Neurology

Overview

The major foci of the clinical activities of the Division of Neurology are epilepsy, stroke, headache, neurometabolic disease, neuromuscular disease, sleep disorders, movement disorders, multiple sclerosis, autism, developmental disorders and functional neuroimaging.

The Division has a Royal College of Physicians & Surgeons of Canada accredited training program in Child Neurology as well as postdoctoral training programs in epilepsy, stroke and developmental paediatrics. The latter is in conjunction with Holland Bloorview Kids Rehab. In addition, there are a number of graduate students and postdoctoral fellows in clinical neurophysiology and molecular and cellular neurobiology.

The research foci of the Division includes epilepsy (both clinical and basic research), magnetoencephalography, stroke, dyslexia, autism, burden of disease and quality of life, attention deficit disorder/hyperactivity, muscular dystrophy, multiple sclerosis, fatty acid oxidation disorders and molecular and cellular neurobiology.

In addition to general Neurology, the focus of our clinical activities are: the medical and surgical management of refractory paediatric epilepsy; the diagnosis and management of paediatric neuromuscular and neurometabolic disease, Multiple Sclerosis in children, paediatric stroke, paediatric headache, and medically complex disabilities including autism. The division provides an approved specialty program in Child Neurology, both three- and five-year programs (Royal College of Physicians and Surgeons of Canada Accredited). In addition, the division has an approved program in clinical neurophysiology training and subspecialty training programs in Paediatric Epilepsy and Paediatric Stroke. The major foci of our research activities fall into the following areas:

Molecular and Cellular Neurobiology;
Epilepsy;
Stroke;
Learning Disabilities;
Attention Deficit Disorder Hyperactivity;
Autism;
Neuroimaging;
Fatty Acid Oxidation Disorders.

Visit sickkids.ca to read more about the Division of Neurology.

The Paediatric Neurology Residency and Fellowship Training Program at The Hospital For Sick Children (SickKids), University of Toronto is a fully accredited program with the Royal College of Physicians and Surgeons of Canada. To date, training is also recognized by the American Board of Neurology and Psychiatry for training in Child Neurology. There are two training tracks - a three-year program with the entrance requirements being two or three years of accredited paediatrics training or a five-year training program with entrance directly from medical school. The program is committed to excellence in training individuals for careers in both academic and community-based practice. The major foci of the clinical activities of the Division of Neurology at The Hospital for Sick Children are epilepsy, stroke, headache, neurometabolic diseases, neuromuscular diseases, sleep disorders, movement disorders, neuroinflammatory disorders, and neonatal neurology.

The Division has fellowship training programs in epilepsy, stroke, neuromuscular disorders, neuroinflammatory disorders, neonatal neurology, and neurocritical care.

Objectives

The program is committed to excellence in training individuals for careers in academic and research-based child neurology and community-based practice. The training program follows the Royal College of Physicians and Surgeons of Canada objectives of training, which are updated regularly.

Training Sites

Primary Site

The Hospital for Sick Children. The Hospital for Sick Children is a 260-bed teaching hospital. The inpatient Pediatric Neurology Unit is shared with neurosurgery in a combined neuroscience unit. There is a large ambulatory and emergency service. A 7-bed epilepsy monitoring unit is part of the inpatient service. There is a large neurophysiology laboratory comprising electroencephalography, evoked potentials and electromyography. Diagnostic capabilities include MRI, MEG, PET, CT and SPECT.

The faculty are affiliated closely with the Program in Neuroscience and Mental Health of the Sickkids Research Institute and the Center for Brain and Mental Health, allowing resident research opportunities in many areas of child neurology.

Secondary Sites

University Health Network; St. Michael's Hospital, Sunnybrook and Women's College Hospital, Holland Bloorview Kids Rehabilitation Hospital, Community Neurology Practices.

Holland Bloorview Kids Rehabilitation Hospital (a long term care facility with a specialty interest in epilepsy management, physical disabilities, neurodevelopmental disorders and neuromuscular conditions) is an affiliated institution. The exposure to adult neurology takes place at St. Michael's Hospital, University Health Network and Sunnybrook Health Sciences Centre.

Trainees are supported by extensive electronic medical resources, including full computer support, full access to the University of Toronto's electronic journal collection and the Epic health information system.

Program Content

5-year Paediatric Neurology Residency Program

The Paediatric Neurology program has launched a Competency by Design based curriculum with the following training experiences.

PGY-1

This year consists of one block of paediatric neurology, one block of paediatric neurosurgery, and 10 blocks of training in general paediatrics (please see rotations outline - Pediatrics Program, University of Toronto). Residents participate in a monthly longitudinal continuity clinic in general paediatric neurology.

PGY-2

This year consists of 5 blocks of general and subspecialty paediatrics, 5 blocks of paediatric neurology, and 3 blocks of adult neurology, which take place at St. Michael's Hospital, University Health Network and Sunnybrook Health Sciences Centre. Residents participate in a twice-monthly longitudinal continuity clinic in general paediatric neurology.

PGY-3 to 5

The PGY 3 through 5 years will complete the requirements for the RCPSC accredited program in Paediatric Neurology. This training consists of rotations in ambulatory and inpatient paediatric neurology services, as well as rotations in epilepsy, electroencephalography, critical care, neuromuscular disorders, developmental paediatrics, neonatal neurology, neuroradiology, neuropathology, stroke, neuroinflammatory disorders and additional rotations in inpatient and ambulatory adult neurology.

Ample elective experiences are available in disciplines such as headache, neuro-ophthalmology, neurogenetics, neurometabolics, and movement disorders. Residents are encouraged to explore elective experiences outside of Toronto, including in global health. Residents follow their own patients longitudinally in a weekly continuity clinic in general paediatric neurology.

3-year Paediatric Neurology Fellowship Program

The three years of training comprise 18 months of General Paediatric Neurology, 6 months of Adult Neurology, and 12 months of training in subspecialties of paediatric neurology or electives as determined in discussion with the program director.

Residents complete 4-5 blocks of inpatient training per year on the Neurohospitalist and Acute Care Neurology teams. Subspecialty rotations include epilepsy, EEG, stroke, neuroinflammatory disorders, neurorehabilitation/neurodevelopment, neuromuscular and neurometabolic disorders, neonatal neurology and ambulatory/community neurology. There are electives offered in neuroradiology, neuropathology, neurosurgery, metabolic genetics and psychiatry, among others. Other electives, including academic electives at other institutions and global health electives, may be arranged in discussion with the program director.

The three-year paediatric neurology training program begun after completion of three years of paediatric training in Canada meets the Royal College of Physicians and Surgeons of Canada requirements for training in Neurology with Special Competence in Child Neurology. Detailed training requirements may be found on the RCPSC website.

Research Experience

The Division, in conjunction with the Program in Neuroscience and Mental Health and the Centre for Brain and Mental Health, supports active clinical and basic science research programs in epilepsy, neurophysiology, stroke, dyslexia, autism, attention deficit disorder/hyperactivity, neuromuscular disorders, neuroinflammatory disorders, fatty acid oxidation disorders, neurocritical care, neonatal neurology and molecular and cellular neurobiology.

Trainees are required to pursue research projects throughout their training, which is supported by protected time, formal research mentorship and an annual research skills course. Trainees are expected to present their work at our annual Prichard research day. Residents are encouraged to attend scientific meetings, including the Canadian Congress of Neurological Sciences, the Child Neurology Society and the American Academy of Neurology. Funding is available to assist with travel. Residents are also encouraged throughout their training to begin to learn the process of writing research grants and there is assistance for this activity through the Research Institute.

Evaluation

Evaluation of trainees accomplished through frequent work-based assessments combined with feedback and coaching, and summative end of rotation evaluations. In training, examinations are also organized to provide formative assessment and feedback to suggest areas for further study: regularly observed history and physical examinations, an annual practice OSCE, a biannual paediatric neurology core curriculum exam, the American Academy of Neurology annual Residency In-Training Exam, the annual Canadian paediatric neurology NITECap exam.

Ways To Get Involved

Residents and Fellows are encouraged to participate in a variety of leadership activities throughout their training, including our Wellness Committee, and Core Curriculum committee. Both residents and fellows have standing representation on the Residency Program Committee. Trainees are encouraged to participate in patient advocacy activities (e.g. Purple Day for Epilepsy), and in nurturing interest among medical students through the U of T Student Interest Group in Neurology.

Additional Educational Opportunities

All trainees benefit from an extensive curriculum in paediatric neurology with dedicated teaching rounds on Wednesday and Thursday mornings. A weekly academic half-day in the principles of neurology is organized in conjunction with the adult neurology training program at the University of Toronto. University of Toronto Residents entering PGY1 are required to complete the web-based PGCorEd* core competency modules as part of their residency program certification. These modules provide the foundation for the non-Medical Expert roles for the Royal College of Physician and Surgeons of Canada Specialty Programs.

The hospital is enriched by an association with the Hospital For Sick Children Research Institute and activities with the basic neuroscientists include regular combined rounds and seminars. There is also an activity with the other clinical neurology groups at the hospital including the neurosurgeons and neuroradiologists with weekly rounds. There is a wealth of educational opportunities including weekly lectures in a paediatric neurology core curriculum, a weekly academic half-day shared with adult neurology program, weekly paediatric neurology and paediatric grand rounds, clinical neuropathological conferences, weekly EEG seminars, a weekly seizure conference, weekly neurovascular and neuroinflammatory rounds, weekly neuroradiology teaching seminars, monthly journal clubs, and many others.

Applying To The Program

We accept trainees via the CaRMS R-1 match into our 5-year residency program and via the CaRMS paediatric subspecialty match into our 3-year program.

We also accept a limited number of international self-funded paediatricians into our 3-year paediatric neurology fellowship training program.

Elective Opportunities

Elective students will join the Acute Care Neurology and/or Neurohospitalist teams, where they will participate in the care of infants and children with a wide range neurological disorders admitted to inpatient wards and the neonatal, paediatric and cardiac intensive care units. Time permitting, students will also participate in general and subspecialty neurology clinics, where they will become familiar with the diagnosis and outpatient management of infants and children with a wide range of neurological and neurodevelopmental disorders. Frequent coaching by neurology residents, fellows and faculty will enable students to develop their skills in neurologic history taking, physical examination, localization and differential diagnosis.

The training program also offers postgraduate subspecialty electives in EEG, Neuromuscular Disorders, Epilepsy, Neonatal Neurology, and Neuroinflammatory Disorders.

Observership Opportunities

Observers are identified as individuals who have no direct patient contact and do not have direct access to medical records. They have no medical responsibilities and are not licensed to provide patient care in our institution. They are distinct from elective students and residents who can perform the above functions and have direct access to patient information and direct interaction with patients and families.

We are only able to accept observers who:

are being considered for a residency or fellowship program in Neurology at SickKids
are trainees registered in foreign medical programs or;
are sponsored by an individual faculty member who assumes responsibility for direct mentorship of the observer in their own clinical program.