Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors.
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.
Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Matthew S
MS
Robbins
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Carrie E
CE
Robertson
Department of Neurology, Medstar Georgetown University Medical Center, Washington, DC, USA.
Jessica
J
Ailani
Department of Neurology, University of California-San Francisco, San Francisco, CA, USA.
Morris
M
Levin
Department of Neurology and Neurotherapeutics and Ophthalmology, University of Texas Southwestern, Dallas, TX, USA.
Deborah I
DI
Friedman
Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
David W
DW
Dodick
D002983:Clinical Competence; D003406:Credentialing; D006261:Headache / Q000628:therapy*; D006801:Humans; D007396:Internship and Residency; D009462:Neurology / Q000193:education* / Q000379:methods*; D009862:Online Systems; D011795:Surveys and Questionnaires; D014481:United States
botulinum toxin; cluster; headache; migraine; peripheral nerve blocks; residency; tension-type; training; trigger point injections