PEDIATRIC NEUROLOGY ROTATION-CHILDRENS’ MEMORIAL
THE METHODIST HOSPITAL
NEUROLOGY RESIDENCY PROGRAM
Faculty: Ian Butler, M.D.
Pedro Mancias, M.D.
John Slopis, MD
Richard Frye, MD, Ph.D.
Charles Dreyer, MD
Institution: Childrens’ Memorial Hermann Hospital
MD Anderson Cancer Hospital
Shriners’ Childrens Hospital
Length: 3 months
Level of Training: PGY3
Type of Experience: 50% inpatient;50% outpatient
1. To provide a concentrated exposure to neurologic disorders commonly
encountered in pediatrics, including nervous system disorders requiring surgical
or psychiatric evaluation and management.
2. To increase the resident's skills at diagnosing infantile and pediatric seizure
disorders and selecting appropriate anticonvulsant therapy.
3. To provide an opportunity for residents to pursue directed readings that focus on
pathophysiology of pediatric neurologic disease processes.
1. To develop a logical approach in the evaluation and decision-making for children
with neurologic problems. Following the rotation, residents should be able to
obtain a detailed history, as it pertains to the pediatric population, and conduct
comprehensive general and neurological examinations. Patient data should be
documented in an organized fashion.
2. To learn to distinguish abnormal from normal patterns of development in the
examination of infants and children.
3. To learn the indications for and interpretations of cranial CT and MRI scans of
pediatric neurologic disorders.
4. To learn to manage pediatric patients with neurological problems, especially those
with intractable epilepsy, neurogenetic disorders, neuromuscular disorders and
neurobehavioral disorders. This will include exposure to basic EEG interpretation
(routine and long-term monitoring).
5. To learn to evaluate mental retardation developmental disabilities, headache
movement disorders, and neurovascular disease.
Pediatric Neurology Resident Responsibilities:
1. Patient Care
Residents are expected to provide patient care that is compassionate, appropriate
and effective for the promotion of health, prevention of illness, treatment of
disease and at the end of life. To that end, residents will:
o Gather accurate, essential information from all sources, including medical
interviews, physical examinations, medical records and
o Make informed recommendations about preventative, diagnostic and
therapeutic options and interventions that are based on clinical judgment,
scientific evidence, and patient preference.
o Develop, negotiate and implement effective patient management plans and
integration of patient care.
2. Medical Knowledge
Residents are expected to demonstrate knowledge of established and evolving
biomedical, clinical and social sciences, and the application of their knowledge to
patient care. Residents will apply an open minded, analytical approach to
acquiring new knowledge, access and critically evaluate current medical
information and scientific evidence and apply this knowledge to clinical problem-
solving, clinical decision making and critical thinking.
3. Practice-Based Learning and Improvement
Residents are expected to be able to use scientific evidence and methods to
investigate, evaluate and improve patient care practices, and
o Identify areas for improvement and implement strategies to enhance
knowledge, skills, attitudes and processes of care.
o Analyze and evaluate practice experiences and implement strategies to
continually improve the quality of patient practice.
o Develop and maintain a willingness to learn from errors and use errors to
improve the system of processes of care.
o Use information technology or other methodologies to access and manage
information, support patient care decisions and enhance both patient and
4. Interpersonal and Communication Skills
Residents are expected to demonstrate interpersonal and communication skills
that enable them to establish and maintain professional relationships with
patients, families, and other members of health care teams, and
o Provide effective and professional consultation to other physician and
health care professionals and sustain therapeutic and ethically sound
professional relationships with patients, their families and colleagues.
o Use effective listening, nonverbal, questioning, and narrative skills to
communicate with patients and families.
o Interact with referring physicians in a respectful, appropriate manner.
o Maintain comprehensive, timely, and legible medical records.
o Complete evaluations of the attending, staff and rotation.
o Learn to give guidance and instruction to families regarding the
management of their children with neurological disease.
Residents are expected to demonstrate behaviors that reflect a commitment to
continuous professional development, ethical practice, an understanding and
sensitivity to diversity and a responsible attitude toward their patients, their
profession and society, and
o Demonstrate respect, compassion, integrity and altruism in relationships
with patients, families and colleagues.
o Demonstrate sensitivity and responsiveness to the gender, age, culture,
religion, sexual preference, socioeconomic status, beliefs, behaviors and
disabilities of patients and professional colleagues.
o Adhere to principles of confidentiality, scientific/academic integrity, and
6. Systems-Based Practice
Residents are expected to demonstrate both an understanding of the contexts and
systems in which health care provided, and the ability to apply this knowledge to
improve and optimize health care, and
o Understand, access and utilize the resources, providers and systems
necessary to provide optimal care.
o Understand the limitations and opportunities inherent in various practice
types and delivery systems, and develop strategies to optimize care for the
o Apply evidence-based, cost-conscious strategies to prevention, diagnosis
and disease management.
o Collaborate with other members of the health care team to assist patients
in dealing effectively with complex systems and to improve systematic
processes of care.
7. Specific Topics
Residents should become familiar with the following topics during their time on
the rotation through experience, didactic sessions or reading:
o Examination of the newborn, child and adolescent
o Intracranial hemorrhage
o Brain tumors
o Pediatric movement disorders
o Coma and stupor
o CNS infections
o Febrile seizures
o Seizure disorders
o Pediatric epilepsy surgery
o Degenerative neurologic diseases
o Demyelinating disorders
o Neuromuscular diseases
o Neurocutaneous diseases (Tuberous sclerosis, Neurofibromatosis)
o School problems, learning disabilities and Attention Deficit disorders
o Cerebral palsy and management of spasticity
o Critically ill child
8. Residents have access to the Pediatric Library located on the 7th floor of the
Neurology Department of University of Texas Medical School and computers
with internet access.
9. Online Learning centers include the:
• Child Neurology Society homepage – http://www.childneurologysociety.org/
• Gene Tests homepage – http://www.genetests.org/
• Online Mendelian Inheritance of Man (OMIM) –
• Neuromuscular Disease Center – http://www.neuro.wustl.edu/neuromuscular/
Methods of Evaluation
Evaluation of resident performance
(see PR VI.A. and III.A.2)
The supervising teaching faculty will discuss expectations with the each resident at the
initiation of the rotation. At each clinical encounter the attending will discuss
performance with each resident, providing verbal feedback regarding strengths areas for
improvement and suggesting educational goals for subsequent outpatient experiences.
Supervising faculty are encouraged to notify the program director at any time during the
rotation with either commendation or concern regarding the resident performance.
Formal evaluation will include an individual monthly evaluation performed by the
attending faculty. Faculty members directly supervising residents will complete a
computer based evaluation form using the residency management software system (New
Innovations) monthly. This evaluation will be reviewed personally with each resident by
the supervising faculty member at the end of a one month rotation. Competency in six
core areas will be assessed. Semi-annual evaluation will also be performed, using New
Innovations, a 360◦ evaluation will be implemented. Assessors will include peer and
other residents, medical students, selected nursing and ancillary personnel, and
administrative personnel. Quarterly evaluation by the program director will also be
performed in which the resident will meet with the residency program director to review
a summary report of the resident’s assessment and performance in the core competencies.
Individual counseling regarding strengths and potential weakness will be provided.
Future career development will be discussed and each resident will have an opportunity
to discuss their concerns. The summary report will be signed by both the resident and the
program director and will become part of the permanent record.
Evaluation of faculty/educational program
Neurology faculty involved in teaching the residents will be evaluated anonymously by
the residents using the electronic residency management software system. Rotation
evaluations (monthly) will include specific items about the rotation, clinical experience,
and the faculty’s teaching activities. The evaluations are confidential and are reviewed
by the program director and departmental chair. Feedback on faculty performance is
used to improve teaching.
Residents will evaluate the program on a monthly basis using the electronic residency
management software system (New Innovations). Residents will have the opportunity
to evaluate and comment on services formally on the Methodist GME-administered
Annual Survey of Residents’ Educational and Clinical Experiences, which is also
administered via New Innovations. The residents will have informally opportunities to
provide feedback about the program to faculty, Program Director, and the chief
Trainees will actively participate in weekly pediatric neurology grand rounds
Suggested readings and references:
Fenichel’s Textbook of Pediatric Neurology
Menkes Textbook of Child Neurology
Textbook of Pediatric Neurology, G. Golden
Pediatric Epilepsy: Diagnosis and Therapy, by John, Pellock, Edwin, Dodson,
Blaise, and Bourgeois
Swaiman, KF & Wright FS (ed): The Practice of Pediatric Neurology. 3rd edition,
Vol. l & 2, Mosby, St. Louis, 1989.
Swaiman, KF: Pediatric Neurology: Principles and Practice, Vol. l & 2, CV
Mosby, St. Louis, 1993.