Pediatric Neurology Residency Program at Loma Linda University Medical Center

Child neurology training at LLUMC

Introduction
The child neurology residency program at Loma Linda University Medical Center provides an outstanding opportunity for clinical training in a dynamic and academically challenging environment. Our program places a high priority on resident education and well-being and prides itself in encouraging the development of clinicians who are well-qualified to go on to practice general child neurology or to pursue fellowship and research interests.

Our attending child neurologists are capable and experienced clinicians who work well with one another and with residents, frequently being commended in their evaluations for their congeniality and strong commitment to teaching. The Children's Hospital (LLUCH) is a thriving and well-respected tertiary referral center caring for thousands of children with a wide variety of neurological symptoms and disabilities. We are strongly integrated with the hospital's large pediatric residency program, with pediatric residents rounding on our ward service and being involved in the workup of the majority of our clinic and consult patients. Our child neurology residents similarly play a major role in educating the pediatric residents and medical students.

Located in sunny Southern California, we invite you to visit our program, meet our residents, and enjoy our hospitable weather and community.

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About the residency program
Child neurology is a three-year residency program. Physicians can become eligible to begin the program after two years of postgraduate training. At least one year of general pediatrics is required, but the additional year may be spent in clinical medicine or basic neuroscience training. Most applicants choose to complete two or three years of a categorical pediatric residency.

We offer three residency positions for each year of training. Available positions starting at the PGY-3 year are filled through the SFMatch program (http://www.sfmatch.org).

The first year of training (PGY-3) is organized and directed by the adult neurology program and consists mostly of ward rotations at LLUMC and at the Jerry L. Pettis Memorial VA Medical Center. On both of these services, residents are responsible for inpatient admissions and consults and are exposed to a wide variety of adult neurologic disorders. During this time residents progressively develop their examination techniques, diagnostic skills, and clinical acumen. Toward the end of this year, PGY-3 child neurology residents assume supervisory roles over interns and medical students. Several months of adult neurology clinic experience are provided, in addition to a weekly half-day adult neurology continuity clinic that spans the year.

The second and third years of training (PGY-4 and PGY-5) are divided among child neurology ward, clinic, and elective rotations. Electives in basic neuroscience, genetics, neuroophthalmology, neurophysiology (EEG/EMG), neuroradiology, neurosurgery, psychiatry, and rehabilitation are available.

Participation in a basic science or clinical research project is a requirement of training, for which several months of elective time are made available. Residents also attend weekly academic neuroscience conferences and seminars throughout their training, to which they increasingly provide contributions, organization, and supervision.

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Training timeline

First year (PGY-3)
INPATIENT:
LLUMC: 5-10 patients on service with three new consults per day and four to five consults per call night (eight months)
VAH: 4-8 patients on service with three new consults per day and four to five consults per call night (three months)
Overnight and weekend (home-based) call is every four to five days.

OUTPATIENT:
LLU professional plaza neurology clinic: one half day per week (12 months)
LLUMC adult neurology clinic: five half days per week (one month)

Second year (PGY-4)
INPATIENT :
LLUMC ward team: 12-20 patients on service staffed by the pediatric residents
LLUMC consult team: 10-15 patients followed with three new consults per day
Examining patients, reviewing diagnostic studies, performing consult evaluations, helping to supervise and teach pediatric residents and medical students, and ensuring efficient and appropriate patient care. There is no call during this year (four months)

OUTPATIENT:
LLUMC continuity clinic: one half day per week (12 months)
LLUCH child neurology clinic: five half days per week (two months)

ELECTIVES:
Neurophysiology: assisting with procedures and interpreting diagnostic studies in the EMG and EEG labs (four months)
Neuroradiology: assisting with reading neuroimaging studies (one month)
Neuroophthalmology: outpatient and inpatient evaluation and management (one month)

Third year (PGY-5)
INPATIENT:
Inpatient ward and consultation services with greater responsibility for supervision and education of residents (four months)
There is (home-based) call one weekend per month throughout the year (12 months).

OUTPATIENT:
LLUMC continuity clinic: one half day per week (12 months)
LLUCH child neurology clinic: five half days per week (three months)

ELECTIVES:
Basic neuroscience: 2 hours per day of lectures given to medical students in combination with other electives (six months)
Genetics: (one month)

LLUMC: one half day of clinic per week with up to five consults per week
RC: one day per month at the Inland Valley Regional Center
CHLA: three half days per week at Children's Hospital of Los Angeles
Neuroradiology and neuropathology: seven half days per week assisting in interpreting diagnostic studies (two months)
Psychiatry: one half day per month in the pediatric neuroassessment program (12 months)
Rehabilitation: assisting the rehabilitation team with patient assessment and treatment (two weeks)
Research: designing and implementing a basic science or clinical research project with emphasis placed on presenting findings at an academic meeting and/or in a publication (three months)

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Conferences
The program's strong commitment to resident education is reflected in the wide variety of teaching conferences provided each month. The weekly neuroscience grand rounds, attended by the departments of adult neurology, child neurology, neurosurgery, and radiology, begins with one hour of discussion of neuroradiology cases, followed by a clinical or basic science lecture.

Separate hour-long EMG and EEG seminars are held once a week, with an emphasis on applying fundamental principles to the interpretation of studies. The adult neurology residency program hosts a weekly clinical conference or Journal Club at the Jerry L. Pettis Memorial VA Medical Center, to which child neurology residents are welcome. Additional neuroscience lectures, with an emphasis on preparation for board examinations, are scheduled for one to two hours a week.

Residents are encouraged to take increasing responsibility in organizing and preparing grand rounds presentations, neuroscience lectures, and monthly basic neurology lectures for pediatric residents and medical students. Residents are also encouraged to assist in brain-cutting laboratories and to supervise problem-based learning sessions for freshman medical students taking anatomy.

Conference schedule
Monday: None
Tuesday: EMG conference 5:00 to 6:00 p.m.
Wednesday: neuroscience grand rounds 8:00 to 9:00 a.m., VA conference 12:00 to 1:00 p.m.
Thursday: None
Friday: pediatric grand rounds 8:00 to 9:00 a.m., EEG and neurosciences 12:00 to 3:00 p.m.

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Compensation and benefits
See the "stipend and benefits for resident physicians" web page for more information.

A health-care plan providing for medical, dental, and optical expenses is available to residents without a premium. Eligible dependents can be enrolled for a small monthly fee paid by payroll deduction. Residents are also provided with long-term disability and life-insurance policies.
Child neurology residents may apply for reimbursement for spending on education-related materials and activities, such as book purchases or conference expenses.

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About LLUMC

LLUMCLoma Linda University Medical Center (LLUMC) is a nonprofit, religious health-care corporation with a dedication to providing whole-person care to the community. The medical center is an academic tertiary care facility with approximately 650 beds. The LLU Children's Hospital is a hospital within a hospital that has 244 beds. This includes a 25-bed pediatric ICU, 24-bed intermediate care unit, 68-bed neonatal ICU, and 127 additional beds in five pediatric units (general and subspecialty pediatric medical and subspecialty patients). The Children?s Hospital has a 16-bed emergency department. Inpatients are assigned to one of seven ward teams, including the child neurology ward service. There are 80 full-time pediatric and pediatric subspecialty attending physicians with 60 pediatric residents and 16 med/peds residents. All subspecialties run extremely active services. There are approximately 11,000 pediatric medical and surgical hospital admissions per year. Of these, about 2700 are admissions or subsequent care by the child neurology ward service. Approximately 675 child neurology consultations are performed yearly.

Patients admitted to the child neurology service are referred from many sources to one of several units depending on their age and severity of illness. Patients are admitted directly from the clinics or the emergency room, accepted as transfers from the PICU or from other hospitals, and referred from community physicians. The child neurology ward team cares for 12-20 inpatients admitted either for treatment of specific conditions or for diagnostic evaluation. The consult service evaluates and follows about 75 patients per month from other services with the majority being from the ICUs. Patients are followed after discharge through the attending or resident's outpatient clinics.

The outpatient clinics are located in the faculty medical offices (FMO) directly across the street from the Children's Hospital. The clinic has 10 fully equipped and comfortable examining rooms. Between 600 and 675 outpatients are seen each month in the FMO child neurology clinics. Of these, approximately 120 are new patients. Each attending physician maintains an average of five half-day clinics per week, including specialized behavioral, epilepsy, and muscular dystrophy clinics.

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Application and contact information

Fourth year medical students who are applying for child neurology residency must submit a separate application for pediatric residency through the NRMP as our program does not currently support a combined residency.  The child neurology residency program at Loma Linda University uses the SF Match service to fill its available positions.  In addition to the general requirements listed on their website (http://www.sfmatch.org) we require residents to submit letters of recommendation from their program directors and physicians in practice to submit letters from their employers or hospital chiefs of staff. 

We are more than willing to consider applicants who are international graduates, so long as they have completed ECFMG certification.  Applicants who have questions about their visa status are encouraged to contact Teresa Meinken at our House Staff Office at .

Please direct any other questions regarding child neurology residency training, availability of positions, and application requirements to:

David Michelson, MD
Assistant Professor and Program Director

LLU Child Neurology Residency Program
Loma Linda University Medical Center
11175 Campus Street, CP-A1120G
Loma Linda, California 92354
Phone: (909) 558-3518
Fax: (909) 558-0207
Email:

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