Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors

Matthew S. Robbins, Carrie E. Robertson, Jessica Ailani, Morris Levin, Deborah I. Friedman, David W. Dodick

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective To survey neurology residency program directors (PDs) on trainee exposure, supervision, and credentialing in procedures widely utilized in headache medicine. Background Clinic-based procedures have assumed a prominent role in headache therapy. Headache fellows obtain procedural competence, but reliance on fellowship-trained neurologists cannot match the population eligible for treatments. The inclusion of educational modules and mechanisms for credentialing trainees pursuing procedural competence in residency curricula at individual programs is not known. Methods A web-based survey of US neurology residency PDs was designed by the American Headache Society (AHS) procedural special interest section in collaboration with AHS and American Academy of Neurology's Headache and Facial Pain section leadership. The survey addressed exposure, training, and credentialing in: (1) onabotulinumtoxinA (onabotA) injections, (2) extracranial peripheral nerve blocks (PNBs), and (3) trigger point injections (TPIs). Results Fifty-five PDs (42.6%) completed the survey. Compared to noncompleters, survey completers were more likely to feature headache fellowships at their institutions (38.2% vs 10.8%, P=0.0002). High exposure (onabotA=90.9%, PNBs=80.0%, TPIs=70.9%) usually featured hands-on patient instruction (66.2%) and lectures (55.7%). Supervised performance rates were high (onabotA=65.5%, PNBs=60.0%, TPIs=52.7%), usually in continuity clinic (60.0%) or headache elective (50.9%). Headache specialists (69.1%) or general neurology (32.7%) faculty most commonly trained residents. Formal credentialing was uncommon (16.4-18.2%), mostly by documenting supervised procedures (25.5%). Only 27.3% of programs permitted trainees to perform procedures independently. Most PDs felt procedural exposure (80.0-90.9%) and competence (50.9-56.4%) by all trainees was important. Conclusions Resident exposure to procedures for headache is high, but credentialing mechanisms, while desired by most PDs, are not generally in place. Implementation of a credentialing process may ensure trainees enter practice with the ability to perform procedures safely and effectively.

Original languageEnglish (US)
Pages (from-to)79-85
Number of pages7
JournalHeadache
Volume56
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Neurology
Internship and Residency
Credentialing
Headache
Medicine
Trigger Points
Nerve Block
Peripheral Nerves
Mental Competency
Injections
Surveys and Questionnaires
Facial Pain
Aptitude
Curriculum
Therapeutics

Keywords

  • botulinum toxin
  • cluster
  • headache
  • migraine
  • peripheral nerve blocks
  • residency
  • tension-type
  • training
  • trigger point injections

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Robbins, M. S., Robertson, C. E., Ailani, J., Levin, M., Friedman, D. I., & Dodick, D. W. (2016). Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors. Headache, 56(1), 79-85. https://doi.org/10.1111/head.12695

Procedural Headache Medicine in Neurology Residency Training : A Survey of US Program Directors. / Robbins, Matthew S.; Robertson, Carrie E.; Ailani, Jessica; Levin, Morris; Friedman, Deborah I.; Dodick, David W.

In: Headache, Vol. 56, No. 1, 01.01.2016, p. 79-85.

Research output: Contribution to journalArticle

Robbins, MS, Robertson, CE, Ailani, J, Levin, M, Friedman, DI & Dodick, DW 2016, 'Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors', Headache, vol. 56, no. 1, pp. 79-85. https://doi.org/10.1111/head.12695
Robbins MS, Robertson CE, Ailani J, Levin M, Friedman DI, Dodick DW. Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors. Headache. 2016 Jan 1;56(1):79-85. https://doi.org/10.1111/head.12695
Robbins, Matthew S. ; Robertson, Carrie E. ; Ailani, Jessica ; Levin, Morris ; Friedman, Deborah I. ; Dodick, David W. / Procedural Headache Medicine in Neurology Residency Training : A Survey of US Program Directors. In: Headache. 2016 ; Vol. 56, No. 1. pp. 79-85.
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abstract = "Objective To survey neurology residency program directors (PDs) on trainee exposure, supervision, and credentialing in procedures widely utilized in headache medicine. Background Clinic-based procedures have assumed a prominent role in headache therapy. Headache fellows obtain procedural competence, but reliance on fellowship-trained neurologists cannot match the population eligible for treatments. The inclusion of educational modules and mechanisms for credentialing trainees pursuing procedural competence in residency curricula at individual programs is not known. Methods A web-based survey of US neurology residency PDs was designed by the American Headache Society (AHS) procedural special interest section in collaboration with AHS and American Academy of Neurology's Headache and Facial Pain section leadership. The survey addressed exposure, training, and credentialing in: (1) onabotulinumtoxinA (onabotA) injections, (2) extracranial peripheral nerve blocks (PNBs), and (3) trigger point injections (TPIs). Results Fifty-five PDs (42.6{\%}) completed the survey. Compared to noncompleters, survey completers were more likely to feature headache fellowships at their institutions (38.2{\%} vs 10.8{\%}, P=0.0002). High exposure (onabotA=90.9{\%}, PNBs=80.0{\%}, TPIs=70.9{\%}) usually featured hands-on patient instruction (66.2{\%}) and lectures (55.7{\%}). Supervised performance rates were high (onabotA=65.5{\%}, PNBs=60.0{\%}, TPIs=52.7{\%}), usually in continuity clinic (60.0{\%}) or headache elective (50.9{\%}). Headache specialists (69.1{\%}) or general neurology (32.7{\%}) faculty most commonly trained residents. Formal credentialing was uncommon (16.4-18.2{\%}), mostly by documenting supervised procedures (25.5{\%}). Only 27.3{\%} of programs permitted trainees to perform procedures independently. Most PDs felt procedural exposure (80.0-90.9{\%}) and competence (50.9-56.4{\%}) by all trainees was important. Conclusions Resident exposure to procedures for headache is high, but credentialing mechanisms, while desired by most PDs, are not generally in place. Implementation of a credentialing process may ensure trainees enter practice with the ability to perform procedures safely and effectively.",
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N2 - Objective To survey neurology residency program directors (PDs) on trainee exposure, supervision, and credentialing in procedures widely utilized in headache medicine. Background Clinic-based procedures have assumed a prominent role in headache therapy. Headache fellows obtain procedural competence, but reliance on fellowship-trained neurologists cannot match the population eligible for treatments. The inclusion of educational modules and mechanisms for credentialing trainees pursuing procedural competence in residency curricula at individual programs is not known. Methods A web-based survey of US neurology residency PDs was designed by the American Headache Society (AHS) procedural special interest section in collaboration with AHS and American Academy of Neurology's Headache and Facial Pain section leadership. The survey addressed exposure, training, and credentialing in: (1) onabotulinumtoxinA (onabotA) injections, (2) extracranial peripheral nerve blocks (PNBs), and (3) trigger point injections (TPIs). Results Fifty-five PDs (42.6%) completed the survey. Compared to noncompleters, survey completers were more likely to feature headache fellowships at their institutions (38.2% vs 10.8%, P=0.0002). High exposure (onabotA=90.9%, PNBs=80.0%, TPIs=70.9%) usually featured hands-on patient instruction (66.2%) and lectures (55.7%). Supervised performance rates were high (onabotA=65.5%, PNBs=60.0%, TPIs=52.7%), usually in continuity clinic (60.0%) or headache elective (50.9%). Headache specialists (69.1%) or general neurology (32.7%) faculty most commonly trained residents. Formal credentialing was uncommon (16.4-18.2%), mostly by documenting supervised procedures (25.5%). Only 27.3% of programs permitted trainees to perform procedures independently. Most PDs felt procedural exposure (80.0-90.9%) and competence (50.9-56.4%) by all trainees was important. Conclusions Resident exposure to procedures for headache is high, but credentialing mechanisms, while desired by most PDs, are not generally in place. Implementation of a credentialing process may ensure trainees enter practice with the ability to perform procedures safely and effectively.

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