Behavioral Neurology and Neuropsychiatry Fellowship Program

The Behavioral Neurology and Neuropsychiatry Fellowship Program at Massachusetts General Hospital is a training program established within the Department of Psychiatry and Department of Neurology with the purpose of training the next generations of outstanding neuropsychiatrists, behavioral neurologists and like-minded clinician-scientists. The program core faculty body includes neuropsychiatrists, behavioral neurologists, neurologists, neuropsychologists and biostatisticians.

The fellowship provides a multidisciplinary training environment with access to subspecialty clinics in the Departments of Psychiatry and Neurology. As a fellow, you will spend time in our clinical services under the supervision of Mass General faculty. These rotations provide with experience in the evaluation, diagnosis and treatment of a wide range of behavioral neurology and neuropsychiatry disorders, including:

• Neurodevelopmental genetic neuropsychiatric disorders
• Geriatric neurodegenerative neuropsychiatric disorders
• Mild cognitive impairment and dementias including Alzheimer's disease, Frontotemporal Dementia and Lewy-Body Dementia
• Movement disorders and Tourette's
• Cerebrovascular disorders
• Epilepsy
• Neuroinflammatory and Neuroinfectious neuropsychiatric disorders
• Traumatic brain injury
• Ataxia and Gait disorders
• Brain tumors
• Circuit-based formulation and treatment planning with neuromodulation therapies
• Functional Neurological Disorder and other Brain-Mind-Body Conditions

For clinically-oriented fellows, you will be expected to take part in at least six sessions/week face-to-face patient encounters. We also offer a two-year 50% clinical / 50% research clinician scientist track. In weekly clinical rounds, you will present cases to senior clinicians expanding your clinical knowledge on several aspects of behavioral neurology and neuropsychiatry from patient care and system-based practice.

Goals of the Fellowship

Goal 1: To develop clinical expertise and competence in the treatment and care of patients with disorders associated with brain dysfunction.

Fellows will further develop the clinical skills they acquired during residency and will learn to perform a thorough clinical assessment that will combine elements of both neuropsychiatry and behavioral neurology data gathering appropriate for each individual case. Fellows will need to be proficient in the neurological and the mental status exam, the selection and administration of the appropriate neuropsychological testing, the use of diagnostic procedures with relevance to both behavioral neurology and neuropsychiatry, and the interpretation of their results.

Fellows will achieve this goal participating in supervised, direct patient care in the Core and Subspecialties Clinics at Mass General. The program clinics are major referral sites for a wide range of conditions spanning from neurodegenerative disorders (e.g. Alzheimer's disease, Frontotemporal Dementia, Lewy-Bodies Dementia, Progressive Supranuclear Palsy), to developmental neuropsychiatry (including acquired and congenital developmental disorders such as Down's syndrome, Williams Syndrome, Fragile X syndrome, ADHD and pervasive developmental disorders), movement disorders (Parkinson's disease, Huntington's disease, dystonia, Tourette's), stroke, epilepsy, multiple sclerosis, traumatic brain injury, brain tumors.

Goal 2: To develop an in-depth knowledge of structural and functional neuroanatomy as they relate to behavior, cognition, perception, and emotion.

Fellows will achieve this goal through:

1. attendance of formal didactics which will include the core curriculum classes, the neuroradiology and the neuropathology rounds and the neuropsychology seminars;
2. clinical rounds and case presentations and discussions;
3. reading and discussion of textbook chapters and research articles during supervision.

Fellows will develop an operational knowledge of structural and functional neuroanatomy and will learn to integrate data gathered through the clinical evaluation and the diagnostic studies in order to identify the brain system/s affected in each individual case.

Fellows are encouraged to improve specific areas through self-learning. To this purpose the Francis Countway Library at Harvard Medical School and the Treadwell Library at MGH offer access to a wide range of tutorials and online textbooks, which can help fellows develop their neuroanatomy knowledge covering areas of relative weakness.

Goal 3: To gain broad knowledge of the diagnostic categories of behavioral neurology and neuropsychiatry, including circuit-based case formulation.

Fellows will learn fundamentals of the major diagnostic categories of behavioral neurology and neuropsychiatry including: epidemiology, genetics, neurobiology and neuroanatomy, clinical manifestations, diagnostic procedures, psychopharmacological treatment, psychotherapy, cognitive rehabilitation, and the roles of social work assessment and support, and family counseling and assistance. This goal will be accomplished through the supervised direct patient care, attendance to the didactics core program, supervision and self-directed learning.

Goal 4: To promote advanced understanding of neuropsychopharmacology including in depth knowledge of neurotransmitter systems, how they are affected in the conditions commonly seen in the behavioral neurology and neuropsychiatry practice, and how they are modulated by psychoactive drugs.

Fellows will expand on previous knowledge on:

1. neurotransmitter systems and their function in health and disease;
2. principles of pharmacokinetics, pharmacodynamics and drug interactions for the major classes of psychoactive drugs including: antidepressants, anticonvulsants and mood stabilizers, sedatives and hypnotics, first and second-generation antipsychotics, psychostimulants, cholinesterase inhibitors, NMDA antagonists.

In addition, they will develop expertise in the use of psychoactive drugs in patients with brain dysfunction and several medical co-morbidities. The fellows will also learn elements of pharmacoeconomics and the importance and challenge of optimal drug choice in the care of complex conditions with high personal and community financial costs.

Goal 5: To promote understanding of the functions and the importance of an interdisciplinary team in the care and management of behavioral neurology and neuropsychiatry patients.

Fellows will learn to work with and coordinate a multidisciplinary team to provide optimal care to their patients under the supervision of a faculty member. This team will most often comprise the fellow, a neuropsychologist, a psychotherapist, a social worker and at times a cognitive rehabilitation therapist, a vocational rehabilitation therapist, a genetic counselor, and a family therapist. Clinical Rounds, supervision, case presentations will offer a forum to discuss the different aspects of patient's care and the role of individual providers in a multidisciplinary team.

Goal 6: To promote and empower fellows in their respective areas of research or clinical interest as they move to build their career post-fellowship.

Fellows will have the opportunity to be mentored by world-renowned researchers at Mass General to develop their research career if they elect to do so. All fellows will attend research statistics seminars in their first year of training to gain proficiency in research methods and statistical analysis.

Clinical Experience

Scheduled Rotations

All rotations take place in our outpatient clinics and include individual, supervised patient care, individual supervision, attendance of case conferences and self-directed learning. At the end of each rotation you will receive written evaluations to assess your progress. Areas of weakness will be addressed with the help of the program director.

Core Clinics

• Neuropsychiatry Clinics
• Cognitive Behavioral Neurology Clinic
• Frontotemporal Dementia Unit (Memory Disorders Unit)
• Tourette's Clinic
• Functional Neurological Disorder Clinic
• Traumatic Brain Disorders
• Neuromodulation Clinics
• Psychological Assessment Center (Neuropsychology)

Elective Clinics

Several electives are available. We aim to design the clinical and research rotations flexibly to maximize the learning experience and adapt to the individual fellow’s interests.

• Ataxia Unit
• Epilepsy and Clinical Neurophysiology Clinic
• Executive Function-Adult ADD Clinic
• Stroke-Neurovascular Clinic
• Brain Health Clinic

Note: This is not an exhaustive list of elective clinical options. The specifics of each rotation are available for more in-depth review upon request.

Formal Didactics

As part of your educational experience, you will attend formal weekly didactics with a diverse curriculum of classes distributed over the course of the academic year.

See sample topics

• Principles of neurobiology
• Nervous system development and aging
• Higher cortical functions
• Anatomy and function of brain systems
• Learning and memory
• Sleep
• Theory of attachment
• Culture and cognition
• Clinical manifestations of brain behavior disorders with specific emphasis of major neuropsychiatric diagnostic categories (e.g. neurodevelopmental disorders, neurodegenerative disorders, movement disorders, multiple sclerosis, epilepsy, mood and anxiety disorders, traumatic brain injury)
• Clinical assessment of patients with behavioral neurology and neuropsychiatry conditions
• Neuropsychological assessment
• Diagnostic studies (neurophysiology, neuroimaging, sleep studies)
• Psychopharmacology
• Neurotherapeutics (e.g. deep brain stimulation, vagal nerve stimulation, rapid transcranial magnetic stimulation)

As part of your clinical training, you will also learn the fundamentals of neuropsychology testing administration and interpretation attending biweekly neuropsychology seminars, which will include case conferences and lectures in the major areas of neuropsychology and assist neuropsychologists during evaluations.

Integral to the core curriculum is the development of in-depth knowledge of diagnostic studies through attendance of weekly neuroradiology and neurophysiology rounds and monthly neuropathology case presentations.

Additional Curriculum Elements

The Neuropsychiatry Interdisciplinary Conference happens monthly, where particularly challenging cases are presented by fellows and discussed with faculty from psychiatry, neurology, neuropsychology and radiology. In addition, the Neuropsychiatry and Clinical Neuroscience journal club also takes place monthly.

You will have protected time for academic and research work. This can take place in the many laboratories and clinics at Mass General, in addition to the larger Harvard system and Boston-area academic centers. You will be expected to produce at least one publishable manuscript during the course of the fellowship and present it at a scientific or clinical meeting. The program has flexibility to accommodate motivated research-oriented individuals, including a specific two-year clinician-scientist track.

As a fellow, you will have access to educational resources from Mass General and Harvard University, including libraries and online resources, in addition to professional meetings.

Research

Through your fellowship, the faculty will strongly encourage you to develop your own clinical and research interests as you access nationally and internationally recognized clinicians and researchers within Mass General and in the neighboring Harvard/MIT Schools. Current areas of research available to fellows encompass basic, translational and clinical neuroscience research including, neurobiology of neurodegenerative diseases, circuit neuroscience, genetics, functional neuroimaging, neurophysiology, neuromodulation, clinical trials, epidemiology and global health.

Individual weekly supervision with behavioral neurology and neuropsychiatry faculty will provide you with the opportunity to discuss clinical cases or specific topics more in depth. You will also meet with the program director to cover issues ranging from patient's care to career development. Emphasis will also be placed on personal well-being, academic growth as well as coping strategies to attend to the demands of training.

Your feedback on the program is crucial to the development of the training academic goals and you will be asked to provide faculty and curriculum evaluations.

How to Apply

Application Requirements

• Candidates must have a MD with residency training in neurology or psychiatry
• Candidates must be board certified or board eligible in their respective field
• Candidates must have a U.S. license or be able to acquire one prior to the start of the fellowship
• International candidates are welcome if they are applying under a J-1 Visa with active ECFMG certification or H-1B Visa with a Canadian medical degree from an accredited institution and complete exams

To apply, please send the following to the program director via email:

• Curriculum vitae
• Personal statement
• Three letters of recommendation

Amy Newhouse, MD
anewhouse@mgh.harvard.edu
Fellowship Director
Departments of Psychiatry and Medicine
Massachusetts General Hospital
15 Parkman St., WACC 812
Boston, MA 02114

Applications will be reviewed by the selection committee throughout the year. We recommend submitting your application 15 - 20 months before your intended start date (For example Fall / Winter of 2022 for a start date of July 2024). Applications are reviewed by our team and qualified candidates are invited to interview.

Please contact the program director with any questions.