The training & organisation of paediatric neurology in Europe

Twenty-five years ago, during my Paediatric Neurology training one of my friends, an adult general physician, told me a story from his daily medical meeting. A specialist from a London teaching hospital had been consulted by the district hospital where my friend worked to give an opinion on appropriateness of long-term ventilatory support for a severely neurologically impaired child. The London specialist was a paediatric neurologist. None of my friend's colleagues had heard of the specialty and he had to convince them that he knew someone training in the discipline, and that the position of paediatric neurologist was a reality not a myth.

The European Paediatric Neurology society (EPNS) now has in excess of 1600 members with almost 2000 delegates attending the last biennial congress in Athens. Dana Craiu, Coriene Catsman-Berrevoets and colleagues describe the origins of the discipline, how it has grown and developed in the last half century and the current organisation and training in Europe []. That our specialty continues to grow and thrive is related to the rapid advances in neuroscience since the 1950s from the understanding of the action potential to neuroimaging and genomic technologies, all contributing to our ability to understand, diagnose and treat neurological disease. Paediatric Neurology developed from both neurology and paediatrics as it became clear that the range and complexity of diseases of the developing nervous system required detailed knowledge of both. Craiu et al. describe these as our “mother” specialties. Close relationships with our mother specialties continue to be key to successful training. Most paediatric neurologists in Europe begin their training in paediatrics but the path may also begin in adult neurology and in some countries there is direct entry into a paediatric neurology programme. Different routes to training can be a strength as they bring complementary perspectives to the specialty however it is important that general standards are set and the EPNS has developed a syllabus which has been approved by the Union of European Medical Specialties and has proved important in shaping training throughout Europe.

The authors of this paper are members of the EPNS Training & Education Committee and the Committee of National Advisors (CNA), a group representing the national paediatric neurology societies. The EPNS provides a forum for voices from every country to be heard and through visits by the Training Advisory Board (TAB) supports national societies in developing their training programmes. It is important that whilst meeting general standards of the syllabus that training reflects the needs of the society in which the physician will work.

The paper should act as a reference for those countries where paediatric neurology is still not recognised as a specialty and for those in which there are challenges to training. These challenges are real and present, and some were not imagined by the authors when they wrote the paper. Challenges to recruitment in paediatrics and the perceived needs of health services to have what they term a “flexible and agile” more generic workforce threaten the duration and quality of specialty training. There is a clear tension between these forces and the rapid developments in neuroscience with technological advances in neurorehabilitation, metabolomics, neuroimmunology and neurogenetics where the paediatric neurologist will be the gatekeeper to novel and highly expensive treatments. The Covid-19 pandemic and its impact on delivery of medical services has inevitably affected training and education and it is essential that imaginative solutions are developed. Our greatest allies in developing and maintaining training standards will be the families, children and young people we serve.