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Published on: July 30, 2009
Modified Delphi Study to Establish Consensus About Child Neurology Residency Education: Next-Gen Training
Rachel Gottlieb-Smith1, Danny Rogers1, Donald L Gilbert1
1From the Department of Pediatrics (R.G.-S.), University of Michigan, Ann Arbor; Department of Neurology (D.R.), University of New Mexico, Albuquerque; and Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics (D.L.G.), University of Cincinnati College of Medicine, OH.
Background And Objectives:
Rapid advances in diagnostics and treatments are shifting child neurology practice, but child neurology training requirements have been much slower to change. Previous literature confirms strong support for modernization, but no formal consensus exists regarding maintaining or changing training. We aimed to develop a holistic consensus regarding the optimal training pathway and requirements using a modified Delphi process.
Methods:
The authors invited 48 child neurologists as panelists, intentionally selecting to represent the diverse geography, practice type, subspecialties, and other demographics of child neurologists practicing in the United States. Panelists participated in an anonymized modified Delphi study with 4 rounds evaluating statements regarding current training requirements, core rotation durations, and mandatory subspecialty rotations with the option to agree or disagree. Statements were derived from current Accreditation Council of Graduate Medical Education, American Board of Psychiatry and Neurology, and American Board of Pediatrics requirements for child neurology training and recent literature. Statements that did not reach a predefined level of consensus (≥75% agreement or disagreement on a 7-point Likert scale) were re-queried or modified for subsequent rounds. Panelists had access to all previous anonymized results and comments. The final modifications were presented in round 4 as a comprehensive training proposal.
Results:
Twenty-seven panelists agreed to participate, with most completing all 4 rounds. In round 1, consensus was reached on 45 of 118 (38%) items; round 2, 28 of 87 (32%); round 3, 16 of 25 (64%); and round 4, 1 of 1 (100%). There was consensus regarding the age scope of practice and certain subspecialties that should be required, but no initial consensus regarding time-based requirements. By round 4, consensus emerged for the following rotations-months: neonatal and pediatric intensive care-4, adolescent medicine-0.5, emergency medicine-1.5, inpatient pediatrics-3, outpatient pediatrics-3.5, inpatient child neurology-9.5, outpatient child neurology-6, inpatient adult neurology-3, outpatient adult neurology-2, genetics-2, EEG/neurophysiology-2, neuroimaging-1, child psychiatry-1, and electives-7.5. The consensus schedule consists of 46.5 total months of requirements.
Discussion:
This study suggests that, despite diverging views prevalent among child neurologists, a diverse panel can, through a multiround Delphi process, arrive at consensus regarding many core features of the child neurology training structure and certification requirements.
