How to become a paediatric neurologist
Authors: Emily Montague, Dipak Ram, Alasdair Parker, Gary McCullagh
Publication date: 18 Aug 2015
Dipak Ram and colleagues dispel some myths about gaining a training post in this diverse and challenging specialty
Many junior doctors are put off applying for paediatric neurology because they believe that they will not gain a place. However, the reality is very different. This year, at least nine junior doctors should have entered the UK’s training programme to meet demand but only three were appointed. The myth that it was difficult to get on the training scheme deterred good applicants, and some trainees did not realise that they needed to gain exposure to the specialty before their application. On top of this, some regions did not advertise an empty post—a situation dealt with by the British Paediatric Neurology Association.
A common misconception is that paediatric neurologists see only patients with rare, chronic, and untreatable disorders. In fact, paediatric neurology is one of the most varied subspecialties, and typical patients include those with epilepsy, neuromuscular disease, neuropathies, developmental delay, meningitis, encephalitis, migraine, and acquired brain injury, as well as those with rare conditions. With such a diverse group of presentations, doctors come across many fascinating diagnostic and intellectual challenges. However, paediatric neurology is also a hands-on specialty, even up to consultant level, and offers a wide range of experience.
A typical week will entail seeing outpatients in clinics, looking after inpatients, team meetings, teaching, and outreach clinics in district general hospitals.
Paediatric neurology has an important acute aspect, and patients may be admitted as emergencies with, for example, central nervous system infection or inflammation, worsening seizures, or status epilepticus. Patients are also admitted electively for investigations such as video telemetry with drug titration or reduction. Patients with pre-existing neurological disease may be admitted with general medical problems as complications of their condition. Inpatient care often takes place in different settings, working alongside other specialists.
Team meetings are frequent because of the multidisciplinary nature of the specialty. Undergraduate and postgraduate teaching may also be a feature of the role.
All the skills of a paediatrician are required, in particular good communication skills: paediatric neurologists work closely with the multidisciplinary team, as well as with parents and children. Considering a patient holistically is also important. Patients often have complex conditions and needs, and good discharge planning is vital. Good knowledge of general medicine is also fundamental as doctors often have to piece together clues from every aspect of the patient’s life and illness to find the diagnosis.
Practical thinking is as important as lateral thinking. For example, controlling a child’s seizures sufficiently to allow them to go to school and ensuring their teachers and parents can manage them, is a valuable outcome.
How do I get there?
At present, paediatrics is offered as an eight year run-through national training programme. The current training curriculum requires doctors to spend five years (specialty training years 1-5 (ST1-5)) in general paediatrics including neonatology, rotating around different departments to get a solid knowledge base before subspecialising. During the first three years trainees work towards the examination for membership of the Royal College of Paediatrics and Child Health, which is required to progress. From ST6, trainees can either continue a career in general paediatrics or opt to subspecialise.
Trainees apply via the national grid training system. It is important to develop an interest early on as application for the grid process begins at the end of the ST4 rotation.
Trainees must spend at least two years in acute paediatric neurology, one year in neurodisability, six months in adult neurology, and three months in child psychiatry. Experience in child psychiatry is usually completed as cumulative half days during the other posts, resulting in a total subspecialty training duration of three and a half years. The availability of grid training centres differs each year, and roughly seven jobs are offered nationally each year.
The clinical academic training pathway allows trainees from ST1 level to integrate academic fellowship and a PhD into their clinical training. The Training in Research for the Benefit of Children document produced by the RCPCH has a lot of useful information for those interested in research and academic training.
Students and junior doctors can improve their chances of securing a training post by gaining experience in related fields. Any general paediatric experience is beneficial, as is work in neurodisability, child and adolescent mental health, and adult neurology. Paediatricians tend to be approachable and welcoming, so potential trainees should organise some shadowing. Paediatric neurology departments welcome students, and student selected modules in paediatric neurology can be an extremely useful eye opener into this diverse subspecialty.
Involvement with children’s clubs or schools for children with disabilities or learning difficulties are also great ways to get experience and start developing all important communication skills.
Most medical schools have a paediatrics society, which can offer opportunities to work with children and young people and help show commitment to the specialty.
Many career paths are available to a paediatric neurologist. Some choose to spend all their time in a clinical environment, and others opt to split their time with a joint clinical and academic post. Even those who choose clinical posts have many opportunities to be involved in research and trials, and there are dedicated children’s clinical research facilities at several centres. Many consultants also have specialist areas of interest, which may include neonatal neurology, epilepsy, neuromuscular disorders, headaches, neurogenetics, neurometabolics, or neuroimmunology.
Some exciting developments in paediatric neurology have taken place in recent years, in particular the Genomics England project, which aims to sequence the whole genome of 100 000 people; this will hopefully lead to many more diagnoses for children with life limiting neurological disorders.
Advances in imaging techniques allow a more thorough understanding of neurological disorders. Radiology plays a big part in the investigation and management of these children, and so as imaging modalities become more sophisticated, neurologists will be able to understand our patients’ conditions better and treat them more effectively.
British Paediatric Neurology Association: [Link] . The website has useful information on training programmes in paediatric neurology. It also contains contact details for regional representatives who can discuss career options or student selected modules
Royal College of Paediatrics and Child Health: [Link] . This has lots of useful information on careers and training in paediatrics, as well as the application process. There is also a useful section on subspecialty training
Competing interests: We have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.
- Royal College of Paediatrics and Child Health. Training in research for the benefit of children. Sep 2013. [Link] .
Emily Montague fifth year medical student, University of Manchester
Dipak Ram paediatric neurology grid trainee, Royal Manchester Children’s Hospital, Manchester
Alasdair Parker national training adviser for paediatric neurology, Addenbrooke’s Hospital, Cambridge
Gary McCullagh consultant paediatric neurologist, Royal Manchester Children’s Hospital, Manchester