Section on Neurological Surgery of the American Academy of Pediatrics

Joseph Piatt, MD

Oct. 3, 2007

The mission of the Section on Neurological Surgery, SONS, of the American Academy of Pediatrics, AAP, includes education of parents, pediatricians, and pediatric subspecialists about conditions that require neurosurgical care, improvement in the quality of neurosurgical services for children, and advocacy for children in society.

Education
At the 2007 National Conference and Exhibition, NCE in San Francisco, the SONS sponsored the following offerings:

• Neurosurgical Lumps, Bumps, Pocks and Divots -- a selected short subject presented by Nathan Selden, MD, PhD
  
  
• Incontinence: Urologic or Neurologic? What About the Tethered Cord Syndrome? -- a seminar presented by Nathan Selden, MD, PhD, and Steven Skoog, MD

The following proposals have been accepted for the 2008 NCE in Boston:

• Lifting the Burden of CSF Shunts: Endoscopic Surgery in the Management of Hydrocephalus -- a plenary session presentation by Liliana Goumnerova, MD
  
  
• The Chiari Malformation: What Does It Mean? -- a selected short subject to be presented by Edward Smith, MD

The 2009 NCE will be held in Washington, D.C. The NCE Planning Group places a high priority on minimization of travel expenses, so members of the SONS living within car or train travel of the conference who are interested in proposing a CME offering for this program are encouraged to step forward.

Quality
Mark Dias, MD, has prepared a CD library of official AAP policies, clinical guidelines, clinical reports, and technical reports pertinent to the practice of pediatric neurosurgery. Copies will be distributed to members of the SONS and to fellowship trainees. Other interested persons are encouraged to inquire of Dr. Dias. A searchable compendium of all official AAP statements is available online at http://aappolicy.aappublications.org.

The AAP has been reassessing its role in the assurance of quality in the prevention and management of pediatric trauma. At the March 2007 Annual Leadership Forum, ALF, members of the board met with members of the Surgical Advisory Panel and other interested parties to survey the organizational landscape, to inventory the AAP’s current activities, and to identify unmet needs. There was a consensus that the AAP should not attempt to duplicate or compete with the current leadership of the Committee on Trauma, COT, of the American College of Surgeons, ACS. The historical roles of the AAP and the ACS in injury prevention and acute care, respectively, have been complementary, and closer cooperation between the two organizations seems to be in the better interest of children. A formal liaison seat on the COT has been requested. The reassessment of trauma is continuing.

Advocacy

The AAP’s highest advocacy priority in recent months has been renewal and expansion of the State Children’s Health Insurance Program, SCHIP. The outcome of its efforts remains uncertain at the time of this writing. Pediatric neurosurgeons will appreciate the importance of this effort for the welfare of American children, children’s hospitals, and their own practices.

Among its "Top 10" resolutions, the March 2007 ALF sent to the Board of Directors a request for a task force on transition to adult care settings for children with chronic medical and surgical conditions. The resolution originated in the SONS and was endorsed or co-sponsored by the Surgical Advisory Panel, the Pennsylvania Chapter, and Pennsylvania’s parent District III. The board has not yet acted on this request.

In a related development the AAP has joined the ACS, the American Board of Internal Medicine, the American College of Physicians, the American Academy of Family Practice, and a number of other medical organizations in an initiative called the Stepping up to the Plate Alliance, SUTTP. The stated purpose of SUTTP is to improve "transitions across locations of care." The initial emphasis of SUTTP has been transition from inpatient to outpatient and from primary physician to specialist, but transition from pediatric to adult seems to be within the scope of its mission. Marion Walker, MD, has been asked to participate in the AAP’s interface with SUTTP.

There are widespread concerns about the adequacy of the pediatric surgical subspecialty workforce, and the SONS is participating in several related workforce initiatives. The Section on Pediatric Neurological Surgery of the AANS/CNS is in conversation with the American Society for Pediatric Neurosurgery about the production of a pediatric neurosurgery workforce study. On behalf the of Surgical Advisory Panel of the AAP, the SONS responded last year to a request from the Agency for Healthcare Research and Quality, AHRQ, with a proposal for a surgical subspecialty workforce study. This proposal was submitted in late 2006 and is still pending. Lastly, this past spring the ACS announced a well-funded study of the national surgical workforce. The Surgical Advisory Panel has petitioned the ACS to carve out the pediatric surgical subspecialties for separate analysis.

A current description of the AAP’s advocacy activities at the federal and state levels can be viewed at http://www.aap.org/advocacy.html.

Membership

The SONS currently has 80 Active Members.

The requirements for Specialty Fellowship in the AAP and membership in the SONS are posted at http://www.aap.org/member/NEUROLOGICAL%20SURGERY.pdf. They are

• certification by the American Board of Neurological Surgery (or Fellowship in the Royal College of Surgeons of Canada as a neurosurgeon), and
  
  
• either certification by the American Board of Pediatric Neurological Surgery or a practice consisting of greater than 75 percent infants, children, and adolescents as demonstrable by a case log. Applications are available at http://www.aap.org/member/SpecFellowApp.pdf. There is a Candidate Fellow status available to surgeons in pediatric neurosurgical practice who are not yet certified by the American Board of Neurological Surgery, and there is a Post-Residency Training Fellow status for trainees in accredited pediatric neurosurgical fellowships.

AAP membership dues for Specialty Fellows are substantial. There is a discounted rate for new members and for Candidate Fellows. The SONS pays AAP dues for fellowship trainees. There is no surcharge for membership in the SONS. The modest financial resources of the SONS are replenished now by a recently instituted arrangement whereby a fraction of AAP Specialty Fellow membership dues are returned to the home section.

Inquiries about membership or about the activities of the SONS may be directed to any member of the Executive Committee: David Adelson, MD, Mark Dias, MD (chair-elect), Hector James, MD, Thomas Luerssen, MD, Andrew Parent, MD, Joseph Piatt, MD (chair), and Marion Walker, MD (immediate past chair).