Clinical Neurophysiology Fellowship
This ACGME-accredited fellowship at the University of Minnesota and affiliated hospitals provides in-depth training in the diagnosis and management of patients with neuromuscular diseases, epilepsy and sleep disorders with emphasis on the performance, analysis and interpretation of electrodiagnostic techniques. Fellows who successfully complete this program are eligible to sit for the sub-specialty board examination in Clinical Neurophysiology (American Board of Psychiatry and Neurology), as well as the EMG boards (American Board of Electrodiagnostic Medicine) and EEG boards (American Board of Clinical Neurophysiology). This fellowship offers intensive training in all areas of Clinical Neurophysiology, and provides fellows with the opportunity to concentrate in selected disciplines (EMG/neuromuscular or EEG/Epilepsy). Training in peripheral electrophysiology focuses on nerve conduction studies and needle electromyography, with additional training provided in single fiber EMG, quantitative MUP analysis, motor unit number estimate (MUNE) techniques, near nerve, autonomic testing, and botulinum toxin injections. Fellows attend various neuromuscular and ALS clinics, in which they develop expertise in the longitudinal care of patients with neuromuscular disorders. Training in central electrophysiology encompasses electroencephalography, evoked potential studies, surgical monitoring, ambulatory EEG monitoring, inpatient video-EEG monitoring and the programming of vagal nerve stimulators. Fellows participate in the various epilepsy clinics offered within the university system. Sleep Fellowship: This is an ACGME accredited one-year program at Hennepin County Medical Center. Intensive training in sleep medicine is conducted in the Minnesota Regional Sleep Disorders Center (MRSDC), housed in the neurology department of one of the core teaching facilities (HCMC). Please contact Cindy Farr at 612-873-6201 for more information.
PROGRAM DESCRIPTION
Curriculum
This is a one-year ACGME-accredited fellowship at the University of Minnesota and affiliated hospitals (Hennepin County Medical Center, Minneapolis VA Medical Center, United Hospital, St. Paul Children’s Hospital) that provides in-depth training in the diagnosis and management of patients with neuromuscular diseases, epilepsy and sleep disorders with emphasis on the performance, analysis and interpretation of electrodiagnostic techniques. Fellows who successfully complete this program are eligible to sit for the sub-specialty board examination in Clinical Neurophysiology (American Board of Psychiatry and Neurology), as well as the EMG boards (American Board of Electrodiagnostic Medicine) and EEG boards (American Board of Clinical Neurophysiology). This fellowship offers intensive training in all areas of Clinical Neurophysiology, and provides fellows with the opportunity to concentrate in selected disciplines (EMG/neuromuscular or EEG/Epilepsy). The training experiences and required rotations differ for the areas of concentration. Training in peripheral electrophysiology focuses on nerve condution studies and needle electromyography, with additional training provided in single fiber EMG, quatitative MUP analysis, motor unit number estimate (MUNE) techniques, near nerve, autonomic testing, and botulinum toxin injections. Fellows attend various neuromuscular and ALS clinics, in which they develop expertise in the longitudinal care of patients with neuromuscular disorders. Training in central electrophysiology encompasses electroencephalography, evoked potential studies, surgical monitoring, ambulatory EEG monitoring, inpatient video-EEG monitoring and the programming of vagal nerve stimulators. Fellows participate in the various epilepsy clinics offered within the university system. EEG/Epilepsy Track: If a fellow selects this concentration, then he/she will spend 10 months working with faculty at one of two sites: Minnesota Epilepsy Group or University of Minnesota, specializing in EEG/epilepsy. Invasive monitoring and an active surgical epilepsy program are available in this facility. The remaining two months of the training year are spent training in EMG or sleep at the other facilities. Program Goals: The goals of Clinical Neurophysiology (CNP) fellowship program are: - Acquire and demonstrate skills necessary to evaluate and treat common and unusual patient problems in epilepsy and sleep disorders (PC, MK)
- independently interpret EEGs, PSGs, and EPs in all age groups in an accurate and safe manner (PC, MK, PBLI)
- Design epilepsy-monitoring protocols for patients undergoing surgical epilepsy evaluation and spell characterization (PC, MK, PBLI)
- Develop the understanding of the principles, indications, contraindications, risk, cost and expected outcome of the various treatments (PC, MK, SBP)
- Continue development of appropriate communication skills with patients, families, peers and health care personnel (PC, CS, Prof)
- Develop skills in life-long learning and in critical analysis, synthesis and reassessment of knowledge, skills and professionalism (PC, Prof, PBLI)
- Ensure that fellows develop independent clinical expertise in evaluating patients with epilepsy and determining their most appropriate management strategy (PC, MK, CS, PBLI)
- Develop independent interpretation skills of intraoperative neurophysiological techniques including electrocorticography, intraoperative EEG and EP (PC, MK, PBLI, SBP)
- Develop independent clinical expertise in evaluating patients with various sleep disorders and their most appropriate management strategy (PC, CS, MK, PBLI)
- Develop an understanding of neuromuscular disease and the role of EMG in their diagnosis (PC, MK, PBLI)
- Develop skills that will enable independent clinical research (PC, MK, PBLI)
Orientation This month serves as an introduction to clinical neurophysiology and the basic science foundations. Orientation comprises a set of lectures, demonstrations, and practice sessions. Learning Objectives: Upon completion of this rotation, fellows are expected to: - Understand nerve and muscle physiology (MK, PC)
- Understand circuit elements and circuits (MK, PC)
- Demonstrate familiarity with the major types of neurophysiologic equipment (PC, SBP)
- Understand the basic principles of EEG (MK, PC)
- Recognize Normal EEG’s (PC, MK, PBLI)
- Perform basic EEG monitoring (PC, MK)
- Understand the basic principles of NCS and EMG (PC, MK, PBLI)
- Understand the basic principles of EP (PC, MK)
- Understand the important elements in standard test results reports(MK, PC, CS)
- Present clinical cases/results to referring physicians/providers in a concise and effective manner (PC, MK, CS)
EMG/Neuromuscular Track CNP fellows participating in the EMG/EEG track will spend three to four months at each of three training sites: UMMC, VAMC, and HCMC. University of Minnesota Medical Center Rotation Objectives: Upon completion of the UMMC rotation fellows are expected to: - Understand the peripheral nervous system neuroanatomy (MK, PC)
- Understand the indications for and limitations of electrodiagnostic testing (PC, MK, PBLI, SBP)
- Perform and interpret nerve conduction studies (PC, MK)
- Perform and interpret nerve conduction studies and needle electromyography (PC, MK, PBLI)
- Perform patient evaluation and develop treatment plans for patient with epilepsy (PC, MK)
- Conduct appropriate evaluation of patients with neuromuscular diseases/symptoms (PC, MK, CS)
- Formulate and implement appropriate treatment plans for patients with neuromuscular diseases (PC, MK, CS)
- Perform and interpret autonomic testing and understand the role of these tests in the evaluation and management of patients with autonomic symptoms (PC, MK)
- Effectively communicate complex and difficult diagnoses and information to patients and their families (PC, CS)
- Understand the role of hospice and palliative medicine in the care of patients with degenerative and terminal conditions (PC, MK, SBP)
- Work effectively with members of a multi-specialty and multi-disciplinary treatment team (PC, SBP, Prof)
- Communicate effectively in written and verbal communications with referring providers (PC, MK, SBP, CS)
HCMC Rotation Learning Objectives: HCMC is a level-one trauma center with a busy emergency department. There is a national ALS center, a neuromuscular clinic, an EMG Laboratory and an epilepsy program. The Minnesota Regional Sleep Disorders is housed in HCMC. The clinical experience at HCMC is divided between the clinical neurophysiology (EMG, EGG, sleep) laboratories and outpatient clinics. Fellows see a mixture of patients referred to the EMG laboratory and are involved in the interpretation of electroencephalograms performed on a wide range of patients drawn from both the inpatient and outpatient settings. The distinguishing features of the HCMC rotation are fellow participation in the sleep disorders clinic at the Minnesota Regional Sleep Disorder Center and the nationally recognized ALS Center. The Sleep Disorders clinic performs approximately 1000 polysomnograms yearly and logs several thousand patient visits annually, and is continually staffed by clinical neurophysiology faculty. CNP fellows gain experience with interpretation of polysomnograms and multiple sleep latency tests, as well as seeing patients with a wide spectrum of sleep disorders. Upon completion of the HCMC rotation, the CNP fellow is expected to: - Understand the basics of nerve and muscle histopathology (MK, PC, PBLI)
- Perform and interpret nerve conduction studies and needle electromyography (PC, MK, PBLI)
- Become proficient in the reading of electroencephalograms and understand their significance as they pertain to patient management (PC, MK, PBLI)
- Evaluate and formulate management strategies for patients with neuromuscular disease (PC, MK)
- Understand the presenting symptoms and diagnostic testing of amyotropic lateral sclerosis (PC, MK, PBLI)
- Understand the major principles of sleep disorder management (PC, MK, PBLI, SBP)
- Conduct an appropriate history and physical exam for patients with sleep issues and problems (PC, MK, CS)
- Score, analyze and interpret nocturnal polysomnography, MSLT, and CPAP/BiPAP recordings
- Identify artifacts during polysomnography (PC, MK)
- Identify and rectify equipment failure during polysomnography recording (PC, SBP)
- Understand role of genetic counselors in the treatment and management of degenerative neuromuscular diseases. (PC, MK, SBP)
- Effectively communicate difficult news and prognoses to patients and families with degenerative neuromuscular disease (PC, CS, MK)
- Effectively and sensitively, plan with patients and families symptom management and palliative treatment in cases of non-curable, progressive conditions. (PC, CS, SBP, MK)
- Work effectively with technical staff in performance of polysomnography (PC, Prof, SBP)
VAMC Rotation learning objectives: Fellows spend four months working in the VAMC epilepsy and neuromuscular disease subspecialty clinics and in EMG and EEG training. At the end of the rotation, the fellow is expected to: - Perform and interpret nerve conduction studies (MK, PC)
- Perform and interpret needle electromyography (MK, PC)
- Evaluate and formulate management strategies for patients with neuromuscular disease (PC, MK)
- Become proficient in the reading of electroencephalograms and understand their significance as they pertain to patient management (PC, MK)
- Understand issues that present in the longitudinal care of patients with neuromuscular disease (MK, PC, SBP)
- Perform and interpret autonomic testing and understand the role of these tests in the evaluation and management of patients with autonomic symptoms (PC, MK, PBLI)
- Provide effective consultation to referring providers within the VA system (PC, MK, Prof, SBP)
EEG/Epilepsy Track In this track, CNP Fellows the will spend 10 months working at either: 1) Minnesota Epilepsy Group (MEG)/St. Paul Children’s Hospital or 2) University of Minnesota Medical Center (UMMC). The remaining two months are spent in EMG or sleep. Minnesota Epilepsy Group Option: The Minnesota Epilepsy Group at United Hospital/St. Paul Children’s hospital houses an active pediatric epilepsy program with inpatient and outpatient pediatric epilepsy services. The areas of focus are epilepsy surgery evaluations, medical management of complex epilepsy patients, and involvement with investigational therapies for epilepsy management. Clinical experience is divided between the clinical neurophysiology laboratory, the outpatient clinics, and the inpatient service. Emphasis will be placed on learning techniques of invasive monitoring and electrocorticography. Months 1-3 of training: Upon completion of the first three months, fellows are expected to: - Perform and interpret routine EEGs (MK, PC, PBLI)
- Understand the principles of long term monitoring video EEGs (MK, PC)
- Perform and interpret ambulatory EEGs (MK, PC)
- Conduct an evaluation of a new patient (MK, PC, CS)
- Formulate and dictate an organized report and communicate the results to referring physicians (MK, PC, CS, SBP).
- Effectively work with members of the clinical team to provide efficient patient care (PC, Prof, SBP)
Months 4-6 of training: Upon completion of months, 4-6 fellows are expected to: - Perform a through and appropriate work up of new patients (PC, MK, SBP)
- Perform and interpret long term monitoring video EEG’s (MK, PC)
- Understand the principles of intraoperative evoked potential recordings (PC, MK)
- Evaluate and formulate management strategies for patients with epilepsy (PC, MK, PBLI)
- Understand the principles of reading intraoperative electrocorticography, subdural electrode array recordings and intracranial depth electrode recordings, and understand their significance as they pertain to patient management (PC, MK, PBLI)
- Effectively obtain patient history, perform physical examination and tests, and formulate an opinion about neurologic localization, etiologic differential diagnosis and a management plan (MK, PC, PBLI)
- Formulate and dictate an organized report and communicate the results to referring physicians (PC, MK, CS, SBP)
- Provide effective ongoing care of patients with epilepsy in the clinic setting (PC, MK, CS, SBP)
- Provide clinical consultations on complex, hospitalized epilepsy patients (PC, MK, SBP)
- Read intra-operative electrocorticography, subdural electrode array recordings, and intracranial depth electrode recordings, and understand their significance as they pertain to patient management (PC, MK, PBLI)
- Understanding the use of ancillary tests used in surgical epilepsy evaluations, such as MRI, PET, SPECT, fMRI and neuropsychological testing (PC, MK, PBLI, SBP)
- Understand the role of investigational treatment options, including new medications and deep brain stimulation in the treatment of patients (MK, PC, PBLI)
- Understand the role of less invasive alternatives to intracranial EEG monitoring and new therapeutic avenues for patients who are not candidates for surgical resection (PC, MK, PBLI)
Months 7-9 of training: Upon completion of months, 7-9 fellows are expected to: - Formulate complex diagnoses of seizures, epilepsy and related conditions (PC, MK, PBLI)
- Provide effective care ongoing care for epilepsy patients including those with intractable epilepsy (PC, MK, CS, SBP, PBLI)
- Perform and interpret intra-operative evoked potential recordings (PC, MK)
- Display proficiency in the reading of intraoperative electrocorticography, subdural electrode array recordings and intracranial depth electrode recordings (PC, MK, PBLI)
- Appropriately use the results of intraoperative electrocorticography, subdural electrode array recordings and intracranial depth electrode recordings in patient management (PC, MK, PBLI)
- Review available clinical trials of investigational treatment options and direct and advise patients as appropriate (PC, MK, PBLI, Prof)
- Understand the role of less invasive alternatives to intracranial EEG monitoring and new therapeutic avenues for patients who are not candidates for surgical resection.
UMMC Epilepsy Center Option: One of the CNP fellows on the Epilepsy track (track 2) will spend 9 months working with in the Comprehensive Epilepsy Center at the University of Minnesota Medical Center. The remaining two months are spent in EMG or sleep. The comprehensive epilepsy center provides multidisciplinary care for epilepsy and seizure disorders. CNP fellows work as part of a team including neurologists, neurosurgeons, neuropsychologists, neuropharmacologists, neuroradiologists, psychiatrists, epilepsy nurses, speech therapists and social workers. The overall educational goals of this rotation are to develop in fellows a current understanding of the role of clinical neurophysiology in the comprehensive care of patients, provide extensive clinical/technical experience in the performance of clinical neurophysiological examinations, and to provide training in the clinical evaluation and management of patients with epilepsy. Months 1-3 of training: Upon completion of the first three months, fellows are expected to: - Perform and interpret routine EEGs (MK, PC, PBLI)
- Understand the principles of long term monitoring video EEGs (MK, PC)
- Perform and interpret ambulatory EEGs (MK, PC)
- Conduct an evaluation of a new patient (MK, PC, CS)
- Formulate and dictate an organized report and communicate the results to referring physicians (MK, PC, CS, SBP)
- Effectively work with members of the clinical team to provide efficient patient care (PC, Prof, SBP)
Months 4-6 of training: Upon completion of months, 4-6 fellows are expected to: - Perform a through and appropriate work up of new patients (PC, MK, SBP)
- Perform and interpret long term monitoring video EEG’s (MK, PC)
- Understand the principles of intraoperative evoked potential recordings (PC, MK)
- Evaluate and formulate management strategies for patients with epilepsy (PC, MK, PBLI)
- Understand the principles of reading intraoperative electrocorticography, subdural electrode array recordings and intracranial depth electrode recordings, and understand their significance as they pertain to patient management (PC, MK, PBLI)
- Effectively obtain patient history, perform physical examination and tests, and formulate an opinion about neurologic localization, etiologic differential diagnosis and a management plan (MK, PC, PBLI)
- Formulate and dictate an organized report and communicate the results to referring physicians (PC, MK, CS, SBP)
- Provide effective ongoing care of patients with epilepsy in the clinic setting (PC, MK, CS, SBP)
- Provide clinical consultations on complex, hospitalized epilepsy patients (PC, MK, SBP)
- Read intra-operative electrocorticography, subdural electrode array recordings and intracranial depth electrode recordings, and understand their significance as they pertain to patient management (PC, MK, PBLI)
- Understanding the use of ancillary tests used in surgical epilepsy evaluations, such as MRI, PET, SPECT, fMRI and neuropsychological testing (PC, MK, PBLI, SBP)
- Understand the role of investigational treatment options, including new medications and deep brain stimulation in the treatment of patients (MK, PC, PBLI)
- Understand the role of less invasive alternatives to intracranial EEG monitoring and new therapeutic avenues for patients who are not candidates for surgical resection (PC, MK, PBLI)
Months 7-9 of training: Upon completion of months, 7-9 fellows are expected to: - Formulate complex diagnoses of seizures, epilepsy and related conditions (PC, MK, PBLI)
- Provide effective care ongoing care for epilepsy patients including those with intractable epilepsy (PC, MK, CS, SBP, PBLI)
- Perform and interpret intra-operative evoked potential recordings (PC, MK)
- Display proficiency in the reading of intraoperative electrocorticography, subdural electrode array recordings and intracranial depth electrode recordings (PC, MK, PBLI)
- Appropriately use the results of intraoperative electrocorticography, subdural electrode array recordings and intracranial depth electrode recordings in patient management (PC, MK, PBLI)
- Review available clinical trials of investigational treatment options, direct, and advise patients as appropriate (PC, MK, PBLI, Prof)
- Understand the role of less invasive alternatives to intracranial EEG monitoring and new therapeutic avenues for patients who are not candidates for surgical resection (PC, MK, PBLI)
Fellow Performance Assessment Informal regular discussion and feedback is provided to trainees during the course of their performance of Clinical Neurophysiologic procedures by the supervising staff. A quarterly formal evaluation of the Clinical Neurophysiology resident by the Program Director, in conjunction ion with the staff with whom they have worked in that quarter. There will be a semi-annual “360-degree” assessment of the Trainees made by the Clinical Neurophysiology technical and administrative staff as well as patients. The Clinical Neurophysiology Trainee will be responsible for maintaining a log of their procedures as stipulated by the Program Director. This serves the purpose of giving the Trainee an accurate idea of how many procedures they have performed, which in turn will form part of the final report that the Program Director will make upon their successful completion of the Program. The Program Director is responsible for a written, final evaluation for each Clinical Neurophysiology Fellow completing the Clinical Neurophysiology Program that comments upon scope of training achieved by that Trainee during their year of Fellowship. Particular emphasis on performance during their final period of training, commentary on the numbers of procedures performed, and commentary on their ability to perform Clinical Neurophysiologic procedures in a competent way in the context of independent practice.
RESEARCH
Fellows are required to execute at least one research project a year. By the fourth month of the fellowship year, fellows are expected to identify their projects and to select faculty mentors. Fellows formally present their projects at a graduation/educational symposium in June.
ADDITIONAL DIDACTIC TRAINING
Each week there are regular conferences which are attended by all CNP fellows in the program. - CNP didactic lecture series: weekly lecture given by one of the CNP faculty expressly for the fellows; curriculum offers a comprehensive review of clinical electrophysiology.
- Waveform conference: weekly conference dedicated to the review of electrophysiologic tracings and data, alternating EMG/EEG by week
- Neuromuscular case conference: weekly conference discussing interesting neuromuscular patients seen in the clinic
- Epilepsy case conference: monthly conference discussing interesting epilepsy patients studied
- Muscle/Nerve Histology Reading Session: review of interesting nerve and muscle biopsies at a multi-headed scope
- Sleep Disorders conference: held weekly; fellows attend twice a month; interesting sleep disorders cases from the week reviewed.
- Monthly resident journal club
- Departmental grand rounds
- Scientific Basis of Neurology Course: weekly lecture series for residents, attended also by fellows; many areas of neurology reviewed; good preparation for Part I of the boards
DEPARTMENT & FACULTY
The Clinical Neurophysiology Fellowship Training Program faculty is comprised of specialists in the Neuromuscular/EMG, Epilepsy/EEG/EP, and Sleep Medicine Units in the Neurology department at the UMMC and affiliated teaching hospitals (UMMC, HCMC, VAMC). These faculty members are committed to patient care, education and research in their daily practices. The Neurology Department at the University of Minnesota maintains a strong commitment to education. John Tulloch, M.D., Program Director Epilepsy EEG Faculty: Miguel Fiol, M.D. (UMMC)
Gerald Moriarity, M.D. (UMMC)
Stephen Holloway, M.D., Ph.D. (VAMC, UMMC)
Frederick Langendorf, M.D. (HCMC)
Rupert Exconde, M.D. (VAMC)
Pat Penovich, M.D. (MEG)
Michael Frost, M.D (MEG)
Frank Ritter, M.D. (MEG)
Deanna Dickens, M.D. (MEG)
El-Hadi Mouderres, M.D. (MEG)
Jason Doescher, M.D. (MEG)
Zhiyi Sha, M.D. (MEG)
Wenbo Zhang, M.D. (MEG)
Neuromuscular EMG Faculty: Gareth Parry, M.D. (UMMC)
David Walk, M.D. (UMMC)
John Tulloch, M.D. (UMMC)
Ezgi Tiryaki, M.D. (HCMC)
Sleep Medicine Faculty: Scott Bundlie, M.D. (HCMC)
Michel Cramer Bornemann, M.D. (HCMC)
Michael Howell, M.D. (HCMC)
Duration of fellowship: 1 year
Number of fellows per year: 4
REQUIREMENTS & APPLICATION PROCEDURES
Applicants must have completed an ACGME-approved residency in neurology at the time of entrance into the program and must be board-eligible/certified in Neurology. Applicants should submit: - A curriculum vitae
- Three letters of recommendation
- A personal statement
- Official test transcripts for all relevant examinations (e.g. USMLE)
- A valid copy of your ECFMG certificate (for Foreign Medical Graduates)
- Visa status (only J-1 visas sponsored by ECFMG are accepted)
- Clinical Neurophysiology Fellowship Application
Competitive applicants will be invited to visit the University of Minnesota for an interview with the program director and selected faculty members. Interviews are conducted May-October. Please mail the above information to: John Tulloch, M.D., Program Director
c/o Pat Bulgerin, CNP Fellowship Coordinator
Dept of Neurology
University of Minnesota
420 Delaware St SE, MMC 295
Minneapolis, MN 55455 Contact Information:
John Tulloch, M.D., Program Director
Email: tullo001@umn.edu
Pat Bulgerin, CNP Fellowship Coordinator
Email: bulge006@umn.edu
Phone: 612-625-9110
FAX: 612-625-7950
The University is an Equal Opportunity Educator and Employer.
|
