Neurology Fellowship Programs

COVID-19 Update

For the academic year 2020-2021 application cycle, all Department of Neurology fellowship programs at MCW will be conducting virtual interviews for all fellowship positions per recommendations from the CDC and the ACGME due to the COVID-19 global pandemic. MCW, in accordance with the CDC and ACGME, will provide updated information as it becomes available.

Our Programs

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Clinical Neurophysiology Fellowship

The Department of Neurology offers a fellowship in Clinical Neurophysiology which is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Successful completion of this one-year program leads to eligibility to sit for the American Board of Psychiatry and Neurology (ABPN) examination in Clinical Neurophysiology.

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Epilepsy Fellowship

The Department of Neurology offers a fellowship in Epilepsy which is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Successful completion of this one-year program leads to eligibility to sit for the American Board of Psychiatry and Neurology (ABPN) examination in Epilepsy.

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Headache Medicine Fellowship

The field of Headache Medicine is rapidly expanding at Froedtert Hospital and the Medical College of Wisconsin. In the past three years, it has grown from one part-time Neurologist to four full-time physicians. Two of whom are UCNS board certified in headache medicine and two who are UCNS board eligible having recently joined the department following successful completion of their headache medicine fellowship. The section on headache medicine sees approximately 5000 new patients and consultations and 10,000 follow-up care visits annually. We are the most common reason for patients to seek care in the Department of Neurology.

The fellowship program is approved by the United Council for Neurological Subspecialties. It is authorized by the Department of Graduate Medical Education at the Medical College of Wisconsin. Fellows during their year spent the majority of their time in direct headache patient care. We provide them with increasing clinical freedom in the management of their patients based on their clinical and academic accomplishments. They spend a half day per week working with and instructing the Neurology residents in the clinic setting.

Based on their interests, experience and expertise they have the opportunity to spend several months in other related disciplines such as pain management, pain psychology, otorhinolaryngology, general neurology, sleep medicine, autonomic disorders, and neuro-ophthalmology. The section provides comprehensive headache care in a multi-disciplinary team setting that also includes outpatient infusions and inpatient headache care.

Ongoing section educational efforts include a journal club, didactic lectures, and case management conferences. The fellow is expected to take a leading role in these efforts. The Fellow is also actively encouraged and provided an opportunity to participate in the educational efforts of the American Headache Society directed towards trainees through online activities. They are provided funding to attend appropriate headache medicine continuing educational programs. Such programs include the offerings from the American Headache Society with the course in Scottsdale and the Annual meeting but which can also include the American Academy of Neurology meeting.

Participation in clinical research is encouraged, and the Fellow should begin planning a clinical research project in well in advance of their commencement of training. The section is actively involved in a variety of multicenter clinical trials.

Compensation includes salary equivalent to PGY-5 Neurology, educational stipends and insurance benefits comparable to the clinical faculty. Fellows are required to hold citizenship in the US or possess a qualified visa. Wisconsin license is required before commencing the fellowship. Applications for the Fellowship may be submitted through ERAS as well as directly to the section of headache medicine fellowship director.

For more information:

Jenny Her, Fellowship Coordinator
(414) 955-0643
jher@mcw.edu

Neurocritical Care Fellowship

The Neurocritical Care Fellowship Program at the Medical College of Wisconsin is accredited through the United Council of Neurological Subspecialties (UCNS). This training program is tailored to fulfill the educational curriculum and requirements as set forth by the UCNS and provides an opportunity to work with nationally and internationally recognized experts in the field of Neurointervention, Stroke, Neurosurgery and Neurocritical Care.

Fellows are trained in the diagnosis and management of a wide variety of pathologies including traumatic brain injuries, subarachnoid hemorrhage, intracerebral hemorrhages, acute ischemic strokes, neuromuscular respiratory failure, status epilepticus, CNS infections, brain tumors and the postoperative care of complicated neurosurgical patients.

Fellows will achieve competence in EVD and ICP monitoring and management, management of bolts and Licox monitors, basics of mechanical ventilation, hemodynamic monitoring, vasopressor support, EEG monitoring, antibiotic therapy, targeted temperature management, etc. Fellows will also achieve competency in the use of transcranial dopplers and have the opportunity to be certified through the American Society of Neuroimaging.

Procedural skills to be mastered include central venous catheterization, arterial catheterization, endotracheal intubation, use of video laryngoscopy and fiber optic scopes for intubation, bronchoscopy, bedside percutaneous tracheostomy, TCDs and limited bedside Ultrasound.

Teaching and supervision of medical students, housestaff and physician extenders as well as functioning as a liaison between the various Primary and Consulting services forms an integral part of their fellowship training.

The primary training institution is Froedtert Hospital which is a 500 bed Level I Trauma Center and Comprehensive Stroke Center ranked consistently in the Top 50 of the annual Best Hospitals list by US News & World Report.

The Neuroscience program at Froedtert and the Medical College of Wisconsin currently houses a 12 bed Neurologic ICU and 6 bed step down ICU (NPCU), staffed full time by Board Certified Neurointensivists. Construction is currently underway for expansion to a state of the art 20 bed ICU and 6 bed NPCU slated to open January 2017.

The Medical College of Wisconsin/Froedtert Hospital is seeking qualified applicants currently for a 2 year UCNS certified Neurocritical Care Fellowship.

Learn more about the Division of Stroke, Neurointervention and Critical Care.

Eligibility for Fellowship position

Successful completion of an ACGME accredited training program in Neurology, Anesthesiology, Emergency Medicine or Internal Medicine.
Physicians with prior Critical Care Fellowship training or currently pursuing such training.
Candidates must be able to obtain an unrestricted Wisconsin license.

The fellowship is under the direction of Assistant Professor of Neurology, Pramod Gupta, MD. Applications are being accepted through the SF Match. Interviews are expected to take place starting in January through March. If you miss the listed deadline and intend to apply, please contact the coordinator.

For more information:

Jenny Her, Fellowship Coordinator
(414) 955-0643 | (414) 955-0127 (fax)
jher@mcw.edu

Neuroimmunology and MS Fellowship

The Neuroimmunology and Multiple Sclerosis (MS) Fellowship is a one- to two-year program for neurologists who are looking for a career in patient care and clinical research in neuroimmunology.

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Neurointerventional Fellowship

The Division of Neurointervention is dedicated to training highly-skilled neurointerventionalists who will be able to continue to expand care for patients with neurovascular disorders.

The fellowship is under the direction of Assistant Professor of Neurology, Marc A. Lazzaro, MD.

For more information:

Jenny Her, Fellowship Coordinator
(414) 955-0643 | (414) 955-0127 (fax)
jher@mcw.edu

Neuropsychology Fellowship

The fellowship is under the direction of Amy Heffelfinger, PhD and Sara Swanson, PhD.

View more information on our Neuropsychology Division page.

For more information:

Jenny Her, Fellowship Coordinator
(414) 955-0643 | (414) 955-0127 (fax)
mcw_neuropsych_postdoc@mcw.edu

Vascular Neurology Fellowship

This is a one year, ACGME accredited program. The Vascular Program is dedicated to training highly-skilled vascular neurologists who will be able to continue to expand care for patients with neurovascular disorders.

For more information:

Jenny Her, Fellowship Program
(414) 955-0643 | (414) 955-0127 (fax)
jher@mcw.edu

Recent Awards

Dr. Christopher Southwood awarded the Daniel M. Soref Fellowship for Clinical Neuroscience

Christopher Southwood, MD

Dr. Southwood, a fellow in Neuro-Critical Care, was awarded the Daniel M. Soref Fellowship for Clinical Neuroscience at the Medical College of Wisconsin for the 2019/2020 academic year in a competitive process. Clinical fellows from throughout Neurosciences are invited to submit research projects for consideration. Those projects are then judged by a group of researchers and leaders in Neurosciences. Dr. Southwood’s research on improving door-to-device times for acute ischemic stroke thrombectomy patients is being generously supported by the Daniel M. Soref Trust. Dr. Marc Lazzaro, a specialist in Vascular Neurology and Endovascular Surgical Neuroradiology and the Program Director of the Neurointervention fellowship program is serving as Dr. Southwood’s mentor.

Dr. Southwood’s Proposal

Stroke is the fifth leading cause of death in the United States and recognized as a leading cause of disability¹. Treatment of acute ischemic stroke has undergone a revolution within the last half-decade with focuses on improving access to thrombolytic pharmacologic therapy and later overwhelming evidence supporting endovascular therapy (EVT). Treatment with pharmacological thrombolysis with alteplase (tPA) has also been refined to enhance access for more patients. Specifically, the American Heart Association/American Stroke Association has implemented a Target: Stroke initiative to streamline processes and efficiently deliver reperfusion therapy in a timely fashion. This initiative has successfully reduced Door-to-Needle times. Specifically, at Froedtert hospital we have been able to improve our door-to-needle times by 34 minutes over the last 5 years.

In 2015, EVT was firmly established within six hours to significantly improve functional recovery. Thrombectomy treatment for acute ischemic stroke has been further validated up to 24 hours, allowing for more stroke patients to attain functional independence. Now, the focus has turned to streamlining the endovascular therapy processes to improve efficiency and outcomes, deemed Door-to-Device (DTD) target times as has been supported by some of the thrombectomy trials^2,3. The ESCAPE trial emphasized efficient workflow to achieve fast vessel recanalization². As the Target: Stroke program enters phase III, the DTD will target 50% of patients in 90 minutes or less for patients entering Froedtert’s emergency room, and for DTD targeting less than 60 minutes for patients transferred from outside facilities⁴.

Aims

Hypothesis: Existing processes and workflows at Froedtert Hospital for patient management, care team activation, and transport in the Door-to-Device (DTD) phase of care contain inefficiencies leading to time delay, which can be improved with a systematic review, revision, and implementation of time-sensitive process updates.

Aim 1: Perform a retrospective analysis of previously collected time intervals for all patients with acute ischemic stroke who underwent thrombectomy.

Aim 2: Convene a multidisciplinary workgroup to review and compare time intervals with published data, identify areas for potential improvement, and propose a revised process for patient management in the DTD phase of care targeting a safe and meaningful reduction in time.

Aim 3: Perform Plan-Do-Study-Act (PDSA) cycles to implement and assess effectiveness of change, specifically for a safe and meaningful reduction in time.

Methods

To accomplish these aims, I will work closely with my mentor to complete a retrospective analysis of time intervals for patients undergoing acute stroke thrombectomy. This project will entail multiple Plan-Do-Study-Act (PDSA) cycles to streamline our DTD process for endovascular therapy. Specifically, there will be an in-depth analysis of our current state and examining our practices, standards, and identifying the stakeholders in this process including representatives from emergency medicine, radiology, stroke neurology, neurointervention, anesthesia, nurses, interventional radiology technologists, the Access Center, operators, and patient transport staff. In order to improve our process, it will be imperative to understand the challenges encountered across our multidisciplinary treatment team. This will require establishing metrics to accurately assess our current state and understanding national standards and targets to set and reach our goals. Changes concepts will aim to eliminate waste, improve workflow, optimize inventory, improve the work environment, reduce variation, and avoid errors. Through multiple PDSA cycles, it will be important to reduce waste and inefficiencies across every team members’ roles to improve our metrics. Future directions include taking patients directly from the CT scanner to the angiography suite without delaying for image interpretation, improving patient transport times to eliminate waste, working with anesthesia in parallel to avoid waste, standardizing a “stroke cart” so the radiology technologists can very quickly reach for the tools needed for any stroke case. The IV tPA door-to-needle times at Froedtert Hospital have already improved by 34 minutes using similar efforts to improve processes and workflow. The environment, multidisciplinary collaboration, and resources exist to make this a successful project.

Significance and potential Impact

Process and workflow inefficiencies may lead to unnecessary delays in delivering the critical and time-sensitive therapy of thrombectomy to acute ischemic stroke patients. Through improving the process of endovascular therapy for acute ischemic stroke, there is potential for significant impact for each patient treated around Wisconsin. The well-established mantra of “time in brain” remains true as the estimated rate of neuron death is 1.9 million for each minute in which stroke is untreated⁵. The aim to improve our metrics to meet the proposed goals in Target: Stroke phase III will undoubtedly improve each patients’ chances of recovery while reducing the burden of death and disability on our community. Similar projects are underway nationwide⁶, but it will be important to understand the unique challenges within the Froedtert health system to help patients in Wisconsin.

Daniel M. Soref Fellowship

Dr. Sam Hooshmand, a fellow in Multiple Sclerosis and Neuroimmunology, was awarded the Daniel M. Soref Fellowship for Clinical Neuroscience at the Medical College of Wisconsin for the 2020/2021 academic year in a competitive process. Clinical fellows from throughout Neurosciences are invited to submit research projects for consideration. Those projects are then judged by a group of researchers and leaders in Neurosciences. Dr. Hooshmand’s research entitled Creation of a Novel, Technology-Based, Multidimensional Tool for Multiple Sclerosis Disability with Integration of Patient-Reported Outcomes is being generously supported by the Daniel M. Soref Trust. Dr. Ahmed Obeidat, a specialist in Multiple Sclerosis and Neuroimmunology and also the Director of the MS/Neuroimmunology fellowship is serving as Dr. Hooshmand’s mentor.

Dr. Hooshmand’s Proposal:
Background:
First developed in 1955, the Expanded Disability Status Scale (EDSS) continues to be the most widely used outcome measure in multiple sclerosis (MS) research1,2. Despite routine implementation in clinical trials, the EDSS is criticized for its time-consuming nature, a lack of inter/intra-reliability, limited sensitivity to changes in patient condition, bias towards changes in ambulation, and neglect of patient-reported symptoms3-7. The National Multiple Sclerosis Society (NMSS) recognized the EDSS shortcomings and the need for better measures of disability, which has led to development of the Multiple Sclerosis Functional Composite Scale (MSFCS) along with other less notable scales4. The MSFCS improves upon the EDSS by including measures of dexterities and cognitive functions; however, MSFCS cannot replace EDSS due to its lack of detailed assessments and difficulties with correlating standardized clinical scoring with z-scores8. A need clearly exists for a quantitative MS disability tool/scale that can provide comprehensive precise measures, which is easy to administer, and can incorporate patient-reported symptoms.

Our project aims to address the limitation of current assessment tools of disability in MS

To design a multi-dimensional novel battery of tests to assess MS disability progression by combining innovative, technology-based measures with classical objective assessments.
Pilot the tool on participants with clinically definitive MS longitudinally to establish the feasibility for repetitive testing and participant retention/adherence.
Obtain feedback from each participant concerning their overall experience with the tool with a focus on increasing study size.

Significance and Potential Impact
The proposed project will be the first to integrate technology-based, detailed measures into a multidimensional battery of tests to assess disability progression in MS. Additionally, it will be the first to integrate patient reported outcome measures into the scoring system of objective tests. Further, the concept of weighted scoring is novel for MS disability assessment tools. Consequently, this project will have the possibility of being a viable alternative to current MS disability measures such as EDSS, in addition to providing an innovated notion of weighted disability scoring in MS. Future directions of this project will aim to test the novel tool in a large population of MS patients, validate the tool against current MS measures (EDSS, MSFC, MSOAC), correlate the measurements with other biomarkers of disease activity (imaging and laboratory tests), and pursue studies to establish the potential for the novel tool as a primary clinical measure of disability in MS clinical trials.

References

Kurtzke, J. (2015). On the origin of EDSS. Multiple sclerosis and related disorders, Mar 31;4(2):95-103.
Obeidat, A. (2016). John F. Kurtzke, MD (1926-2015). Neuroepidemiology, Jan 20;46(2):118-9.
van Munster, C., & Uitdehaag, B. (2017). Outcome Measures in Clinical Trials for Multiple Sclerosis. CNS Drugs, 217 - 236.
Whitaker, J., McFarland, H., Rudge, P., & Reingold, S. (1995). Outcomes assessment in multiple sclerosis clinical trials: a critical analysis. Multiple Sclerosis Journal, Apr;1(1):37-47.
Noseworthy, J. H., Vandervoort, M. K., Wong, C. J., & Ebers, G. C. (1990). Interrater variability with the Expanded Disability Status Scale (EDSS) and Functional
Systems (FS) in a multiple sclerosis clinical trial. Neurology, 40(6), 971-971.
Francis, D. A., Bain, P., Swan, A. V., & Hughes, R. A. (1991). An assessment of disability rating scales used in multiple sclerosis. Archives of neurology, 48(3), 299-301
Goodkin, D. E., Cookfair, D., Wende, K., Bourdette, D., Pullicino, P., Scherokman, B., & Whitham, R. (1992). Inter‐and intrarater scoring agreement using grades 1.0 to 3.5 of the Kurtzke Expanded Disability Status Scale (EDSS). Neurology, 42(4), 859-859.
Cutter, G., Baier, M., Rudick, R., Cookfair, D., Fischer, J., Petkau, J., Ellison, G. (1999). Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain, May 1;122(5):871-8.