MOVEMENT DISORDERS FELLOWSHIP PROGRAM
Subspecialty Fellowship Offered
The Movement Disorders Fellowship Program at CUMC was founded by Dr. Stanley Fahn in 1980 and is one of the longest running programs in the world. It has contributed to the development of Movement Disorders as a subspecialty of neurology. He has trained over 115 fellows over the years and remains active in training fellows.
Columbia has a tradition of fostering academic careers of both clinical researchers and basic science researchers with superb clinical skills. Our 16 faculty members serve as mentors and consist of clinicians, clinical researchers including epidemiologists, motor physiologists, and basic scientists demonstrating the interdisciplinary nature of our academic training and activities.
Our program is a unique combination of superb clinical training and intense research training program although we individually tailor the training program depending on the academic goals and background of the fellows. In their letter of intent, applicants are required to specify their interests.
Most of our fellows seek a combination of solid clinical training in diagnosis and management of movement disorders with a heavily clinical first year and rigorous research training in the subsequent years. First year is about 50% clinical, with 5 half-day clinics per week for most of the fellows. The rest of the time is devoted to developing research skills and exploring a research agenda. Fellows often spend Year 2 to Year 3 to prepare for a successful independent research career. Their research years are usually 20-30% clinical (including 1-2 half-days of clinical care) with 70-80% devoted to protected research and educational time.
Description of Training Program
A. Clinical Training:
The goal of the clinical training of the fellowship program is to train neurologists to become experts in the diagnosis and treatment of patients with movement disorders. The main component of the clinical education consists of learning how to diagnose and treat movement disorders by evaluating outpatients and hospitalized patients with these neurologic conditions at CUMC. The Fellows work directly with the movement disorder faculty. The fellows perform clinical evaluations of patients under the attending physicians' direct supervision, and they follow the patients regularly with visits and phone calls to make adjustments to their treatment and subsequent outpatient evaluations. They review management decisions with the attending physicians.
The first year of the clinical fellowship program consists of four half-days a week in a clinic supervised by individual faculty members, working with and being mentored by three to four movement disorder faculty members, one for each session. Each of these 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 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.
Patients with movement disorders may be admitted to the hospital for other neurologic or medical problems, and the Movement Disorder Division is often asked to consult on these patients. Clinical movement disorder fellows in both the first and second 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.
Many fellows spend additional one or more half-days per week in our botulinum toxin injection clinic, which is a powerful method for treating a variety of movement disorders, especially torsion dystonia. There include EMG guided limb injections. Fellows will also have elective time to learn DBS programming and to rotate in the operating suite to observe DBS surgery. There is also the opportunity to work in our motor control physiology lab, learning techniques such as tremor analysis, and back-averaging for myoclonus.
Each fellow is given a laptop computer and a digital video camera while with us. 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, essential and other 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].
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"), monthly clinicopathologic conferences (CPCs) made possible by an active brain and video collection program, topic reviews, and frequent journal clubs. These are all led by fellows and supervised by faculty members. Clinical fellows gain familiarity with rating scales and develop a core of clinical knowledge relevant to the field of movement disorders.
The faculty meets quarterly to discuss each fellow's progress, and a feedback is provided back to the fellow. Clinical Faculty members are Drs. Stanley Fahn, Roy Alcalay, Blair Ford, Un Jung Kang, Sheng-Han Kuo, Oren Levy, Elan Louis, Pietro Mazzoni, Seth Pullman, and Cheryl Waters. They may elect to spend time with Dr. Toni Pearson for pediatric movement disorders and in Huntington disease clinic (one half day a week for six months).
B. Academic Core:
The Program fosters a stimulating academic environment. Fellows in this track pursue educational academic activities such as case reports, retrospective case reviews, review articles and book chapters with faculty mentors. There is a weekly clinical research conference in which the faculty members and fellows present their research plans, progress reports, and results as well as weekly translational research seminar in which fellow or faculty member pairs, once each from basic science and clinical research present stimulating topics in a brainstorming session for new translational research ideas and directions. Fellows will gain exposure to research design and data analysis, and develop experience in clinical trials and epidemiology. They will have exposure to critical reading of the literature including basic science topics relevant to movement disorders. There are sessions after national and international neurology and movement disorder meetings where the important papers presented are discussed. Journal club is regularly held on selected topics.
C. Research Training:
Fellows are expected to formulate a research plan toward the end of the first year of their fellowship with their mentors and present their proposal to fellowship research committee before advancing to their research years. Most fellows write up their proposal to seek external research support from NIH, AAN, and private foundations for further research training to gain more experience before launching an independent career. All of our current Assistant Professors have NIH career development awards (K) and private foundation awards.
Fellows are free to seek mentors outside the division and outside the department anywhere at Columbia University including Taub Institute, Sergievsky Center, Mailman School of Public Health, New York State Psychiatric Institute, Departments of Pathology & Cell Biology, Neuroscience and Psychology. Parkinson’s Disease Foundation has been supporting our fellowship program as a leveraging launching pad for the careers of young motivated researchers in Parkinson’s disease and related movement disorders.
C.1. Clinical Research:
The aim of this program is to train clinical fellows in the techniques and methodologies of clinical research. This exceptional opportunity to integrate clinical and methodological fellowship training is not available in any other movement disorder program in the country and affords trainees a distinct educational advantage. Trainees complete the program with the tools they need to design, implement, and independently investigate clinical and/or epidemiological studies on movement disorders. One of the goals of this track is to prepare the fellows for a successful submission of mentored grant applications to the American Academy of Neurology, private foundations, or the National Institutes of Health (NIH).
The mechanisms through which trainees receive intensive exposure to clinical research training include institutional NIH funded Master’s programs such as Patient Oriented Research (POR) Master’s Program partly funded by NIH National Center for Research Resources (NCRR) and the Neuro-epidemiology Training Program (NETP) directed by Dr. Elan Louis in our division. NETP is one of only two such programs in the country and the oldest one in existence since 1981. Fellows are encouraged to apply to both movement disorders fellowship and POR/NETP program at the same or at least express clear interest in doing both in their cover letter. They could apply to POR/NETP during the first clinical year of movement disorders fellowship. In addition to epidemiology, clinical research projects include biomarkers, genetics, human imaging, motor physiology, rehabilitation, and therapeutic trials.
C.2. Basic Science Research
The primary goal of this combination fellowship is to provide both the clinical training and an experience in research design and laboratory techniques devoted to addressing basic questions in movement disorders, using tools of modern molecular genetics, cell culture, electrophysiology, immunohistochemistry, biochemistry, pharmacology and animal models. It is anticipated that graduates of the lab fellowship will develop careers as laboratory researchers in the field of movement disorders. Current projects include human genetics, pathogenic mechanisms of neurodegeneration in Parkinson’s disease including those involving mutations of PINK1, parkin, LRRK2, alpha-synuclein, and glucocerebrosidase. Projects on program cell death, autophagy, and axonal regeneration as well as basal ganglia plasticity involving dopaminergic therapy and dyskinesia are also available, but applicants should check individual laboratory website for more details and updated projects. Our group has been recognized as a Morris K. Udall Parkinson’s Disease Center of Excellence (PI: Dr. Robert Burke) by NIH. Training support is available from various sources including a fellowship position funded by the NIH Udall Center.
How to Apply for the Fellowship Program:
The subspecialty of movement disorders is not an ACGME accredited program.
Columbia is a member of a consortium with other movement disorder fellowship training programs in which a matching plan is utilized, and all consortium members notify fellowship candidates of acceptance on the same date. Thus, our program participates in the San Francisco Match for Movement Disorders Fellowship Match. In order to apply to our fellowship applicants should register through the San Francisco match website and then submit their application to us directly (firstname.lastname@example.org) with the following documents:
Applicants who are interested in NETP who are invited for interviews will also be given information about applying to the Mailman School of Public Health for the Masters Degree in Epidemiology Program. NETP is funded in collaboration with the NIH, and only open to US citizens or those holding a green card, Candidates are strongly encouraged to contact potential research mentors directly and indicate them in their letter of interest so that interviews are arranged with appropriate faculty members.
- a cover letter which summarizes candidate’s qualifications (completion of neurology residency, ECFGM certificate if applicable) and check list that consist of the following requirements (personal statement, CV, names of people who are writing recommendation letters) and possible research mentors whom the candidate wishes to meet during interview visit.
- a personal statement explaining the candidate's interest in movement disorders and her/his future career goals including their research interests,
- a curriculum vitae and bibliography, and
- three letters of recommendation, addressed to Dr. Fahn, the Fellowship Director, with one letter being from the candidate's department chairperson.
Applications should be submitted during PGY3 and must have successfully completed a neurology residency program before entering this fellowship.
After the application process, select candidates will be scheduled for an interview. No candidate is accepted without undergoing a formal interview process, whereby the candidate meets the movement disorder faculty. Interviews take place from May through August of PGY4 (9-12 months before starting the fellowship) here at Columbia. Candidates are required to submit their final ranking by September 4, 2014 and will be notified of their final match result on September 19, 2014.
We accept international applicants and support their J1 visa. Applicants, however, should be eligible for a New York State License, which requires an ECFMG certificate from all candidates who graduated medical schools outside the USA or Canada. A New York State medical license is required to see patients.
STANLEY FAHN, MD
H. Houston Merritt Professor of Neurology
Emeritus Founding Director, Center of Parkinson’s Disease and Other Movement Disorders
UN JUNG KANG, MD
H. Houston Merritt Professor of Neurology
Director, Center of Parkinson’s Disease and Other Movement Disorders
For general inquiry and application:
For specific information:
For NETP and Clinician Scientist track
Elan Louis, MD
For Udall Center Fellowship and Basic Scientist track
Un Jung Kang, MD