Institution/Department Address (with email/phone/fax): Neurology (GEC), Atlanta VA Medical Center, 1670 Clairmont Rd., Decatur, GA 30033

Primary contact for training information (name, address, fax (if different than above) and email): William Tyor, MD, Contact through Ms Simpson at 404-321-6111, ext 5142

Brief information on program: The primary goal of the multiple sclerosis fellowship at the Emory/Atlanta MS Center is to provide fellows with a one to two-year-long experience focusing on the evaluation of patients with multiple sclerosis. The fellow will also be trained in other neurological autoimmune inflammatory and infectious conditions and will have an opportunity to participate in MS related clinical and/or basic research.

Types of training programs: Resident, Fellowship, Other

How many fellows/residents per year: 1

Fellowship Duration: 1 year and 2 years

Area/s of Training: Multiple Sclerosis, Neuroimmunology, Neurology, Other

What aspects: Demyelinating diseases (MS, NMO, Etc.), Neuro-rheumatology, Paraneoplastic, Encephalitis, Vasculitis, Autoimmune Epilepsy

Fellowship program structure: Clinical, Research-based

Percentages of clinical and research-based components: Depends on the applicant

Is On-call duty and/or general clinic participation required?: Yes, if desired

Additional training: Required/Offered: Neuropathology, Neuro-ophthalmology, Neuro-radiology, Neurorehabilitation, Neuropsychology

Visa Sponsorship?: No

Approved by Institution’s ACGME office?: Yes

Is independent funding required for Fellows?: Possibly

Additional information:

http://neurology.emory.edu/programs_centers/programs/multiple_sclerosis/index.html

Facilities, Faculty

The fellowship is primarily based at the Atlanta VA Medical Center and Emory University. This includes outpatient clinics, inpatient consult service, clinical research space and the Atlanta VA Clinical Research Unit. There are also basic laboratories affiliated with the Emory/Atlanta MS Center on the Emory and Atlanta VA campuses. There is an opportunity to observe at the Shepherd MS Center, which is located next to Piedmont Hospital in Buckhead. The Director is Dr. Ben Thrower

Key teaching faculty include: Drs. Saindane, Lava, Tyor, and Vargas.

Program Objectives
The curriculum is individualized depending on the fellow’s needs and proficiencies.

Upon completion, fellows will have exceptional knowledge of demyelinating diseases of the central nervous system. This will comprise basic and clinical aspects of MS and include other demyelinating diseases such as neuromyelitis optica, acute disseminated encephalomyelitis, optic neuritis, and transverse myelitis. In addition, training will include basic neurological issues, continuously improving knowledge of neuro-immunological and neuro-infectious issues, and the ability to formulate appropriate assessments and plans for even the most complicated patients. Fellows are also exposed to a wide range of patients with other neuro-infectious and autoimmune inflammatory conditions, including lupus cerebritis, neurosarcoidosis, HIV dementia and opportunistic infections, neuroborreliosis, viral encephalitis, and meningitis. Fellows participate in clinical and research conferences with the faculty. History taking, examination skills, and ordering and interpretation of neurodiagnostic studies are taught and supervised by the faculty. Fellows and faculty also discuss and evaluate scientific articles, including evidence-based approach and basic science articles applicable to the mechanisms and treatment of the diseases under consideration in the patients they are seeing. Fellows are also expected to teach their knowledge to residents, medical students, and other associated health professionals who may participate on the service or in the conferences.

Clinical
The fellow will be expected to attend all existing multiple sclerosis clinics on a regular basis:
1. Wednesday mornings at the Atlanta VA with Drs. Tyor and Vargas.
2. Monday MS clinics with Drs. Tyor and Lava.
3. Friday MS clinic at Emory with Dr. Vargas.

There is also opportunity to staff inpatient neuroimmunology consults at the Atlanta VA, Emory and Grady Medical Centers as needed and depending on the vailability of the fellow. Additionally, at a minimum, the fellow will establish a weekly 1/2 day continuity MS clinic at the VA.

Educational Opportunities:
1. Emory MS Clinics: The fellow will attend Emory MS clinics with Drs. Tyor and Lava on Mondays and with Dr. Vargas on Fridays. These faculty will supervise the training/education of the fellow in the context of patients seen in these MS clinics.

2. The fellow may also attend a half day of clinical education activities once a month at the Shepherd Multiple Sclerosis Center, supervised by Dr. Thrower. Like the Atlanta VAMC and Emory, the Shepherd MS Center is active in providing comprehensive care to patients with demyelinating diseases, and participates in multicenter MS therapeutic trials, which could provide another source of training for the fellow in clinical research, in addition to the Atlanta VA and Emory.

3. Inpatient clinical education activites: The fellow will participate with the established inpatient Neuroinfectious/Neuro-immunology Consult Service. This service covers three major teaching hospitals in Atlanta: the Atlanta VAMC, Emory University Hospital, and Grady Memorial Hospital. Therefore, the Neuroinfectious/Neuro-immunology Consult Service provides an outstanding opportunity for the fellow to participate in both common and unusual clinical cases seen in these institutions.

4. There is an opportunity to obtain neuroradiology training with Dr. Saindane a half-day every other week.

5. There is an opportunity to obtain neuropathology training with Dr. Brat a half-day every other week.

6. As appropriate, the fellow will be expected to participate in didactic course work related to clinical trial design, statistics, etc. Possible courses, offered through the Laney School of Graduate Studies at Emory, include:
Introduction to Clinical and Translational Research
Clinical Decision Analysis, focusing on evidence-based analytic techniques for clinical trials
Data Collection, Management and Analysis
Analytic Epidemiology
Biostatistics for Clinical and Translational Research
Clinical Trial Design
Fundamentals of Bioinformatics
Scientific and Grant Writing
Bioethics, Legal and Social Issues of Clinical Investigation

Clinical Research
1. The fellow will participate in all of the ongoing MS studies at the Atlanta VAMC and Emory MS Centers. For the multicenter trials, the fellow will be the primary examining physician. For the VA study (VALOMS), he/she will completely evaluate enrolling patients (about 1/month).
2. The fellow will develop his/her own research project. This will include development of a VA and Emory database of MS patients. One possible study which the fellow may undertake is to correlate cognitive impairment in MS patients through a limited neuropsych battery, with advanced MRI as directed by Dr. Saindane, and also with CSF biomarkers, which she may learn to perform herself in Dr. Tyor’s laboratory. The fellow will be expected to present his/her data at a national meeting.
3. There are opportunities to participate in ongoing multicenter MS trials at Emory under Dr. Lava.
4. There are opportunities to observe ongoing multicenter trials at Shepherd MS Center under Dr. Thrower.

Basic Research

Basic research opportunities are available in Drs. Tyor, Evavold or Galipeau’s laboratories.

Teaching
The fellow will teach residents who rotate through the established Neuroimmunology/ NeuroID resident elective, through our inpatient service and in our outpatient clinics.

The fellow will be responsible for keeping track of patients presented at our monthly NeuroID/Neuroimmunology Case Conference, and giving follow up on their progress or outcome. He/she will also prepare brief talks on various subjects to present at this conference when time allows.

Individual and Programmatic Evaluation
The objectives will be discussed by the faculty and fellow at the beginning of the fellowship, and returned to for clarification during the fellowship as needed.

Fellows will receive immediate informal feedback about their performance, especially if there are any concerns or issues.

On a monthly basis, fellows will be asked to evaluate the faculty and program and faculty will be asked to evaluate the fellow. Dr. Tyor will distribute and collect evaluation forms. Dr. Tyor will review this feedback and take action as needed to help improve the performance of the faculty, fellow, and/or program. In addition to filling out and turning in evaluation forms, fellows and faculty will be encouraged to have a formal meeting for verbal performance review and feedback.

The ultimate goal of the MS fellowship program is to prepare MS specialists who will contribute to the well being of patients with MS. Our preference is that these MS specialists remain in academics with some research and teaching efforts.

Fellowship Map