to ABPN site w/ this broken down:
    http://www.abpn.com/certification/faqneurology.html#trainingchild

    re bread and butter problems you'll see as a pedi neuro (listed by a great pedi neuro at my school): epilepsy, neuromuscular disease, cerebral palsy, ADD/ADHD, mental ******ation/developmental delay, CNS malignancy, neurogenetics.
    it's a pretty broad spectrum, but as a general pedi neuro you can prolly expect >50% of your practice to be epilepsy. of course, if you subspecialize you'll skew your patient population (esp if you're at a big academic center w/ a strong pedi neuro presence)

    also, adult neuro has a huge spectrum as well. during our medical school experiences (which are mostly inpatient) we're going to see inpatient problems, and thus many people think that adult neuro is mainly stroke, stroke, and more stroke.

    part of the challenge is to know your personality and emotional strength. it takes a very special person to be able to deal w/ these innocent kids and their parents. i think kids are great, but i hate to see them sick and wouldn't be able to deal w/ so much suffering (esp as you'll see many of your patients die).

    good luck on your decision. try to schedule as much elective time in adult and pedi neuro at your home and outside institutions, and see if you can't spend a good deal of time in clinics w/ a general adult neurologist and a general pedi neuro. remember that you will have a little pedi neuro training as an adult neuro resident (the minimum is 3 months, which is what all the programs that i applied to required; you could prolly use some of your elective time to do a pedi neuro elective if that floats your boat. BUT i doubt you'd be able to practice as both an adult and a pedi neuro).
     
  6. omores

    omores sleep deprived
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    Thanks, panch, for all the information.

    You're right -- I'd been mostly comparing inpatient adult neuro with outpatient pediatric neuro, and that's lopsided. My plan for next year is to work one afternoon a week in an outpatient neurology clinic, alternating between adult and pediatric. That ought to help clarify things for me.

    If I do go into pediatric neurology, I'll likely apply to programs in my fourth year, rather than in the middle of a peds residency. Do you know how integrated the application process is? My impression was that you apply for the peds part via the regular match and the neuro part via a flexible process of negotiation. From what I've heard (very limited sample size, though) the difficult part is getting a peds position for those first two years: I've been told that peds programs are often not very fond of residents who are planning to leave after one or two years. Do you know of any programs where the neurology and pediatrics programs actually work together to facilitate the process?

    Yes, I've thought about ways to avoids two years of peds as well (though by the end of my peds rotation, I figured it wouldn't be so bad). The one adult + one peds year sounds gruelling (you'd just finish one intern year and then have to go start a second one) but the research year sounds promising. I'll be doing a year of neuroscience research starting in August, but it's at the pre-doc level so I doubt it will count toward the ABPN requirements. Alas.
     
  7. panch

    panch Member
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    i've been poking around on the sfmatch.org website in their listing of pedi neuro res places. unfortunately many of the links are dead, but there is contact info for a lot of places. i'd recommend dropping a few lines to these places and using google to get some live links.

    so far, the only 5 year one-shot program that i've found is the U Cincinnati program (many more prolly exist):
    http://www.cincinnatichildrens.org/ed/clinical/resident/neurology/default.htm

    but, last year at the aan meeting in denver i met a (then) 4th year student (very nice person btw) who had matched pedi-neuro at hopkins for 5 years. dunno exactly how she swung that, but i assume the depts of neurology and peds are more than willing to work together to facilitate the process. (it's in both of their interests to provide a nice package deal, esp at the top programs).

    i agree that two intern years (one adult, one peds) sounds grueling

    your plan of checking out both clinics sounds great.

    good luck in your quest, i'll post anything else that i find out and will try to track down someone who has gone thru the process.
     
  8. Voxel

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    If you're committed to doing pedi neuro, I think it would probably be in your best interest to do 2 years of peds vs the other options since you will be basically seeing children the rest of your life and need to also know the pediatric management of non-neurologic conditions. 1 year as an intern in internal medicine sounds like a waste of time and painful on top of it.
     
  9. dkn79

    dkn79 Junior Member

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    Does anyone know where the top pediatric neuro residencies are at or who the top researchers in peds neuro are?
    do programs accept fourth year med students or do they prefer applicants who have already started their peds residencies?
    how competitive is it for a peds neuro residency?
    it is really hard to get info on peds neuro so any info on it would really help

    Thanks! :confused:
     
  10. tinylilron

    tinylilron Member
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    I a reviving an old thread because I am interested. What have all of you learned? Could someone do pediatrics then switch into neurology or do you have to do a ped neurology residency? Also, are these residencies are open to DO students as well... or only MD students?

    Thanks for the information.
     

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