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.

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修改后的 Delphi 研究以建立关于儿童神经病学住院医师教育的共识：下一代培训。


背景和目标 诊断和治疗的快速进步正在改变儿童神经病学的实践，但儿童神经病学培训要求的变化要慢得多。以前的文献证实了对现代化的强烈支持，但关于维持或更改培训尚无正式共识。我们旨在使用改进的 Delphi 流程就最佳培训路径和要求达成整体共识。方法 作者邀请了 48 位儿童神经学家作为小组成员，有意选择代表在美国执业的儿童神经学家的不同地理、实践类型、亚专业和其他人口统计数据。小组成员参与了一项匿名修改后的 Delphi 研究，该研究进行了 4 轮评估，评估了有关当前培训要求、核心轮换持续时间和强制性亚专业轮换的陈述，并可选择同意或不同意。声明源自当前研究生医学教育认证委员会、美国精神病学和神经病学委员会以及美国儿科委员会对儿童神经病学培训和近期文献的要求。未达到预定义共识水平的陈述（在 7 分李克特量表上 ≥75% 的同意或不同意）将被重新查询或修改以进行后续轮次。小组成员可以访问所有以前的匿名结果和评论。最终修改在第 4 轮中作为综合培训提案提出。结果 27 名小组成员同意参加，其中大多数人完成了所有 4 轮比赛。在第 1 轮中，对 118 个项目中的 45 个 （38%） 达成共识;第 2 轮，87 人中的 28 人 （32%）;第 3 轮，25 人中的 16 人 （64%）;第 4 轮，1 选 1 中 （100%）。 关于实践的年龄范围和应该要求的某些亚专业达成了共识，但对基于时间的要求没有初步共识。到第 4 轮，对以下轮换月份达成共识：新生儿和儿科重症监护 - 4、青少年医学 - 0.5、急诊医学 - 1.5、住院儿科 3、门诊儿科 - 3.5、住院儿童神经病学 9.5、门诊儿童神经病学 6、住院成人神经病学 - 3、门诊成人神经病学 2、遗传学 2、脑电图/神经生理学 2、神经影像学 1、儿童精神病学 1 和选修课 7.5。共识时间表包括总共 46.5 个月的需求。讨论 这项研究表明，尽管儿童神经学家普遍存在不同观点，但多元化的小组可以通过多轮 Delphi 过程，就儿童神经病学培训结构和认证要求的许多核心特征达成共识。