Clinical Neurophysiology Fellowship Program


Program Overview

The Clinical Neurophysiology Fellowship Program will:
  1. Prepare fellows for the independent practice of clinical neurophysiology, i.e. the measurement and assessment of function of the central, peripheral, and autonomic nervous systems and skeletal muscles for the purpose of diagnosing, monitoring and treating neurological disorders.

  2. Provide fellows with the opportunity to acquire a thorough understanding of clinical neurology, normal neurophysiology and abnormal findings that occur in various neurological disorders so that they can select and apply properly clinical neurophysiological procedures to evaluate and manage patients.

  3. Provide fellow training based on supervised clinical work of increasing responsibility with both inpatients and outpatients in association with a foundation of organized instruction in basic neurosciences and neurophysiology.
Educational Goals & Objectives

  1. CNP fellow education is to include at minimum the proper application of clinical neurophysiological procedures including, but not limited to, EEG, EMG, nerve conduction studies, evoked potentials, epilepsy monitoring, intraoperative monitoring, polysomnography, and autonomic nervous system testing.

  2. Clinical and/or didactic experience is to include, but is not be limited to, the evaluation and treatment of encephalopathies, epilepsies, cerebrovascular disease, demyelinating disorders, tumors, CNS infections, movement disorders, sleep disorders, trauma, myelopathies, neuropathies, neuronopathies, radiculopathies, myopathies, and neuromuscular transmission disorders.

  3. The CNP fellow will obtain direct clinical experience in one of the two major areas of clinical neurophysiology (EEG/Epilepsy and EMG/Neuromuscular) with subspecialization in at least one area.

  4. The level of supervision provided to the CNP fellow and the clinical and teaching responsibilities of the fellow will evolve with his/her skill level, knowledge, and experience. Direct instruction of the fellow by CNP faculty will be replaced in turn by continuous and then selected supervision. Similarly, the CNP fellow will evolve from an assistant in medical student and neurology fellow education to a supervised instructor and finally to an independent instructor.
Supervisory Guidelines

  1. Fellows on subspecialty rotations are supervised by the attending clinical neurophysiologist(s) of that subspecialty for that day.

  2. CNP attendings must inform the CNP fellow scheduled to be supervised on a given day of any changes in the attending schedule for his/her supervision.

  3. If a CNP fellow requires assistance or supervision and the subspecialty attending of the day cannot be reached by the resident, the fellow should contact the laboratory director of that CNP subspecialty.

  4. If a CNP fellow requires assistance or supervision and neither the subspecialty attending of the day or the subspecialty lab director can be reached, the fellow should contact the director of the CNP laboratories.

  5. Ascending levels of CNP fellow supervision are as follows:

    1. CNP Subspecialty Attending (of the day)
    2. CNP Subspecialty Laboratory Director
    3. CNP Laboratories Director.
Curriculum

Fellows will receive exposure to each of the areas outlined below during their training.
  1. EEG/Epilepsy

    1. Overview - This subspecialty track consists of training in clinical neurophysiology focused on EEG and epilepsy. The main objective is to master skills necessary for recording and interpreting EEG and epilepsy monitoring studies and to develop competence in clinical management of patients with epilepsy.

    2. Clinical Duties - Fellows will be responsible for attending three one-half days of outpatient epilepsy clinic per week under the supervision of John Ebersole MD, James Tao MD PhD, and Maria Baldwin MD. Exposure to multiple epilepsy attendings is desirable.

    3. EEG - Fellows will be responsible for pre-reading CNP laboratory EEGs daily, for reviewing these EEGs with an EEG attending daily, and for creating a final report. Fellows will also be on first call (phone) for emergency EEGs, whenever fellow duty hour regulations permit this.

    4. Long-term EEG Monitoring - Fellows will be responsible for pre-reading Epilepsy Monitoring Unit recordings daily, for reviewing these records with an Epilepsy attending, and for creating a final report. These recordings will include intracranial EEG from epilepsy surgery candidates, as well as routine scalp EEG monitoring. Fellows will be on first call (phone) for consultation by the neurology fellow regarding seizures in a patient being monitored, whenever fellow duty hour regulations permit this.

    5. Conferences - Fellows will be responsible for preparing materials for the monthly epilepsy surgery conferences. Data to be organized and presented include patient history and exam, EEG and video monitoring, radiographic and neuropsychological findings.

    6. Teaching - Initially fellows will be expected to assist EEG and Epilepsy attendings in teaching activities. After four to six months experience the fellows will be expected to progress from supervised to independent teaching of the basics of EEG and epilepsy monitoring to other CNP fellows, technologists, neurology residents, and medical students.

    7. Research Opportunities - Fellows are encouraged to participate in the ongoing clinical research of the Adult Epilepsy Center or to initiate new projects deemed appropriate by the Program Director.

  2. EEG/Evoked Potential/Intraoperative Monitoring

    1. Overview - This subspecialty track consists of training in clinical neurophysiology focused on EEG and evoked potentials of both outpatients and inpatients undergoing operative procedures. The main objective is to master skills necessary to record and interpret EEG and evoked potential studies and to develop competence in clinical management of patients being monitored during surgery.

    2. Clinical Duties - Fellows will be responsible for pre-reading CNP laboratory EEGs daily, for reviewing these EEGs with an EEG attending daily, and for creating a final report. Fellows will also be on first call (phone) for emergency EEGs, whenever fellow duty hour regulations permit this.

    3. Intraoperative Monitoring - Fellows will be expected to attend intraoperative monitoring sessions at least three half days per week under the supervision of V. Leo Towle PhD and to prepare monitoring reports.

    4. Teaching - Initially fellows will be expected to assist EEG and Intraoperative Monitoring attendings in teaching activities. After four to six months experience the fellows will be expected to progress from supervised to independent teaching of the basics of EEG and intraoperative monitoring to other CNP residents, technologists, neurology residents, and medical students.

    5. Research Opportunities - Fellows are encouraged to participate in the ongoing clinical research or to initiate new projects deemed appropriate by the EEG Laboratory Director.

  3. EMG/Neuromuscular

    1. Overview - This subspecialty track consists of training in clinical neurophysiology focused on electromyography and neuromuscular diseases. The main objective is to master electromyography skills and to develop competence in clinical management of patients with neuromuscular diseases.

    2. Clinical Duties - The fellow will attend one day per week in a neuromuscular clinic under the supervision of Betty Soliven MD, Kourosh Rezania MD, and Raymond Roos MD.

    3. EMG - The fellow is expected to obtain a brief history and examine the patient prior to performing the tests in order to tailor the exam accordingly. The following tests will be performed and interpreted:

      • NCV and Reflex Studies
      • Repetitive nerve stimulation
      • Needle Exam
      • Quantitative Motor Unit Analysis and SFEMG (for second year fellows)
      • Autonomic and Quantitative Sensory Testing
      • Interpretation of Results (including writing the reports and communicating results to the referring physician in urgent cases):
        • Normal vs. Abnormal
        • Neuropathy vs. Myopathic vs. Neuromuscular Disorders
        • Radiculopathy vs. Plexopathy
        • Localization of Peripheral Nerve Entrapment
        • Axonal vs. Demyelinating Neuropathy
        • Motor Neuron Diseases

      All the studies will be performed initially under the supervision of Betty Soliven MD, John Jacobsen MD, Kourosh Rezania MD, and Helene Rubeiz MD (three and a half to four days per week). After four to six months, a half day will be set aside for the fellow to do routine studies unsupervised, but the cases will be discussed with Betty Soliven MD or her designate.

    4. Biopsy Interpretation - The fellow will spend two hours per week reading biopsies with Robert Wollmann MD or Peter Pytel PhD.

    5. Conferences - The fellow will organize neuromuscular pathology conferences once a month (3:00pm to 4:00pm, alternating with neuropathology conference). The format will be a brief vignette, EMG and histological correlation to be coordinated with either Robert Wollmann MD or Manuel Utset MD. This will be followed by brief literature review. In addition, the fellow will participate in grand rounds and neuromuscular lectures to residents.

    6. Teaching - Initially fellows will be expected to assist EMG attendings in teaching activities. After four to six months experience the fellows will be expected to progress from supervised to independent teaching of the basics of EMG and NCV studies to other CNP fellows, technologists, neurology residents, and medical students.

    7. Research Opportunities -

      • Clinical trials where electrophysiological studies are required
      • EMG Case Reports and Reviews
      • Cross-sectional or prospective EMG studies; normative data for new programs
      • Animal physiology and patch clamp studies for senior fellows who may be interested

      Fellows that become interested in the basic science aspects of nerve and muscle diseases are encouraged to apply to the MDA for research fellowship grant.
    Eligibility Criteria

    Applicants with one of the following qualifications are eligible for a CNP residency appointment:
    1. Graduate of a United States or Canadian medical school accredited by the Liaison Committee on Medical Education (LCME);

    2. Graduate of a college of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA); and

    3. Graduate of a medical school outside of the United States or Canada with one of the following qualifications:

      1. Have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) prior to appointment;

      2. Have a full and unrestricted license to practice medicine in Illinois;

    4. Graduate of a neurology, child neurology or psychiatry residency program;

    5. All applicants must fully complete the application form and process. Necessary information to be provided include education, training, and certifications to determine eligibility. This includes a certificate of completion from the director of the neurology, child neurology, or psychiatry residency program at the institution where the applicant completed training. Three letters of reference from faculty members are also required.
    How to Apply

    Click here to Download an Application.

    Residents are selected for the CNP fellowship from eligible applicants based upon their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities.

    No discrimination is made based upon sex, race, age, religion, color, national origin, disability, or veteran status.

    All applicants are sent an aplication form to complete. Necessary information to be provided include education, training, and certifications to determine eligibility. Applicants are asked to specify the area within CNP in which they wish to subspecialize (EEG/Epilepsy or EMG/Neuromuscular). Three letters of reference are also required.

    Completed applications are reviewed initially by the program director and the laboratory director of the subspecialty for which the fellow is applying. Approximately 20% to 40% of the eligible applicants are invited for personal interviews.

    Invited appicants are interviewed by the program director, at least one laboratory director, and as many CNP faculty as possible, particularly in the area in which the applicant wishes to subspecialize. Interviewers rate each applicant independently.

    A CNP faculty meeting is held after interviews are completed at which time applicant ratings are reviewed. Subspecialty lab directors each provide a summary of those candidates applying for their subspecialty. Decisions regarding appointments to the residency are then made by concensus.