Intraoperative Neurophysiology Monitoring Fellowship

Overview

The overall educational goal of the IONM Fellowship Program is to prepare fellows to practice competently and independently as experts in the field of clinical intraoperative neurophysiology, thus being able to efficiently monitor and map both peripheral and central nervous systems (PNS and CNS, respectively) during surgeries.

By the end of the fellowship, fellows will be:

• Able to individually evaluate each case based on the patient’s neurological exam, medical history, and type of surgery to be performed in order to determine the most useful neurophysiological test or combination of tests to be used for monitoring
• Able to discuss the plan for monitoring with the surgical and anesthesia team
• Able to explain the monitoring procedure as well as its risks and benefits to the patient
• Familiar with all the pertinent technical aspects of each test, thus being able to perform them, starting with the set up
• Able to accurately interpret all neurophysiological tests used during monitoring (EEG, ECoG, Somatosensory Evoked Potentials, Motor Evoked Potentials, Brainstem Auditory Evoked Potentials, Free and Triggered EMG)
• Able to determine if changes in the neurophysiological tests seen during monitoring are due to dysfunction of the nervous tissue or they are a result of anesthetic regimen, technical difficulties, or other external factors (troubleshooting)
• Able to advise the surgeon as to the possible mechanism through which each injury occurred as well as what steps can be taken to reverse the neurological dysfunction
• Able to write a comprehensive and informative report for each neurophysiological procedure used
• Familiar with literature of specialty
• Involved with an Intraoperative Neurophysiology Monitoring (IONM) research project, with the final goal of finalizing and submitting for publication the results in a peer-reviewed specialty journal
• Well prepared for and strongly encouraged to pursue a formal board certification in the IONM specialty (American Board of Clinical Neurophysiology – IONM track)

Fellows will be evaluated on the six ACGME core competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

Requirements

Candidates must be board-eligible in Neurology, have completed residency in good standing prior to the start of the fellowship, and have a solid background in clinical neurophysiology. Fellowship training in Clinical Neurophysiology is preferred, but not required.

Curriculum

The IONM Fellowship Curriculum is designed as a stand-alone one-year fellowship and is structured in three parts:

Rotation one (two months): offers intensive theoretical and practical learning through a set of lectures, workshops, and live technical set up in the operating room (OR). This will constitute the cornerstone for further training in this specialty.

Rotation two (six months): implements the basic knowledge learnt in rotation 1 and builds hands-on expertise in the OR by involving fellows in live coverage of monitoring and mapping cases and familiarizing them with the OR environment.

Rotation three (four months): allows a combination of in OR and outside OR training. Fellows will learn to prioritize his/her involvement in different cases, at different stages, and of different degrees, based upon necessity. Additionally, throughout the year, the fellow will gain IONM research exposure by getting involved with an assigned IONM research project.

There is the opportunity of extending the fellowship for a second year. The scope of a second year is to allow academic growth, by placing significant emphasis on IONM research. A second year of fellowship is contingent upon external funding availability, such as grant support. For example, this could be achieved by developing an independent IONM research project submitted for funding during the first year of training.

Clinical Experience

The clinical aspects of their education will include in-depth training in all practical and theoretical aspects of IONM procedures including: electroencephalography (EEG), electrocorticography (ECoG), functional supratentorial mapping, brainstem auditory evoked potentials (BAEPs), cranial nerve monitoring and mapping, free and triggered electromyography (MEPs), and compound nerve action potentials (CNAPs).

Research Experience

The research aspect of their training will include involvement with at least one assigned IONM research project with at least one faculty member from the fellowship staff with the ultimate goal of submitting for publication. It is expected that the fellow will obtain ACNS Board Certification in IONM within two years of completing the fellowship.

How to Apply

We are currently accepting applicants on a rolling basis. In your letter of intent, please clearly indicate the academic year for which you are applying.

Applicants should send a CV, a letter of intent, and three letters of reference to Dr. Mirela Simon and Fellowship Coordinator Erica Ratti. Administrative questions and requests for general information should be directed to Erica Ratti.