Dr. Dara Albert talks with Dr. Bruce Cohen about the future of child neurology residency training, exploring current models, consensus areas, and challenges in evolving the curriculum to meet future healthcare needs.

Read the related article in Neurology® Education.

Disclosures can be found at Neurology.org. 

Podcast Transcript: 

Dr. Jose Merino: This is Jose Merino, editor-in-chief of the Neurology Family of Journals. The Neurology Podcast provides practical information to neurologists and other clinicians to help them provide better care for their patients. Thanks for listening and have a great week.

Dr. Dara Albert talks with Dr. Bruce Cohen: Hi, this is Dara Albert from Nationwide Children’s Hospital and Ohio State University. I am delighted to be joined today by fellow Ohioan, Bruce Cohen, a child neurologist at Akron Children’s Hospital and an expert in the care of children and adults with mitochondrial disorders. Bruce is the lead author of a paper published in June 2026 called Education Research: The Future of Child Neurology Residency Training: The Perspective of a Child Neurology Society Task Force. Child neurology occupies this unique space at the intersection between pediatrics and adult neurology and pediatric neurology. And really there are a few topics in our field that generate as much discussion amongst child neurologists as how we should train the next generation. You get 10 child neurologists in the room, maybe there’s 15 different opinions on how we should do this. Recognizing that there’s a lot of evolution in our field, the Child Neurology Society, or CNS as I’m going to refer to it, assembled a task force to explore whether the current training models continue to meet the needs of our trainees, practicing physicians, and the patients that they serve. And we’re going to talk about the results of that task force and what was published in the paper. Before we dive into that though, I do want to note that Bruce is joining us today as a representative of the task force and its findings. And while he contributed to this work, the perspectives and recommendations outlined in the paper are going to reflect the collective views of the task force and may not always fully align with his individual opinions. So Bruce, welcome to the podcast.

Dr. Bruce Cohen: Thanks. It’s great to be here.

Dr. Dara Albert talks with Dr. Bruce Cohen: Absolutely. Let’s start with a little history. Many may not be as familiar with how child neurology training developed in the United States. Can you tell us a little bit more about the current training model, how it came to be, and how it has evolved over the decades?

Dr. Bruce Cohen: The current training model is about 50 years old. 50 years ago, there was no CAT scans or MRI scans or genetic testing. We had pneumoencephalograms. So there really have been major changes in the last 50 years in how we take care of children with neurological problems and how we treat them. And one would expect that the training needs would change as well over that timeframe. So here we are today to discuss the differences of opinions among my colleagues.

Dr. Dara Albert talks with Dr. Bruce Cohen: It’s hard to imagine doing an encephalogram these days. We’ve come a long way from that.

Dr. Bruce Cohen: Well, it just shows my age. I remember taking tours of medical school, seeing the pneumoencephalogram suite. It was still up and running when I was in training. It doesn’t seem that long ago. It was in the 1980s, but they still had the chair.

Dr. Dara Albert talks with Dr. Bruce Cohen: Wow. Why did the Child Neurology Society or CNS feel that this task force was needed at this particular moment? What questions or challenges were you hoping to address?

Dr. Bruce Cohen: So we know the ACGME is going to go on their 10-year cycle and look into the training requirements of child neurology in 2027. They’re getting set up to do that. And it was just seemingly an appropriate time at the end of my term as president of the Child Neurology Society, which ended in 2023 to set up this task force just to see what we could contribute to the body of knowledge and the differences of opinions. I didn’t really expect us to reach a consensus when we set up this task force, but I just wanted to lay out the differences of opinions that are out there.

Dr. Dara Albert talks with Dr. Bruce Cohen: Yes. And we will definitely get into the opinions that came up as part of this task force. But before we talk about that, one of the strengths of this effort was the attempt to bring together a variety of perspectives. Can you walk us through how the task force was assembled, how you approached building consensus around these complex issues during discussions?

Dr. Bruce Cohen: So the task force was assembled over a period of a month or so. I don’t think I lost any friends by not asking them to join the task force, but I certainly got a lot of calls asking me why I didn’t appoint them to the task force. But we started out with nine task force members that were mainly people that have dedicated their lives to education of child neurologists or have been some authoritative positions in the field of child neurology. But we needed to balance those appointed members of the task force with younger and more diverse group of individuals, some right out of training. We also tried to get people who practice mainly in a private practice environment. We didn’t really succeed on that in terms of balancing that aspect of the membership, but we basically asked for volunteers and we got 65 applications or four additional members of the task force. We did have some diversity. Nine were female, 10 were white, 12 had US board certifications through the American Board of Psychiatry and Neurology. And initial certification ranging from 1988 to 2022, one was certified through the Royal College of Physicians and Surgeons of Canada. In the meantime, since the initial certification was 14 years with a range of two to 36 years, 12 members were currently clinically active in academic or hospital-based practices. So we did have a bit of diversity. We didn’t get the private practice applicants that we hoped to have gotten. And so we may have missed a bit in terms of what those opinions may have been. We also had some diversity among the sub-subspecialty education of the members. We had one person trained in developmental disabilities, three trained in epilepsy neurophysiology, one in neuromuscular neurology. And again, the majority having held positions of authority within the child neurology, either child neurology training or child neurology national administration as officers in the CNS or AAN child neurology section. Eight of the members either currently or formally were residency program directors.

Dr. Dara Albert talks with Dr. Bruce Cohen: Seems like a nice slice through a lot of different aspects of our field, although as you mentioned, not as much in private practice, but otherwise a good diversity of experience and time out from training and all of that. That’s awesome. So it seems from reading the paper that the task force met and had discussions around these topics and tried to form consensus, identify lack of consensus around a lot of topics related to child neurology training. So I’m curious, where did the task force find the strongest consensus or areas of agreement and where were the opinions most divided?

Dr. Bruce Cohen: Going back a little bit to maybe your first question is how are child neurologists trained in the first place? The majority of child neurologists enter a two and sometimes three year pediatric training program, but currently the majority have two years of general pediatrics followed by a three-year neurology residency. We sometimes refer to this as our neurology fellowship, but it’s really a residency. That neurology residency is classically one year of adult neurology and two years of child neurology with the electives divvied up between both specialties. And at the end of this five-year training track, which majority of people go through, we call it the two plus three program, allows one to sit for the general pediatric boards as well as their neurology boards. And the certificate awarded to a child neurologist trained in this fashion is neurology with special qualifications in child neurology. And that ostensibly allows us to take care of patients of any age with neurologic problems. Of course, one shouldn’t venture into taking care of patients that one doesn’t have experience taking care of. And certainly child neurology has changed over the course of the years. 50 years ago, neonatal neurology was pretty much non-existent and probably consisted of children born 26 to 28 weeks gestation and older. And of course now neonatal neurology is blended into topics that are covered in fetal neurology, something that I have no training in doing. I didn’t do it when I trained 40 some odd years ago and I certainly haven’t picked that up any time along the way. I would also say that I would never take on patients with adult onset multiple sclerosis. The training I had back when I was in residency was intrathecal steroids and we’ve come a long way since then. So there’s a constant learning curve on what we should be doing and what we’re boarded to do. There’s two issues of non-consensus. One is how long the training program should be in the first place. And the second is do we really need that whole year of adult neurology? So the strongest consensus has to do with the definition of what a neurologist is. We’re on solid footing in that regard. We need structured programs both in terms of didactic activities and the residents must be provided protected time to participate in these core didactic activities. So issues like that we all agreed upon with almost unanimity as we discuss these areas. We also agree that residents must attend a longitudinal continuity clinic at least one half day a week throughout the duration of the program. Something that really didn’t exist 50 years ago was a topic of neurogenetics and that we needed to have a ramped up education in neurogenetics and it be mandatory part of our training. And although not available at all training sites, new therapies including molecular therapies that would include but not limited to gene therapy should be at least part of the didactic training, if not part of the actual hands-on training. So we really had a lot of areas of consensus.

Dr. Dara Albert talks with Dr. Bruce Cohen: So one of the biggest takeaways for me in reading the paper is that the task force could not really reach consensus on what to do with the adult neurology and the general pediatrics components of training. Why do you think these questions remain so difficult for our field to answer?

Dr. Bruce Cohen: When I look back at my old textbooks of pediatrics and my old textbooks of neurology, they were thin. There wasn’t a whole lot in them and now they’re thick and two volumes, some of them. The last edition of Swaiman’s weighs about as much as a bowling ball. I’m referring to Swaiman’s Textbook of Pediatric Neurology. There’s a lot more to learn in these two plus three years or one plus three years or however we’re going to do it. And one of the questions being raised, is it time to give up that full year of adult neurology so we can squeeze more into our 36-month training program of neurology? And again, that’s been an area of non-consensus ever since I started having this discussion back probably about 15 years ago.

Dr. Dara Albert talks with Dr. Bruce Cohen: Yes. I likewise have had many conversations with colleagues over the few years I’ve been a child neurologist and that seems to be an area of a lot of disagreement. So a challenging question to answer, but it is quite remarkable how much we have grown and expanded and learned as a field such that like you gave the example of the textbook being really small when you were in training and now we’re in these big giant multi-volume textbooks. That’s so true. I’m curious, was there a perspective or argument raised during the discussion that changed your thinking or at least maybe challenged some of your assumptions about this topic?

Dr. Bruce Cohen: It certainly opened up my mind. Again, some of the people I chose to be on this task force I knew would disagree with my own personal opinions about this. And I chose them because the purpose of the task force is to lay all the issues out on the table so that the RRC can deliberate and come up with what’s going to be best for the field. 50 years ago, we really didn’t think about how much debt a resident would land themselves into after four years of college and four years of medical school and being paid a salary that would likely be considered a poverty salary if that resident had a small family. And one of the questions is that if you can train an adult neurologist in four years, one year of adult general medicine, three years of neurology, can you train a pediatric neurologist in four years, one year of pediatrics, three years of pediatric neurology? So that was one issue that came up. And just the finances of that is daunting. The other question is would we improve our labor force of child neurologists if we cut a year of training out? And then of course, no one’s really done that and the question that arises, is it safe to do this? And we talked about that as well.

Dr. Dara Albert talks with Dr. Bruce Cohen: Like safe for our patients.

Dr. Bruce Cohen: Safe for our patients. Safe for us too. There were some members of the task force thought that it really took five years of post-graduate maturity and training to become a fully trained child neurologist, the two plus three model, but you could also tiptoe into what about a one plus four model if you’re going to do that? And of course, I don’t think once we create a one plus three model, my own personal opinion is that there’s no stepping back on going back to a two plus three model if we chose to go to the one plus four.

Dr. Dara Albert talks with Dr. Bruce Cohen: Yeah, sure. If we shorten training, it’s going to be hard to lengthen it again after that change has been made for sure. Yeah, lots to consider. And yeah, the student debt is not an insignificant factor at this point in time, unfortunately. What do you see as the most important next step for our field? Who else needs to be involved in this conversation and what other perspectives might we be missing?

Dr. Bruce Cohen: We need the perspective of the American Board of Pediatrics and the RRC of general pediatrics because we’ve been part of their first two years of training for a half a century and to pull back unilaterally saying we’re changing our training to a one plus three model or a one plus four model or whatever without consulting the pediatricians would be not taken well. About half of us work in departments of neurology and half of us work in departments of pediatrics. And it varies between hospital and university, the university as to where pediatric neurology lands. And it’s not an insignificant portion of the patients either that are being cared for. And so if you’re in the department of pediatrics and all of a sudden you’re changing the training of the labor force that will be taking care of these children, we may have something to say about it.

Dr. Dara Albert talks with Dr. Bruce Cohen: Yeah. Gosh, there are just so many perspectives to think about. This is such a complex issue and lots of potential downstream consequences to any decision that might come out of this review, even if that decision is to keep things the way they are. Throughout this process, the task force spent considerable amount of time thinking about the future of our specialty. So looking ahead 10 years, what do you think the task force would consider an ideal outcome for child neurology training and how would we know if we’ve achieved it?

Dr. Bruce Cohen: The most important thing is that we have a labor force that can take care of the children, the newborns, the pre-borns, and be able to do so not only in big cities like Northeast Ohio or Columbus, Ohio, but in the tiny towns. Ohio’s an interesting state because it’s really got a lot of pediatric neurology going on in it, but there are lots of states without pediatric neurologists. There are certainly not enough pediatric neurologists to take care of the kids. So how do we make sure that those children get taken care of? So anything that we do, we really need to think about putting boots on the ground so that we can deliver the care that we need to be able to deliver. So that would be one measure of success for sure. Being able to build our numbers up, I think would be another measure of success. Child neurology has done a great job, especially compared with what’s going on in some of the subspecialty fields of pediatrics that are really having difficulty with creating a stable labor force. So we’ve done a really nice job, but we certainly could do better. And being able to attract more students into the residency programs I think would be another measure of success.

Dr. Dara Albert talks with Dr. Bruce Cohen: Another thing that I’ve heard in talking with colleagues about this topic, about what the future of residency could look like is maybe allowing some flexibility for individual programs to tailor training to what makes the most sense at their institution or for their trainees. Did the task force address this question? And if not, do you have an opinion on this question?

Dr. Bruce Cohen: In some respects, programs are already doing this. At our hospital, for example, we’re now defining pediatrics up to the age of 26. Where pediatrics ends and adults begin is now becoming more of an economic and political debate more than we think about adulthood beginning at 16 or at 18. To some extent, training programs are already taking some leeway, the program requirements. I don’t think the programs are overstepping their bounds. For a program to differ or make themselves different, there would have to be agreement amongst the child neurology core of trainers and the adult neurology core of trainers. You’d have to get the programs to agree internally to make any changes. There are some members of the task force that are pushing for this within their own programs. And so that’s one possible solution is to let the programs have a little more flexibility on how much adult training would be required. The bigger issue about how many years does it take to train a child neurologist, that’s going to have to be something decided on a national level.

Dr. Dara Albert talks with Dr. Bruce Cohen: To some extent, the flexibility also needs to be decided on a national level, just in the sense that we don’t want to give programs the opportunity to change their training such that their graduates would not be board eligible, for example. So we need the boards and the governing body, the ACGME, to allow for that flexibility with retained board eligibility at the end of it.

Dr. Bruce Cohen: I personally think the most important or if not one of the most important aspects is the training certificate that says I’m boarded in neurology with special qualifications in child neurology. I really personally would not want to see that certificate type disappear.

Dr. Dara Albert talks with Dr. Bruce Cohen: Yeah. So if program A decided they wanted to do less than 12 months of adult neurology, but the ABPN, the American Board of Psychiatry and Neurology said, «Nope, you wouldn’t get that certificate at the end of it,» then that flexibility isn’t really supported. So there needs to be that conversation with the governing bodies as well.

Dr. Bruce Cohen: Yeah. And I guess one of the questions would be, could we define how you spend your month? If you’re going to do, let’s say a two-month stroke rotation, can you get both adult and pediatric credit if the ratio of patients, adults and kids fits the bill?

Dr. Dara Albert talks with Dr. Bruce Cohen: Sure. Yeah.

Dr. Bruce Cohen: Same thing with neurophysiology. How many adult EEGs versus child EEGs do you interpret over the course of that one to three month training period?

Dr. Dara Albert talks with Dr. Bruce Cohen: Yes. There are so many facets. It’s so complicated to think about all of the things that go into training and where are the areas where we can be flexible and where are the areas where we can’t? It’s just interesting to think about, but I am optimistic for the future that we’re having this conversation, that the CNS is behind that you assembled this task force to have these discussions, and hopefully we can move forward as a field together with something that makes sense.

Dr. Bruce Cohen: I think what we both would agree upon is that this is the best time to be a child neurologist.

Dr. Dara Albert talks with Dr. Bruce Cohen: Absolutely. It’s a great field. Thank you so much, Bruce. I’ve been speaking with Bruce Cohen from Akron Children’s Hospital and lead author on a paper published in June 2026 in neurology education titled Education Research: The Future of Child Neurology Residency Training: The Perspectives of a Child Neurology Society Task Force. Thank you, Bruce, so much for your time and your insights into this important topic.

Dr. Bruce Cohen: Thank you.

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