Advanced Training

Supervising Committee

Advanced Training Committee (Neurology).

Definition of Specialty

Neurology encompasses the science, investigation and treatment of all inherited and acquired diseases affecting the nervous and neuromuscular systems.

General Principles of Training

1. The duration of advanced training in neurology is three years. The three-year training will usually be completed within a six-year period, allowing for interruptions to training, part-time training and mid-training research. Of the three years, a maximum of 12 months of either research in neuroscience or of an elective subspecialty of neuroscience may be accredited (non-core training). While useful research may be readily accomplished in 12 months, many trainees will spend a longer period of time in such pursuits. A minimum of 12 months core training will usually be full-time.
   
2. Emphasis will be given to the management of inpatients, outpatients, on-call emergency neurology and exposure to neuropathology, neurophysiology and neuroimaging.
   
3. Training in more than one site is encouraged, and unless there are exceptional circumstances all training at one site will not be approved.
   
4. Post FRACP training (FRACP already obtained in another speciality) has the same requirements of two core years and one non-core year.

Components of Training

Core training
Core training
The period of core training is 24 months. Within this time the following minimum requirements must be achieved:

• 18 months full-time (or equivalent part-time) direct responsibility for emergency assessment and inpatient care of general neurology patients.
  
  
• 12 months on-call for neurological emergencies.
  
  
• 12 months of neurology consultations within a general hospital.
  
  
• 24 months of neurology ambulatory care at a minimum of one clinic per week or the equivalent number over a shorter duration.
  
  
• Exposure to:
  
  • Neuroimaging (including one neuroradiologist conducting weekly review period over two years).
  • Neuropathology (one neuropathologist teaching period per month for two years, or attendance at two neuropathology teaching courses, e.g. University of Sydney Postgraduate Neuropathology Course).
  • Neurorehabilitation (one period per week for six months preferably at an approved rehabilitation facility or involvement in rehabilitation activities in a general hospital).
    
    
• Neurophysiology training may be completed during the third year of training even if it is a non-core year of training.
  
  
• Subspeciality training may include neurogenetics, neuroophthalmology, paediatric neurology, neurootology, neuromuscular, behavioural neurology, stroke, epilepsy, movement disorders and neuroimmunology and is generally obtained during the second or third year. This training may be gained by attendance at appropriate clinics, ward service, clinical meetings and seminars, during either the core training years or a non-core year.

Procedural Skills
Neurophysiology training will comprise a minimum 4 hours per week for 24 months or an equivalent total over a shorter period of time but not less than three months, in an accredited laboratory during which time it is expected that at least 300 EEGs and 250 EMG studies will be reported with a supervisor with all studies logged. 150 of the EMG studies are to be done ‘hands on’ by the trainee under supervision. The logbooks are required to record the extent of the experience during the course of training. The supervisors will use these logbooks to formulate the annual report and the ATC may review these logs. Each trainee must attend the annual ANZAN EEG & ANZAN EMG workshops at least once during advanced training.

Non-core Training (Elective)
This need not be directly related to clinical neurology but must be related to the neurosciences. The principal aims are to enable trainees to develop ability for critical appraisal of specific research and publications and to promote research within the neurosciences by clinicians. The non-core training also allows for development of more experience in a particular subspecialty area of clinical neurology.

Other Specific Requirements

• Two neurologists from each training institution and a supervisor in clinical neurophysiology will be required to sign the supervisor's report. Each will review the neurophysiology logbook.
  
• The extent of subspecialty exposure will be specifically documented on the supervisor's report.
  
• During the training program and prior to gaining the FRACP, the trainee will attend at least two ANZAN scientific meetings or international equivalents and two other Australasian or international meetings which may be general or specialty, open or training. Attendance at scientific and educational conferences will be documented in the supervisor's report.
  
• Advanced trainees are required to sit the American Academy of Neurology Residency Inservice Training Examination (RITE). This is a formative examination to be taken in February at the start of the second core year of advanced training. The results will only be available to the trainee and the trainee’s supervisors to enable both to assess the level of knowledge and training of the trainee and identify deficiencies that can be addressed during the training year. Each trainee is also expected to conduct three mini-CEX encounters with their supervisor during each year of core training.

Research

Research should be within the neurosciences and enable the trainee to develop an ability for critical appraisal of scientific research and publications. The trainee should be encouraged to undertake a research project in either clinical or basic neuroscience research during their core training years.

Training Posts
Institutions suitable for approved advanced training will satisfy minimum criteria. The suitability of institutions for approved training is undertaken by ANZAN. Applicants should confirm with the ANZAN Secretariat, that the post is an approved core training post.

It is envisaged that some institutions will satisfy all the requirements for an advanced trainee post on site but others may have to make arrangements with institutions and departments in geographical proximity to do so.

Training in Regional or Rural Centres
The ATC in Neurology supports trainees who seek to undertake part of their training in regional or large rural centres. Such training would be suitable for the non-core clinical (elective) year of advanced training. The coordinator of the ATC is prepared to advise individual trainees on request of the opportunities available in particular centres.

Retrospective accreditation of Training

Applications for retrospective accreditation of neurology training conducted after the trainee has met the basic training requirements of the RACP (36 months of approved basic training and success in the Part 1 exam) will only be considered by the Neurology ATC after an advanced trainee successfully completes 12 months core training in Neurology. The eligibility rules are covered in the RACP Recognition of Prior Learning Policy, which is available on the RACP website, (http://www.racp.edu.au/page/education-policies).

Retrospective approval will only be considered by the ATC for an elective period of training. There is no retrospective approval of core training.

Further Information

Special Society
Australian & New Zealand Association of Neurologists (ANZAN).
For information regarding the registration with the association, please contact:

The Secretariat
Australian & New Zealand Association of Neurologists
145 Macquarie Street
SYDNEY NSW 2000
Tel: 02 9256 5443
Fax: 02 9241 4083
E-mail: anzan@anzan.org.au
Website: www.anzan.org.au