General Principles
The American Board of Psychiatry and Neurology (ABPN) mandates that demonstration of clinical skills competency as a basic requirement in order to apply for certification in the specialties of neurology and neurology with special qualification in child neurology. Competency in these skills should be achieved during residency. The ABPN requires that residents demonstrate competency in the following areas:
- Medical interviewing
- Neurological examination
- Humanistic qualities, professionalism, and counseling skills
Demonstration of competency in evaluating a minimum of five different patients (as specified below) during residency training is required. An individual training program may elect to do more such evaluations.
Required Clinical Skills Evaluations
Adult Neurology Residents
- Critical care: One critically ill adult patient with neurological disease (may be in either an intensive care unit or emergency department setting or an emergency consultation from another inpatient service)
- Neuromuscular: One adult patient with a neuromuscular disease (may be in either an inpatient or outpatient setting)
- Ambulatory: One adult patient with an episodic disorder, such as seizures or migraine (most likely in outpatient setting)
- Neurodegenerative: One adult patient with a neurodegenerative disorder, such as dementia, a movement disorder, or multiple sclerosis (most likely in an outpatient setting)
- Child patient: One child patient with a neurological disorder (most likely in an outpatient setting)
Child Neurology Residents
- Critical care: One critically ill child patient with neurological disease (may be in either an intensive care unit or emergency department setting or an emergency consultation from another inpatient service)
- Neuromuscular: One child patient with a neuromuscular disease (may be in either an inpatient or outpatient setting)
- Ambulatory: One child patient with an episodic disorder, such as seizures or migraine (most likely in an outpatient setting)
- Neurodegenerative: One child patient with a neurodegenerative disorder, such as an inherited degenerative disease (most likely in an outpatient setting)
- Adult patient: One adult patient with a neurological disorder (most likely in an outpatient setting)
At least one of the above child patients must be:
- An infant or child aged younger than two
- A child aged six to ten
- An adolescent (aged 11 – 15)
Selection of Patients
The selection of patients (outlined above) by type and age is at the discretion of the residency director.
If possible, the patients should be unknown to the resident. While it is preferable that the patients have not been seen previously by any resident, patients previously seen at the institution may be asked to participate in the evaluation process. Whenever possible, patients with conversion disorders or somatoform disorders should not be selected. The selection of patients is at the discretion of the residency director.
Evaluators
Each resident must be evaluated by a minimum of three ABPN-certified neurologists/child neurologists who are faculty members Adult neurologists must perform the adult neurology evaluations, and child neurologists must perform the child neurology evaluations.
The faculty member must observe the resident’s performance and score the resident’s medical interviewing skills; neurological examination skills; humanistic qualities, professionalism, and counseling skills. The resident’s ability to present and formulate the case should also be evaluated, but that assessment is not to be factored into the overall evaluation.
Duration of Each Encounter
Each evaluation session should last approximately one hour. The residents should be given up to 45 minutes to do the history and neurological examination. Thereafter, he/she should have 10-15 minutes to present a summary of the important findings on history and neurological examination. The remainder of the time should be spent in discussion and feedback from the faculty member who observed the encounter.
While the faculty member may wish to discuss the diagnosis, differential diagnosis, and plans for evaluation and treatment with the resident, these steps are not required by the ABPN. The resident does not need to demonstrate proficiency in these aspects of the encounter to pass the clinical skills evaluation. These competencies will be tested by the ABPN on the certification examination.
Timing of the Evaluations
The ABPN encourages administering these evaluations early in residency training. The ABPN anticipate that many residents may not “pass” all their evaluations on the first attempt. Early evaluation provides an opportunity for the residents to rectify any deficiencies and to successfully complete the process in order to apply to take the certification examination.
Evaluation Forms and Scoring Criteria
Approved evaluation forms are posted on the ABPN web site (http://www.abpn.com/forms.htm). Two forms are currently available (NEX v.1 and NEX v.2). Programs can add additional items for their own purposes. Criteria for scoring the components of the clinical skills evaluation are provided below.
Determination of Passing the Evaluation
The individual faculty member will determine if the resident passed all three core components (A. medical interviewing, B. neurological examination, and C. humanistic qualities, professionalism, and counseling skills) of them clinical evaluation.
A passing score is required for all three components (A, B, and C) for an overall passing score. Regardless of when during training the resident takes the evaluation, the standard for passing remains the same.
Because the resident may take each of these clinical skills evaluations multiple times if necessary (which will not affect the resident’s eligibility for taking the ABPN certification examination), there should not be pressure to pass a resident’s performance on an evaluation. If the performance is less than desired, the resident and faculty can schedule other encounters and use these experiences as teaching exercises.
Submission of Documentation to the ABPN
The ABPN requires written attestation from the training director that the resident has successfully passed all five clinical skills evaluations at the time of application for certification. The number of times that the resident takes one of the clinical skills evaluations is not required. It is recommended that the program retain the evaluation forms as part of the resident’s training file.
Updated 7/21/25