Program Description - Year Three Objectives
During the third year of training, the resident will build on earlier experiences in the pediatric neurology outpatient clinics by serving as pediatric neurological consultant in the pediatric emergency room and on the inpatient floors, including well-baby and intensive newborn nurseries. This will include several months as pediatric neurology chief resident at Boston Medical Center. The third year will also include in-depth training in sleep medicine, epilepsy and clinical electrophysiology, behavioral pediatric neurology and elective experiences dedicated to further sub-specialized training and/or research.
The Primary Objectives of Year Three
- To expand understanding of normal and abnormal development, from preterm and full-term newborns, through infancy, early and later childhood, adolescence and early adulthood.
- To learn to obtain detailed developmental and neurological histories and to complete detailed developmental and neurological examinations at each stage of development.
- To expand exposure to the full spectrum of neurological disorders seen in children and foster further library work and critical reading of related literature.
- To expand the ability to manage acute neurological problems in children, including those seen in the emergency room and the pediatric intensive care units, including treatment of refractory status epilepticus and acutely increased intracranial pressure.
- To learn to recognize normal and abnormal EEG patterns and acquire the ability to:
- Identify normal EEG patterns at each developmental age
- Understand the interpretation of various EEG montages use
- Recognize normal and abnormal background EEG rhythms, including those seen in the various stages of sleep
- Recognize artifacts, spikes, sharp waves and other EEG abnormalities
- Recognize EEG patterns typical of the many childhood epilepsies and epilepsy syndromes
- Recognize traumatic, metabolic, toxic, infectious and other encephalopathies
- Become fully familiar with the criteria needed for the clinical diagnosis of brain death
- To learn to interpret evoked response neurophysiological studies, visual, auditory and somatosensory evoked responses.
- Development of one or more clinical and/or laboratory research project for presentation and publication.
- To learn to conduct comprehensive and stimulating didactic teaching conferences.
- To become knowledgeable in the use of the many anticonvulsant medications and non-medication treatments for epilepsy, including the ketogenic diet and vagal nerve stimulator.
- To learn clinical neuropharmacology and clinical indications for the use of SSRI medications, typical and atypical antipsychotic mediations, drugs for Tourette syndrome and its co-morbid conditions, medications for autistic spectrum disorders, oppositional, conduct and aggressive behaviors, and attention deficit hyperactivity disorder.
- To learn to perform a psychologically-oriented mental status examination, and develop skills to facilitate the accurate diagnosis of childhood depression, anxiety disorders, other mood disorders, childhood psychoses, psycho-physiological disorders and behavioral disorders, and gain familiarity with the different treatments used for these disorders, including the many medications used in their management.
- During a pediatric rehabilitation rotation, to learn how to carry out detailed evaluation of children with neuromuscular disorders and different means to manage abnormalities of muscle tone, including spasticity, hypotonia and dystonia. This teaching in management will include applications of physical therapy, use of orthotics and other appliances, drug treatment, botox and phenol injections, use of the baclofen pump and surgical interventions