Neurology

Upon training with us, the fellow is expected to demonstrate an appropriate, evidence-based, approach to evaluation and diagnosis of neuroimmunological diseases of the central nervous system such as Multiple Sclerosis and other related disorders, and will provide appropriate care of these disorders to patients and their caregivers.

The training will focus on demonstrating clinical competency in the following targeted examinations and assessments:

• Conduct and interpret a general assessment of mental status including appearance and behavior, speech, thought process, thought content, emotion, and personality.
• Administer and interpret extended office-based testing, including, MoCA, MMSE, MSFC, SDMT, and timed 25-foot walk.
• Administer and interpret the Expanded Disability Severity Scale (EDSS) for assessment of Multiple Sclerosis baseline disability and progression.
• Conduct and interpret a targeted neurological examination for central demyelinating disorders including cranial nerves (especially eye movements, visual acuity, pupillary response, color testing, and funduscopic exam), motor examination (including a detailed assessment of spasticity), sensory examination (including cortical sensory function), coordination, gait, and reflexes.
• Perform and interpret findings from the spinal tap in the assessment of neuroimmunological disorders including assessment of emerging biomarkers.
• Appropriately order and interpret serum and CSF studies relevant to the routine evaluation of demyelinating patients including CBC, biochemistry, B12, folate, directed TSH, Vitamin D, RPR, CSF cell count, CSF protein, CSF glucose, oligoclonal bands, IgG index, CSF ACE, and cytology.
• Appropriately order and interpret serum and CSF studies for evaluation of atypical demyelinating disorders or mimics of demyelinating disorders including autoimmune and paraneoplastic profiles, celiac profile, and hypercoagulable disorders.
• Appropriately order and interpret imaging and biomarkers of demyelinating disorder including structural MRI. CSF studies, autoimmune markers of systemic autoimmune diseases, evoked potentials.
• Demonstrate the ability to formulate a treatment plan for CNS neuroimmunological diseases including but not limited to Multiple Sclerosis management.
• Demonstrate awareness of indications, side effects, drug-drug interactions, age considerations for dosing/administration and discontinuation criteria for currently utilized disease-modifying therapies.
• Non-pharmacologic measures for the management of symptoms such as sleep, fatigue, spasticity, pain, depression, bladder dysfunction, cognition, and ambulation.
• Appropriately refer patients for further evaluation from other specialists such as neuro-ophthalmology, neuro-urology, PM&R, mental health, psychiatry and integrative medicine.
• Effective methods to educate patients and their families.
• Integrate the concept for patient-centered, comprehensive care model for all patients encountered at the clinic.

In addition to the clinical experience in the neuroimmunology/MS clinic, the fellow will have the opportunity for clinical rotations in neuro-ophthalmology, neuro-urology, and neuro-psychology.

The fellow will have the opportunity to participate in a clinical research project during training. We highly encourage the fellow to attend national and international meetings related to the field of study such as the American Academy of Neurology, Americas/European Committee for Treatment and Research in Multiple Sclerosis and the Consortium of Multiple Sclerosis Centers. Fellows may also elect to participate in clinical drug trials offered within the neurology department. As part of the development of broad reading of the literature and maintaining updated knowledge, case study presentations are encouraged in which there is a detailed review of the literature tied to challenging, rare or complicated clinical case presentations. If the fellow selects the 2-year program, then a mentoring committee will form to guide the fellow to complete a structured clinical or translational research project. This committee will include the program director, and the director of the neuroimmunology centers at MCW, as well as translational and clinical scientists who are experts in the area and technique of the proposed research study.

If the fellow is interested in imaging research, he or she can participate in ongoing imaging studies utilizing 3T and 7T MRI magnets.

Initial lectures/conferences
The new fellow will be given a copy of the current Continuum series on neuroimmunological disorders and Multiple Sclerosis as an assigned reading and the topics/chapters are briefly reviewed in a series of one-on-one meetings with the program director.

Monthly Journal Club
Sessions consist of a specific topic related to diseases of interest and attendance is open for interested faculty, residents, other fellows, and other members of the department. The fellow will generally be responsible for leading this discussion together with the program director.

Case Conference
The fellow will discuss a challenging or an educational case that they encountered during clinical rotations with faculty, other trainee and members of the care team in a scholarly manner, approximately once a month.

The fellow will be allowed to participate in online clinical case conferences offered by the AAN autoimmune neurology section, or MS section, or National MS Society Fellow lecture series.

This is an exciting time for neuroimmunology and MS specialization. The field continues to grow, with opportunities for clinical or research career. Academic and non-academic medical centers continue to look for neuroimmunology and MS specialists to establish new programs or to join already established ones.

Interested candidates can apply for a fellowship position by submitting the following documentation:

• Fellowship Application
• Curriculum vitae
• Personal Statement
• Three letters of recommendation
• USMLE/COMLEX Score Reports
• Currently valid ECFMG certificate (applicable for International Medical Graduates only)