Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA.
Department of Neurology, Hofstra North Shore LIJ Medical Center, Pain and Headache Center, Cushing Neuroscience Institute, Manhasset, NY, USA.
Headache. 2018 Jan;58(1):102-108. doi: 10.1111/head.13186. Epub 2017 Sep 21.
Headache disorders are exceedingly common, debilitating neurological conditions, and there is a striking paucity of headache specialists nationally. However, headache education is underrepresented in the curriculum of neurology residency programs and few neurology residents elect to pursue headache medicine fellowships. We aimed to explore the possibility that a low degree of headache interest among neurology department chairs and residency program directors (PDs) underlies this mismatch.
We performed a cross-sectional analysis of chairs and PDs associated with ACGME neurology residency programs. Data sources included the ACGME program list, faculty profiles on institutional webpages, Doximity profiles, the American Headache Society (AHS) membership directory, and the roster of United Council for Neurologic Specialties (UCNS) headache diplomates. A headache interest was deemed to be present with the presence of a declared headache or concussion interest, completion of a headache fellowship, active AHS membership, or UCNS certification.
Our review included 137 residency programs comprising 127 department chairs, 132 PDs, and 5 faculty who were both chairs and PDs. Of all faculty, 62 (23.5%) were women. Headache expertise was declared by 10 (7.6%) chairs and 13 (9.5%) PDs. Headache fellowship training was pursued by 1 (0.8%) chair and 5 (3.6%) PDs, and among all faculty was the 10th most common subspecialty fellowship pursued. Three (2.3%) chairs and 7 (5.1%) PDs were AHS members. Seven (5.3%) chairs and 10 (7.3%) PDs were UCNS headache certified. An overall headache interest was present in 29 (11.0%) faculty, including 14 (10.6%) chairs and 15 (10.9%) PDs. A graduate degree aside from an MD (eg, PhD, MPH) was more likely to be achieved in faculty without a headache interest (29.4%) than faculty with a headache interest (6.9%, P = .0076). Residency programs where either the chair or PD had a headache interest were just as likely to feature a UCNS headache fellowship program than programs without chair or PD headache interest (25.0 vs 23.0%, P = .83).
Current neurology department chairs and residency PDs have low rates of headache interest, which may influence the emphasis of headache education in neurology training. Headache interest is associated with lower rates of other graduate degrees, and future analysis should examine if academic faculty interested in headache are less likely to be in leadership positions because of a lack of research funding, opportunities, or accomplishments.
头痛障碍是非常常见的使人虚弱的神经疾病，全国范围内头痛专家明显短缺。然而，头痛教育在神经病学住院医师培训课程中代表性不足，很少有神经病学住院医师选择从事头痛医学研究员培训。我们旨在探讨头痛兴趣程度低是否是神经科主任和住院医师培训计划主任（PD）之间不匹配的原因。
我们对与 ACGME 神经病学住院医师培训计划相关的主任和 PD 进行了横断面分析。数据来源包括 ACGME 计划清单、机构网页上的教师资料、Doximity 资料、美国头痛协会（AHS）会员名录以及联合神经病学专业委员会（UCNS）头痛认证人员名单。如果存在宣布的头痛或脑震荡兴趣、完成头痛研究员培训、积极的 AHS 会员资格或 UCNS 认证，则认为存在头痛兴趣。
我们的审查包括 137 个住院医师培训计划，涉及 127 名主任、132 名 PD 和 5 名既是主任又是 PD 的教师。所有教师中，有 62 名（23.5%）为女性。有 10 名（7.6%）主任和 13 名（9.5%）PD 宣布了头痛专业知识。有 1 名（0.8%）主任和 5 名（3.6%）PD 接受了头痛研究员培训，这是所有教师中第十大最常见的专业研究员培训。有 3 名（2.3%）主任和 7 名（5.1%）PD 是 AHS 会员。有 7 名（5.3%）主任和 10 名（7.3%）PD 是 UCNS 头痛认证医师。有 29 名（11.0%）教师表现出整体头痛兴趣，包括 14 名（10.6%）主任和 15 名（10.9%）PD。与具有头痛兴趣的教师（6.9%，P=0.0076）相比，没有头痛兴趣的教师更有可能获得医学博士以外的研究生学位（例如博士、公共卫生硕士）（29.4%）。有头痛兴趣的主任或 PD 的住院医师培训计划与没有主任或 PD 头痛兴趣的培训计划一样，同样可能具有 UCNS 头痛研究员培训计划（25.0%比 23.0%，P=0.83）。
目前的神经科主任和住院医师 PD 对头痛的兴趣较低，这可能会影响头痛教育在神经病学培训中的重点。头痛兴趣与其他研究生学位的较低比例相关，未来的分析应该检查对头痛感兴趣的学术教师是否因为缺乏研究资金、机会或成果而不太可能担任领导职务。
