strong programs for fellowship in...?

Neuro-Oncology: Sloan Kettering, UCSF, MD Anderson, Duke, Dana Farber, Hopkins

Vascular/stroke: pretty much same list as neurocritical care. Maybe add Pittsburgh and Cincinnatti.

EMG/neurophys: Mayo, Cleveland Clinic, Case Western, MGH, Univ Rochester
Keep in mind that "neurophys" is a very broad area, often split into "EMG/neuromuscular" and "EEG/epilepsy." At many institutions one area may be markedly stronger than the other. The ones I listed above are my picks for the "EMG" side since that's what you asked for. If you were interested more in EEG, I'd replace Case and Rochester with Rush and maybe Yale or Penn.

Neuro-ID: Maybe Univ of Washington?

The issue in fellowship is what are your goals. Just like in Medical School rankings, you need to consider whether you will become an academician or a private practitioner. Furthermore, many of the programs cited above require you to do a 2-year fellowship that prepares you for an academic career.

Epilepsy: Cleveland Clinic, Columbia, Duke, Mayo, Montreal Neurological Institute, UCLA, and Yale are the top academic programs.
However, there are many very strong groups along the US. In Texas, it is now a toss-up between UT-Southwestern and UT-San Antonio. Both have 9 monitoring beds. The programs in Houston have cannibalized each other, and none are bigger than those above. Look at the NAEC list.

For Stroke/Vascular, I would suggest that the recommendation above is based primarily NeuroICU programs, while there are Stroke/Vacular programs with more emphasis in Secondary Prevention and clinical care. For the latter, our center shines (look for SPS3 or SPAF in pubmed). We also have a Neurointensivist who was faculty at Columbia.

In Clinical Neurophysiology, there are few truly combined EEG/EMG fellowships that prepare you for private practice. At my institution (UT-HSC-San Antonio), we offer 6 months of each while reading Sleep twice a week during the 6 months of EEG. You also have 1/2 - 1 day clinic/week in Neuromuscular or Epilepsy/Sleep. I believe that it prepares private practitioners very well. However, one could choose to pursue the EEG/Epilepsy track. We have 4 EEG, 4 EMG and 4 Sleep faculty. Last month, a Rush resident was offered there but took our position.

What matters is your goals and not the sexiness of your program.

Stroke fellowships are different from Neurocritical care. Also because the ACGME requirements for 'Vascular Neurology' fellowships are different from the UCNS requirements for Neurocritical care certification. Till 2008 someone with a NICU fellowship could also take the 'Vasc Neuro' boards and vice versa, but now these fields have gone separate ways.
Most NICU fellowships will not involve dedicated 'Acute stroke' management and subsequent follow up. Certainly stroke fellows go not manage TBI, Status or neuromuscular illnesses. Both manage bleeds (ICH).
I interviewed at quite a few places at the major programs for Stroke as well as NICU and shared my experiences with friends who did the same. Most places have separate stroke and NICU services. But fellows rotate for a few months on either services as a part of their training.
The only places where it is still possible (as of now) to combine stroke with NICU are MGH, Jefferson and UCSF, but this may change.
It is also important to see which faculty are renowned and academically more accomplished. These programs do not necessarily have the best (top 20 or so) residency training, but have the best NICU or Stroke programs in the country. Most people (including colleagues and faculty at major programs) I spoke to recommend the following programs as probably the best. It goes without saying that all these programs are big on research and publications.
For NICU:
Columbia: fantastic NICU, Stephan Mayer is a major strength to the program. But some other faculty have recently left.
Mayo Clinic: Wijdicks and Manno are a strength.
MGH: Lee Schwamm is a strength. Walter Koroshetz was the former vice chair in neurology and now is the associate director of NINDS.
UCLA: Paul Vespa is a strength. Excellent multimodality neuro-monitoring.
UCSF: J Claude Hemphill is a strength. Daryl Gress has now moved to U Va. Excellent multimodality neuro-monitoring.
UVa: among the first NICU programs. Has had very prominent people including Thomas Bleck (who moved to Northwestern). Now Daryl Gress is chair
Wash U: Michael Diringer is a strength. Tremendous research on PET imaging in NICU.
Hopkins: Mirski is a prominent name. But the program appears to be anesthesia dominated, if that matters to you.
I also interviewed at CCF- but it had a lot of turn over recently. Michael DeGeorgia has moved to Case Western. Penn is a new program, but appears good. Andrew Kofke is a strength. Duke: is good, Graffagnino is a strength.

For Stroke: The best stroke programs are in major cities with high volume of stroke patients. The future of stroke care is 'telemedicine'. At some programs that I saw, a single center is providing stroke coverage to over 10 hospitals and multiple ERs using telemedicine. Whenever a patient shows up to any ER, say 50 miles away, the 'stroke beeper goes on' so the stroke fellow/attending gets notified immediately. They access the telemed system and get connected immediately to the peripheral ER, do a quick NIHSS, authorize thrombolysis and get the patient transferred to their center. This gives them a high volume of patients in treatable time windows for intravenous and endovascular thrombolysis. This I felt was fantastic. These programs did a high volume of intra-arterial as well as endovasc thrombolysis. There are regular protocols for CT/CTA/CT Perfusion. Very few programs in the US have a telemed stroke program.
The best stroke fellowship programs (in the opinion of many people) are
MGH: has telemed, Schwamm and Koroshetz are prominent. Have fellows going into neurointerventional as well.
UT Houston: excellent telemed program. Jim Grotta is a major name in cerebrovasc disease. Has largest volume of stroke patients in the US (over 700 patients a year). TPA rate exceeds 30 % (national average is 2-3%). Largest volume of stroke patients receiving endovasc stroke therapy. Fellows have trained in interventional as well.
U Cincinnati: Joseph Broderick is a major name in stroke. He is also the PI of IMS (Interventional management of stroke) study. I am not sure about telemed. Fellows trained in interventional as well.
UCLA: excellent telemed and interventional stroke program. Jeffrey Saver is a strength. Fellows trained in neurointerventional as well.
U Pittsburgh: Lawrence Wechsler is a strength. Excellent acute stroke and endovascular service. Fellows trained in interventional as well.
CCF: Anthony Furlan is a strength. Tremendous work in intracranial stenting.
Columbia: heavy on stroke epidemiology. JP Mohr is a strength (but more epidemiology). Ralph Sacco has moved to Miami. Strength is stroke epidemiology, TCD, not heavy on thrombolysis.
UCSF: fellows train in NICU as well as stroke (but not sure how it would change, now that ACGME and UCNS requirements are different for stroke and NICU)
Some other programs that have excellent NICU fellowships and do not have as good stroke services. Duke: only stroke epidemiology and basic science. Larry Goldstein is a prominent name,but confined to epidemiology. The general neurology svc does acute stroke management, so there is no stroke svc per se. Wash U: was big in PET imaging in stroke, but William Powers has now left. Mayo Clinic: more in epidemiology. Robert Brown ia prominent name (current president of the ANA), but more involved in epidemiology and basic sciemce; acute stroke svc has a lot to be desired. Hopkins: stroke faculty not as academically renowned as NICU (but certainly have the hopkins name).
There are other programs that may not be at the highest level, but have prominent faculty-
U Chicago: Jeffery Frank (NICU), Wayne State: Bill Coplin(NICU) and Seemant Chaturvedi (Stroke), Baylor: Jose Suarez (NICU), Emory: Owen Samuels(NICU) and Marc Chimowitz (Stroke), Barrow: Mark Malkoff (NICU) and Alexandrov (stroke), BIDMC: Louis Caplan (stroke), BU: Viken Babikian (stroke)

I gathered this information from the experiences of people including me who interviewed this year for Stroke and NICU fellowships. Hope this helps all those neurology residents who share the same passion for Stroke and critical care as I do.

I _really_ appreciate all of your help, as will many others who will read this down the line. maybe see in Vegas on Friday?scm

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No, but I'll be in New Orleans in february for the International Stroke Conference

scm said:

thanks! this has all been extremely helpful

"Columbia: fantastic NICU, Stephan Mayer is a major strength to the program. But some other faculty have recently left."

namely Sacco who most people wouldn't consider just "some other faculty" unless you are referring to other NICU people?

"UCLA: Paul Vespa is a strength. Excellent multimodality neuro-monitoring."

i hear UCLA is very neurosurg heavy? i see they are within the dept of neurosrug. also heard something about a pretty crazy schedule awhile back, though that might have changed. Vespa does some very interesting stuff.

"Michael DeGeorgia has moved to Case Western" i see he did his NICU training in Germany. is this unusual/possible? it would be awesome to train overseas, if a language barrier isnt a problem.. there seems to be a lot of interesting research coming from europe and japan..

"There are other programs that may not be at the highest level, but have prominent faculty"

let me add Bhardwaj @ OHSU

heard anything about NICU @ BIDMC?

I haven't heard of this new chair @ UVA via UCSF, I'll look him up, but presumably this gives strength to the program? is Bleck going to be starting an NICU at northwestern?

I _really_ appreciate all of your help, as will many others who will read this down the line. maybe see in Vegas on Friday?

scm

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Just to clarify:
Sacco was the chief of the 'Cerebrovasc division' at Columbia which also included the NICU. Since he left for Miami, the NICU and the stroke divisions have separated in many ways with Mayer being the chief of NICU and Randolph Marshall the acting chief of 'Stroke'. The other faculty that have left include Augusto Parra and Neeraj Badjatia. But I heard Kiwon Lee from Jefferson recently joined the Columbia NICU group.
UCLA: the NICU fellowship is within the dept of neurosurg with a lot of overlap with neurology. This is a blessing in many ways for anyone who trains in NICU, because you would be able to 'actually place' ventriculostomies, LICOX and ICP monitors. This is a major plus. Many NICU programs incl Columbia, Hopkins, CCF, Mayo, Duke will not let you do these procedures due to 'political' reasons. However all the NICU programs will let you manage these and do intraventricular thrombolysis for IVH.
CCF: Michael DeGeorgia did train in Germany. He was in fact the first neurointensivist to pursue hypothermia as a neuroprotective therapy in the US. Germany has been the pioneer in many such technologies including hypothermia and he (I feel) should get credit in bringing these concepts to the US.
UVA: New chair is Daryl Gress (who can rightly be called as among the founding fathers of the field of Neurocritical care, including Thomas Bleck and Allan Ropper). He started the NICU program at UCSF

Penn should be included among the top NCC training programs.
They have excellent faculty (Andy Kofke, Josh Levine, Peter LeRoux, Soojin Park) and have among the most experience with multimodality monitoring of any institution. They see a large volume of both trauma and vascular disease. Their fellows are trained to insert intracranial monitoring devices. Academically, Penn is among the most prolific institutions as well.

Agree with comments about Columbia, MGH, UCSF, JHU as well - all superb training programs.

its been a while since someone post about the topic
I was curious, how will you rank the following places for a EEG/academic fellowship?

-Hopkins
-NIH
-Duke
-Emory
-Yale
-UT-Southwestern
-UT-San Antonio
-Baylor

Thank you so much for all your input!

Fencer said:

The issue in fellowship is what are your goals. Just like in Medical School rankings, you need to consider whether you will become an academician or a private practitioner. Furthermore, many of the programs cited above require you to do a 2-year fellowship that prepares you for an academic career.

Epilepsy: Cleveland Clinic, Columbia, Duke, Mayo, Montreal Neurological Institute, UCLA, and Yale are the top academic programs.
However, there are many very strong groups along the US. In Texas, it is now a toss-up between UT-Southwestern and UT-San Antonio. Both have 9 monitoring beds. The programs in Houston have cannibalized each other, and none are bigger than those above. Look at the NAEC list.


In Clinical Neurophysiology, there are few truly combined EEG/EMG fellowships that prepare you for private practice. At my institution (UT-HSC-San Antonio), we offer 6 months of each while reading Sleep twice a week during the 6 months of EEG. You also have 1/2 - 1 day clinic/week in Neuromuscular or Epilepsy/Sleep. I believe that it prepares private practitioners very well. However, one could choose to pursue the EEG/Epilepsy track. We have 4 EEG, 4 EMG and 4 Sleep faculty. Last month, a Rush resident was offered there but took our position.

What matters is your goals and not the sexiness of your program.

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To piggyback:

Strong programs in MS? In Movement disorders?

Movement disorders:
http://www-forums.studentdoctor.net/threads/movement-disorders.931659/


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