FELLOWSHIP PROGRAMS
Subspecialty Fellowship Offered
Movement Disorders Fellowship program
Fellowship Directors
STANLEY FAHN, MD
H. Houston Merritt Professor of Neurology
Director, Center of Parkinson’s Disease and Other Movement Disorders
Email: fahn@neuro.columbia.edu
STEVEN FRUCHT, MD
Associate Professor of Clinical Neurology
Center of Parkinson’s Disease and Other Movement Disorders
Email: sfrucht@neuro.columbia.edu
Contact Person w/ Contact Information
KATHERINE MARQUEZ
Fellowship Coordinator
Neurological Institute
710 West 168th Street, 3rd Floor
New York, NY 10032
Tel: (212) 305-5295
Email: km2069@columbia.edu
FELLOWSHIP PROGRAM
Brief Description of the Fellowship Including Duration
The Movement Disorders Fellowship Program is a 1-2 year training program consisting of a choice of one of two distinct tracks: a clinical program and a basic science program. A combination of the two tracks is also possible.
Clinical Fellowship Program:
The goal of the clinical fellowship program is to train neurologists to become experts in the diagnosis and treatment of movement disorders. The core component of their education consists of learning how to diagnose and treat movement disorders by evaluating outpatients and hospitalized patients with these neurologic conditions at Columbia University Medical Center. Fellows work directly with the movement disorder faculty. The fellows perform clinical evaluations of patients under the attendings' direct supervision, and they follow the patients regularly with phone calls to make adjustments to their treatment. They review all management decisions with the attendings.
In addition to dealing directly with patients, fellowship education is also provided by weekly conferences in which patients’ clinical problems are discussed along with review of videotaped neurologic examinations ("video rounds"); presentation of individual patients in conference ("patient rounds"), monthly clinicopathologic conferences made possible by an active brain collection program, and monthly research conferences in which the faculty present their current research results. There are sessions after national and international neurology and movement disorder meetings where the important papers presented are discussed. Journal club is held on selected topics.
Clinical fellows gain familiarity with rating scales and develop a core of clinical and basic science knowledge relevant to the field of movement disorders. Fellows learn the techniques and therapeutic use of botulinum toxin injections for dystonia, hemifacial spasm, and related disorders. They have the opportunity to learn the techniques of programming for deep brain stimulation and motor control physiology, develop skills in research design and data analysis, and develop experience in clinical trials and epidemiology.
Each fellow is given a laptop computer and a digital video camera. All patients are asked to give permission for being videotaped so that their movements can be followed over time. The diseases encountered are Parkinson disease, atypical parkinsonism, cerebellar ataxia, chorea, dystonia, myoclonus, paroxysmal dyskinesias, tardive dyskinesia, tics, tremors and psychogenic movement disorders. Less common types of movement disorders are also encountered. A description of the types of patients encountered by the fellows has been published [Portera-Cailliau C, Victor D, Frucht SJ, Fahn S. Movement disorders fellowship training program at Columbia University Medical Center in 2001-2002. Mov Disord 2006 Apr;21(4):479-485].
The first year of the clinical fellowship program consists of three half-days a week in a clinic supervised by individual faculty members, working with and being mentored by three movement disorder faculty members, one for each session. Each of these three specific weekly sessions is supervised by the same faculty member for consistency and follow-up care. The fellow sees each patient first (obtaining a history and performing a neurologic and a movement disorder examination) and then presents the patient to the faculty member. Following that, the patient is discussed in terms of a differential diagnosis, a working diagnosis and a plan for treatment. Another half-day per week is set aside to take care of the patients who cannot afford private physician fees including those covered by Medicaid insurance. This weekly clinic evaluates patients predominantly from the surrounding neighborhood. The faculty rotates through this clinic, and the fellow presents the patient to the faculty member. All patients encountered in any of these four outpatient clinics is followed throughout the fellowship by the assigned fellow, who prepares the consultation report back to the referring physician, handles all telephone inquiries, and arranges laboratory tests and treatment schedules. If any of the patients requires hospital admission, the fellow follows the patient during the hospital stay. The fellow spends another half-day per week in our botulinum toxin injection clinic, which is a powerful method for treating a variety of movement disorders, especially torsion dystonia. The other half-days are available to become involved in a research project.
Second-year clinical fellows will be assigned different faculty members to be mentored by during this year. The fellow will have the same schedule as in the first year with one fewer half-day private clinic, to allow the fellow to become more involved in research and to provide elective time to learn DBS programming and to rotate in the operating suite to observe DBS surgery. There is also the opportunity to work with Dr. Seth Pullman in his motor control physiology lab, learning techniques such as tremor analysis, back-averaging for myoclonus, and injecting botulinum toxin into limbs for limb dystonia.
Patients with movement disorders may be admitted to the hospital for other neurologic or medical problems, and the Movement Disorder Division is usually asked to consult on these patients. Movement disorder fellows in both years provide these in-patient consultations, assigned on a rotating basis. The fellow sees the patient first, writes a consultation note, and then sees the patient again with a movement disorder faculty attending to discuss the patient in detail.
Each clinical fellow must have New York State medical license. The faculty meets quarterly to discuss each fellow’s progress, and a report is issued to the fellow. Clinical Faculty members are Drs. Stanley Fahn, Steven Frucht, Paul Greene, Blair Ford, Cheryl Waters, Elan Louis and Pietro Mazzoni.
Laboratory Fellowship Program:
The primary goals of the laboratory fellowship are to provide an experience in research design and laboratory techniques devoted to addressing basic questions in movement disorders, using tools of modern molecular genetics, immunohistochemistry, biochemistry, pharmacology and animal models. Specific techniques employed include stereotaxic brain injections of toxins, monitoring animal behavior, receptor binding assays, receptor autoradiography, assays of neurotransmitter agents and metabolites in tissues and body fluids using high-performance liquid chromatography, tissue culture, immunohistochemistry, enzymatic assays, molecular biology of DNA mapping, and developing mouse genetic models of movement disorders, including Parkinson’s disease and torsion dystonia. It is anticipated that graduates of the lab fellowship will develop careers as laboratory researchers in the field of movement disorders. Current projects include studies on dopamine, acetylcholine and other neurotransmitters and their receptors, evaluation of potential therapeutic agents, production of animal models of movement disorders, transplantation in animal models, molecular genetics and pathogenic mechanisms of neurodegeneration. Movement Disorder Faculty heading our basic science laboratories are Drs. Robert Burke, Serge Przedborski, William Dauer, David Sulzer, Ai Yamamoto and Lloyd Greene. Our group has been recognized as a Morris K. Udall Parkinson’s Disease Center of Excellence by N.I.H.
A combination of both clinical and laboratory fellowships are available.
One route is to take the first year of fellowship as a pure clinical fellowship, followed by the second year fellowship being a laboratory one, with only one-half day a week seeing patients in order to maintain clinical skills. Another possible route is to combine clinical and laboratory training in both the first and second years, with one day a week doing clinical work and the remainder of the time being in the laboratory. A joint 2-year program with neuroepidemiology training is available on a competitive basis, enabling one to be trained in both movement disorders and neuroepidemiology.
Research and Funding Opportunities
Clinical and laboratory fellows participate in ongoing research projects and are encouraged to develop their own ideas and research. The Program fosters a stimulating academic environment that helps young investigators successfully compete for grants.
How to Apply for the Fellowship Program:
The application process includes sending to Katherine Marquez (address above) 1) a letter requesting a fellowship interview, 2) a personal statement explaining the candidate’s interest in movement disorders and her/his future goal, and 3) a curriculum vitae and bibliography. Also required, but sent in separately, are at least three letters of recommendation, addressed to Dr. Fahn, with one letter being from the candidate’s department’s chairperson. There is no separate, identifiable application form. No candidate is accepted without undergoing a formal interview process, whereby the candidate meets the movement disorder faculty. Ms. Marquez will schedule the interview. Interviews take place in July through September.
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