True Integrated Programs for Child Neurology

I just matched in child neuro and know the field pretty well.

There are a few programs I know of that advertise a combined five year track and these include:
- Wash U
- Cleveland Clinic
- Cincinatti Children's
- and one of the VA schools - either UVa or VCU (cannot remember which)

Some of these require both an ERAS and SF Match application - others only the later. To make matters more confusing, some want you to go through both the early and regular matches while others only ask you to do the former. According to most people I spoke to on the interview trail, the trend in upcoming years will be toward having more "combined" programs like these.

Most other places have a "handshake deal" where you are given special consideration for the peds training if the child neuro dept wants you. This applies to most programs and includes the following to which I applied:
- U of Rochester
- Pittsburgh
- Rainbow Babies
- OSU

Others don't like to take folks going into pedi neuro because it causes them to be short on seniors in their peds program. These are the exception.

Your best bet is to find child neuro programs you like in places you would like to train and call/e-mail them to find out what their relationship is with their respective peds department and exactly how their combination works.

 

U.Mich has an integrated five-year program (just instituted). I was very impressed with their program when I interviewed there, and Ann Arbor seems great.

I'll be doing all five of my years at Children's National Medical Center in DC, starting this June. It's not an integrated program, but the peds residency is large enough that they often take the child neuro residents into the peds residency, and they don't hold it against you that you will be leaving in two years. My co-child neuro resident will also be doing her general peds at CNMC. Both the peds faculty and neuro programs and faculty are great as well (CNMC is the home peds site for my medical school). They take two Child Neurology residents per year, and in the past they have been split up for the adult neuro year, with one going to George Washington University Hospital and one to Georgetown.

- Erick

 

I wrote two personal statements, and there was no way to tell from my peds application that I would be doing peds-neuro (I received the same advice you did). My goal was to try to ensure I'd get invited to an interview. My applications to peds were otherwise very competitive, and I figured that I wanted to give myself a shot at convincing the programs that I was a good investment despite only being there for two years. At every interview, however, someone made a point of asking me if I was going to specialize, and I was honest each time. The last thing you want to do is end up at a program that will have a difficult time accommodating your leaving after 2 years. You'll just end up a pariah during your time in the general peds program. Also, after the child neuro match in January, I emailed the peds programs to let them know I had matched in neuro, and reinforce that I was still very interested in their program for my general peds training.

As far as West Coast, I did go out to OHSU to interview. They have a very new program, and OHSU's peds residency is pretty dead-set against accomodating their residents. It wasn't an issue for me, because I knew I wanted to do my 2 years of peds at DC Children's regardless of where I'd be going to do neuro (like I said, it's a great program).

Oh, and CHOP is really great about taking their child neuro residents into their peds residency. CHOP takes 4 child neuro residents a year, and in their PGY-1 peds class right now are all four of their neuro folks, as well as I believe a resident who will be leaving CHOP to do neuro elsewhere.

I'll post more if and when I remember it.... now that the Match has come and gone, it feels like all of that interviewing and applying was ages ago.

- Erick

 

I prepared two separate letters as well but my peds letter mentioned my intent to pursue child neuro. I was granted a peds interview at each of the 12 programs to which I applied. They were: U of Rochester, Pitt, Duke, UNC, Rainbow, Cleveland Clinic, OSU, Cinci Childrens, Wash U, Vandy, UVa and VCU. I was told by at least two people to "lie about" or "omit" my intention to go into pedi-neuro when dealing with pedi programs but I chose to ignore the advice because I wanted to be up front and honest about my intention. Moreover, since I wanted to do all five years of my training at a single institution (and yes, all the aforementioned programs are open to that approach), I saw no benefit in not mentioning my intention to enter pedi neuro.

As I mentioned in a prior post, most of the larger programs are transitioning to offering 5-yr spots and I was told by several PDs that this would be the trend in the future. In my oponion, the only reason not to mention your intent to go into pedi-neuro is if you plan to split your training between two programs (e.g. peds at one place and pedi neuro at another). While this approach was common in the past, it seems to be becoming more difficult. The only people I met on the interview trail who wanted to do pedi neuro at an institution other than that at which they were doing peds fell into two groups:
(1) Those who were geographically limited for their peds years because of a spouse/significant other who could not relocate immediately
(2) Those who were alreay in a peds residency where they were finishing a full three years or cutting out early

This segways into an interesting point which came up when I tried to work out my final rank list. I really liked the pedi-neuro program at the Cleveland Clinic but felt their peds was realatively weak so I considered splitting my training with peds at rainbow and pedi neuro at the clinic. I passed this idea by the pedi neuro PD at my school who said taking this approach would put me at a disadvantage relative to other applicants willing to commit up front to five years at these competative programs.

I agree with eviorr regarding selecting a program that can accomodate you leaving after two years and about the "pariah" issue.

 

Hi everyone,

Thanks for the helpful info. I'm pretty early in the process (entering med school in August), but I am very interested in peds neuro (with the caveat that I know my interests could change...). Just to clarify, it sounds like to do peds neuro one has to start with a peds residency, but only do 2 years of it before doing a child neuro fellowship? Does one apply for the child neuro fellowship right out of med school (assuming it's not an integrated 5-year program), or wait and apply as a peds resident? If someone could clear this up for me that would be great!

 

Peds-neuro is structured differently than any other pediatric subspecialty. It is five years total, and you are correct that after the two years of peds, you transition into the neuro component (usually 1 year of adult neuro, followed by two years of pediatric neuro). The neuro component is called a child neurology residency, not a fellowship. It's a minor distinction, but the difference is that when you begin the neuro training you still have not completed any residency, and are not board eligible for anything, so you cannot be a fellow. That said, in some programs (such as DC Children's) the PGY-4 and PGY-5 residents are essentially treated like fellows, while in some other programs, the impression I received during interviews is that you are treated much more like a resident still.

The application process involves applying to both pediatric residencies and child neuro residencies as a 4th year medical student. Child neuro is an early match process through the SFMatch. I interviewed in November and December, and the match occurred in late January. Pediatrics is a regular match, so I interviewed in November, December, and January, and the match occurred on March 15. One benefit of this set-up is that you know where you will be for neuro before you have to submit your ranked list of pediatric programs.

- Erick

 

Great - thanks for clearing that up!

 

If you're interviewing at a program for peds neuro and for pediatrics, do you have to schedule two interview days for this, or can these be combined? My dean thinks I'll have to go twice, but I wasn't sure.

 

It's two different interview days. Most programs try to help you arrange them back-to-back, but I also did some weeks apart, especially if the programs were close by and drivable.

 

Oh, and the interview days are very different -
For pediatrics, you are generally interviewed by two faculty members. There will be a large group of you interviewing on the same day, you'll get the tour and presentations, etc.
For child neuro, the day is closer to what I've been told a fellowship interview is like. Usually there are only 1 or 2 of you interviewing that day (although there were 6 of us at CHOP, which is a huge program, and four of us at MGH). No really elaborate presentation, you just show up and go from office to office being interviewed by faculty members. Usually you will have 7 to 10 interviews in a single day, which can get exhausting. It is also not uncommon to have gaps in the day, and to spend an hour just sitting around waiting for next interview. Pretty much, they want as many faculty members to meet you as possible, since you will usually be either their only child neuro resident, or one of two residents, meaning that at some point everyone will have to work with you. Anyways, it was by far a more grueling process than the peds interviews, but all of the attendings I met with were very laid-back and pleasant.

- Erick

 

For Child Neuro, is there a way that you can complete a full pediatric residency and still continue in the child-neuro track? In otherwords, can you work it so that you are board eligible in both pediatrics and neurology? (simliar to the IM/Neuro combined programs).

 

Doing the program in five years as outlined above does make you board eligible for both peds and neuro in most programs, and most docs sit for both. A child neuro residency director told me that some peds programs have had difficulty in making sure their residents will have met certain requirements prior to the end of that second year, so it is something you should ask about if it is a concern.

That said, it is certainly possible to do child neuro after three years of peds (for a total of six years). You can apply to child neuro as a peds intern (for spots that begin two years from when you are applying). You can also apply as a PGY-2 peds resident, as many programs don't fill their spots, and there should be some opening available to start after you finish your peds residency. One guy I met on interviews is a peds PGY-2, and he was trying to either match to an open spot to start in 2008, or in 2009 (in which case he'd work as a peds attending for a year). The only downside (besides an extra year of residency) is going from being a peds PGY-3 right into the adult neuro year, where in most cases you are treated exactly the same as the adult neuro PGY-2's.

- Erick

 

I'm currently trying to set up my fourth year and have a question regarding the boards. Do I need to take step 2 CK before the San Francisco match, or can I wait? I was told by my administrators that it is merely a graduation requirement and if I did well on step 1, I should wait to take it. Any information would be appreciated. Thanks.

 

I did CS in December and CK about a week before the SFMatch, so the programs had neither score. My Dean advised me that most Child Neuro programs were used to making decisions without a Step II score, so it wouldn't be that big of a deal. The only caveat I would add is that I had a really good Step I score, otherwise I might have tried to do Step II earlier.

- Erick

 

I would be careful about deciding when to take Step 2 Ck and Step 2 CS, I had the same question myself a while ago. I would suggest emailing the San Francisco Match, I do know that applicants for the regular match need to have passed Step 2 CK and Step 2 CS before the match or they will be withdrawn from the match. I get the impression that taking Step 2 CK and Step 2 CS late may delay some interviews, . . .

 

I applied and matched in child neuro last year. My Step 1 scores were good enough that I was not worried about proving myself with a good score on Step 2 CK. I took the CS early (October) to get it out of the way but did not sit for the CK exam until 12/30 (yeah, the day before New Year's). The match took place on 1/16ish and I got my scores at the end of January. I had no problem with either programs or the SF Match caused by not having scores from Step II prior to entering the match.

 

One point my dean brought up is that prior to a few years ago, medical students did not have the option of scheduling their Steps, and had to take them on specific test days. When that was the case, early match programs just accepted that they would not have Step 2 scores for any of their applicants, so most of those program directors are used to making their decisions without the scores.

 

I agree with all the previous posts. I matched without even taking either step 2's. I feel that child neuro programs don't make as much out of test scores. They are more concerned with your interest in the specialty and overall application. Because your actual neuro training is 3 years after the match, prgrams are more worried about matching peeps who wont loose interest during the pedi years. Good scores never hurt anyone tho

 

Wow, I thought for sure that SF match needed Step 2, it must be required in the contract that a person pass Step 2 CK & CS for the residency position, . . .