Clinical Neurophysiology at Rhode Island Hospital

Mission Fellowship DirectorAndrew S. Blum, MD, PhD: Fellowship Director

To provide each of our trainees with an exceptional, balanced and individually tailored immersion in clinical neurophysiology, to thereby achieve a superb education in its breadth. This training is based upon a rich and extensive hands-on experience that permits achieving a mastery of both electroencephalography and electromyography at one teaching site within one year.

Program Overview

The fellowship involves rotations (1-3 months each) in EEG/Epilepsy and in EMG/Neuromuscular over the year. Two fellows are admitted annually and rotate between these two main concentrations. Many fellows spend 6 months per year in each discipline; however, many have opted to tailor this balance to afford a concentration in one or the other discipline.

When rotating on EEG / Epilepsy, fellows preview EEGs, provide preliminary readings to requesting services, and read out studies each day with our various EEG faculty (5 adult, 1 pediatric). Our EEG lab performs >5500 studies per year. These include inpatient and outpatient EEGs, adult and pediatric studies, routine and portable studies, long term monitoring (LTM) tracings in our EMUs and prolonged EEGs in ICU and floor patients. Many LTM studies are conducted in our new 18-bed neurocritical care unit at Rhode Island Hospital (RIH), and in other ICUs. EEGs are also done in the RIH/Hasbro emergency departments and in the neighboring Women & Infants Hospital neonatal ICU. We have two dedicated LTM beds in our adult EMU, two in our pediatric EMU, one in the neonatal ICU, and one in the EEG lab for up to 6-hour outpatient studies. During this rotation, fellows participate in 1-2 half day clinics every week, seeing new patients with spells, seizures, and epilepsy and supervised by our epilepsy faculty.

When rotating on EMG / Neuromuscular, fellows performs diverse types of EMG studies in the RIH EMG laboratory. This involves five ½-day sessions each week. Fellows are supervised by the EMG faculty in each session. The EMG lab performs >2000 studies annually. These involve inpatient and outpatient studies and include routine tests of nerve conduction and electromyography, plus repetitive nerve stimulation and single fiber EMG testing. Fellows also help our faculty and technologists provide ischemic forearm and autonomic testing in the EMG lab. Evoked potential studies are provided by the EMG lab as well. Intraoperative studies (EMG and EP) are available. Exposure to EMG-guided Botox® administration for dystonia care is also available. In addition to this lab component, fellows participate in clinics while on this rotation. These include a neuromuscular clinic, an MDA clinic, and a multidisciplinary ALS clinic.

Sleep study interpretation occurs over two-weeks in the spring for each trainee. This also includes outpatient sleep clinic exposure, with the bulk of time learning how to approach sleep studies.

Research is woven into the fellowship. Fellows are encouraged to participate in research with one or more of our teaching faculty. Often, this leads to a poster presentation and eventually to publication. As this is a one-year clinical fellowship, research is necessarily a modest component. Trainees present a Neurology Grand Rounds talk at the end of their year. Usually, this will focus upon a topic of their interest, and often will incorporate some of the research conducted during the year.

Supervision of medical students and residents rotating in our labs is expected of all fellows. Each PGY2 neurology resident spends 3 weeks in the EEG lab and enjoys one-on-one instruction with our fellows. Each PGY3 neurology resident rotates for 2 continuous months in the EMG lab and receives similar supervision and teaching from our fellows. Fellows convey preliminary results of electrophysiological studies to residents across the hospital every day. In this way, our fellows are highly integrated into the life of the neurology department, helping teams understand the implications of their patients' EEG and EMG results and providing care advice where appropriate (e.g. status epilepticus care in relation to ICU LTM studies).

Didactics in the fellowship program include a weekly conference that covers the basics of clinical neurophysiology. (This conference parallels a textbook on clinical neurophysiology, edited by Andrew Blum, MD (program director). Most lectures are provided by the fellows to each other and to faculty and rotating neurology residents. Topics cover EEG, EMG, sleep, and autonomic testing, among others. Journal clubs and lectures on specific clinical topics are also woven into this conference schedule over the year. In addition to a weekly neuromuscular pathology conference when on EMG and a monthly surgical epilepsy case conference when on EEG, fellows help our EEG faculty conduct a twice monthly EEG review session with our neurology residents. In-service examinations are conducted concerning knowledge of EEG, EMG, sleep, EPs, and related topics every year and help the trainees identify areas of strength and weakness, as they prepare for their board examinations.

Application Process

To apply, an application form and three letters of recommendation are needed, including one from your current Residency Program Director.

Requests for information and applications should be sent to:
Andrew S. Blum, MD, PhD
Director, Clinical Neurophysiology Fellowship Program
5th floor, APC Building
593 Eddy Street, Providence, RI 02903
Phone: (401) 444-4364
FAX: (401) 444-8781
E-mail: ablum@lifespan.org

Accreditation status

Full accreditation by the ACGME Neurology Residency Review Committee, Program #: 1874321015.

Length of training

1 year; (2 years possible, depending upon research and funding availability.)

Prerequisites

Successful completion of an ACGME-accredited Neurology, Pediatric Neurology or Psychiatry residency.

Training Schedule

All training takes place at Rhode Island Hospital

  • 6 to 9 months in an area of extensive training, either EMG or EEG.
  • 3 to 6 months comprised of the reciprocal major area, EMG or EEG.
  • 1-3 half-days weekly of supervised outpatient clinics, in epilepsy and in neuromuscular, per rotation.
  • 4 weeks of vacation.

Call

There are no on-call responsibilities for our fellows.

Core Conferences

Click here to view a description of all recurring conferences on the residency page

  • Residents' EEG – Tuesday 12 noon, biweekly
  • Clinical Neurophysiology - Wednesday 9:45 AM, weekly
  • Neurology Grand Rounds and Case Conference - Wednesday 8-9:30 am, weekly
  • Neuroradiology – Wednesday 12 noon, weekly
  • Neuropathology (Muscle/Nerve) - Thursday 9 AM, weekly
  • Epilepsy Surgery Case Conference – first Thursday of the month at noon 

Affiliated Faculty

A roster of our core faculty can be found on the Epilepsy and Neuromuscular division pages

John Donahue, MD
Associate Professor of Pathology and Laboratory Medicine
Associate Professor Neurology

David Mandelbaum, MD, PhD
Professor of Neurology, Professor of Pediatrics
Director of Pediatric Epilepsy

Richard Millman, MD
Professor of Medicine, Professor of Pediatrics
Director of the Sleep Disorders Center of Lifespan Hospitals

Edward G. Stopa, MD
Professor of Pathology and Laboratory Medicine
Professor of Neurosurgery
Director, Division of Neuropathology, RIH