Neuromuscular

I. Introduction

The goal of The University of North Carolina at Chapel Hill Neuromuscular Fellowship Program is to train the fellow in the skills, knowledge, and attitude necessary to take care of patients with neuromuscular disorders. This is achieved as the fellow interacts with patients under the guidance and supervision of faculty members who give value, context, and meaning to those interactions. Graded and progressive responsibilities are earned as the fellow gains experience and demonstrate growth in their ability to care for patients with neuromuscular disorders. The objectives of the program will be achieved as the six ACGME core competencies in the areas of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice are attained.

II. Background

The University of North Carolina at Chapel Hill Neuromuscular Fellowship Program offers a unique setting for the fellow to become an expert in neuromuscular medicine. This is made feasible because of 1) a large patient population within UNC Healthcare serving the Research Triangle area, the State of North Carolina and the states surrounding North Carolina and 2) a faculty with expertise in all aspects of neuromuscular medicine.

III. Fellow Eligibility Criteria

The Neuromuscular Medicine fellow must have successfully completed a residency program in PM&R or Neurology accredited by the ACGME.

IV. Timetable for Training

The ACGME Neuromuscular Medicine fellowship program is 1 year long. Fellows who are interested in additional training in clinical research methods are encouraged to pursue an additional year of non-ACGME accredited training.

V. Clinical Training

Outpatient:

The neuromuscular fellow will spend 3-4 half days in the outpatient neuromuscular clinic. The fellow will be rotating through the:

  1. Myasthenia Clinic with Dr. James Howard every other Monday morning.
  2. Myopathy Clinic with Dr. Nizar Chahin every Tuesday.
  3. ALS clinic with Dr. Chafic Karam every other Friday.
  4. Peripheral Neuropathy Clinic with Dr. Chafic Karam every other Friday morning.

During their rotation, the neuromuscular fellow will be assigned pre-triaged patients with increasing complexity as they earn more experience. The fellow will be responsible to obtain a thorough medical history and neurological examination. The fellow will then formulate a differential diagnosis and management plan. The fellow will present to the neuromuscular faculty the findings, discuss the differential diagnosis and formulate a plan. The fellow will explain to the patient the impression and the plan of care. The fellow will knowledgeable of the current literature and level of evidence regarding of the management of particular disorders in the field of neuromuscular medicine.  The patients will be followed-up by the same fellow. The fellow will be supervised by a neuromuscular faculty. The fellow will be seeing patients of an adequate number of patients of both sexes, and a spectrum of socioeconomic status and age, including pediatric, adolescent and geriatric groups.

Inpatient

The fellow will be evaluating neuromuscular inpatient consultations, including in the intensive care setting. The patients seen at the hospital will have a variety of neuromuscular conditions and will provide expertise for inpatient neuromuscular consultations and emergencies. These consultations will be seen up to twice a week.

VI. Electrodiagnostic, autonomic studies, nerve imaging, chemodenervation and nerve and muscle biopsies training

The fellow will spend 6 half days in the EMG laboratory. The fellow will be performing nerve conduction studies and needle electromyography under the supervision of a neuromuscular faculty. With further experience gained, the fellow will learn more advanced techniques such as single fiber EMG, short and long exercise tests, chemodenervation, nerve ultrasound etc.

The last half day of the week will be either spent in the autonomic laboratory or observing muscle and nerve biopsies. When the fellow feels confident, opportunities to perform and interpret autonomic testing or muscle or nerve biopsies will be offered.

VII. Lectures

A. Neuromuscular medicine didactic lectures series

Mandatory Lectures are held every other Wednesday at 7:15 am (apart from major holidays and national/international meetings)

B. Neuromuscular pathology conference

Held every other Wednesday at noon.

C. EMG-clinical correlation conference.

Held every Friday at 7:30am.

D. Journal Club

Held once a month, Monday at noon.

E. Scholarly Activities

The fellow will be trained in the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. The fellow will be expected to participate in scholarly activity. In addition to being able to participate in residents and medical student teaching, the fellow will be trained on how to review a scientific paper as well on how to write a scientific paper. The fellow will be encouraged to contribute to the scientific community by writing case reports, case series and if possible designing a research study (an additional year of research fellowship may be needed). UNC allocates adequate educational resources to facilitate the fellow involvement in scholarly activities. The faculty is compensated for teaching, research activity and publications.

VIII. Conclusion

At the end of the fellowship, the neuromuscular fellow will be able to expertly evaluate, diagnose and treat patients with a wide variety of neuromuscular disorders. The fellow will know the values of the tests relevant to neuromuscular conditions, their cost and limitations. The fellow will have a background that will enable them to critically appraise data published on neuromuscular conditions. The fellow will be able to take the Neuromuscular Medicine ABPN board as well as the ABEM electrodiagnostic board.

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