Subspecialty Fellowship Offered
The Columbia Movement Disorders Fellowship Program was founded by Stanley Fahn, and has been training movement disorders fellows since 1980. A total of 129 fellows have been trained, including many current and former chairmen (eg, Bressman, Giladi), and Movement Disorders Division heads (eg, Dauer, Frucht, Henchcliffe, Przedborski, Louis, Xie). About 80% of fellowship graduates are in academic and industry research positions. In a survey of 47 movement disorders fellows trained at Columbia between 2000 and 2012, 10 (21%) fellows have obtained NIH grants (K or R awards) as PIs worth a total of $8.1 million since their graduation (excluding industry trials and foundation grants). Since 2010, graduates of the fellowship were awarded 2 AAN Foundation Fellowship Awards, 3 NIH K awards, a Brookdale Leadership in Aging Award, a DMRF James C. Kilik Memorial Research Award, and a HDSA Human Biology Project Award. In addition, they received competitive Columbia University-wide awards including 2 Gerstner awards, 2 endowed Assistant Professorships, and 1 Janssen Fellowship in Translational Neuroscience. Many of the fellows who are in private practice are the only movement disorders specialists in their areas, covering 26 states and 15 countries outside the North America. See some of our former and current fellows.
Our fellowship program has been successful in obtaining competitive fellowship training grants: we have received two MJFF Edmond J. Safra Fellowship in Movement Disorders Awards, and two Parkinson Foundation Institutional Movement Disorders Fellowship Awards.
Description of Training Program
The Movement Disorders Fellowship is a 2-year program that offers a unique combination of superb clinical training and intensive research opportunities. While the fellowship design is tailored to meet the individual academic goals and background of each fellow, there are two broadly defined tracks for training. The clinician trackemphasizes clinical training, ensuring coverage of all relevant skills, including DBS and botulinum toxin injection. Fellows will engage in tailored research training and projects, such as authoring review articles, book chapters, or case series, or participating in clinical trials. The research trackaims to provide fellows with the foundations for a research-centered career in academic neurology. The program provides protected time in the 2nd (and, if applicable, 3rd) year to devote to research activities. Fellows in this track are expected to apply for mentored research awards/grants. Research can be in basic science or clinical, with opportunities for earning an advanced degree in Neuro-epidemiology.
The clinical goal of the fellowship program is to train neurologists to become experts in the diagnosis and treatment of Parkinson disease and other movement disorders. The core component of their clinical education consists of evaluating outpatients and hospitalized patients at Columbia University Medical Center. The fellows perform clinical evaluations of patients under the faculty's direct supervision, review management decisions and write up the evaluation letter. Follow-up care is as important as the initial evaluation, and fellows follow the patients closely with subsequent outpatient visits and non-office contact, i.e. phone calls and emails. Furthermore, longitudinal follow-up of the same patient over time is particularly crucial for a chronic disease like PD. The division runs a clinic for Medicaid patients. The fellows are the primary caregivers and decision makers (with faculty guidance) for their patients, and will follow the same patients for their entire fellowship. Furthermore, fellows can serve as attendings in this clinic beginning in the second half of their second year, affording them the opportunity to begin supervising and teaching more junior fellows and residents. Fellows may also choose to do a 6-month elective in the multidisciplinary Huntington disease clinic, located in the adjacent New York Psychiatric Institute.Our center’s combination of referral patterns (tertiary referral center and primary community center of care) provides a rich patient population. In both a publishedformal assessment and a more recent review of billing codes, we found that approximately half of the patients evaluated had PD, allowing for rigorous training in the diagnosis and management of PD. The other half of patients spanned a wide range of other movement disorders, including atypical parkinsonian syndromes, essential tremor, dystonia, ataxia, myoclonus, chorea, tardive syndromes, and functional disorders.
The program trains fellows in specialized techniques and procedures for movement disorders, consisting primarily of DBS and BTx injections. Fellows learn these techniques during clinical sessions wholly devoted to each modality. This training typically begins during the second half of their first year, followed by more intensive training during their second year. The division has an active DBS program, and fellows are intimately involved in all aspects of DBS-related care: evaluation and selection of patients, intraoperative recording, and post-operative programming. Our multidisciplinary DBS team is comprised of movement disorder specialists dedicated to DBS (Ford, Vanegas), a neurosurgeon (McKhann), a DBS nurse, and a neurophysiologist. Fellows also gain experience with other more intensive modalities for the treatment of PD, such as carbidopa/levodopa intestinal infusion and titration visit for apomorphine injection. Fellows learn botulinum toxin injections, with and without EMG guidance, for treatment of dystonia and related disorders.
As a Parkinson’s Foundation Center of Excellence, our program provides fellows with opportunities for engagement with the PD patient community. These include participation in support groups, events such as the Parkinson Unity walk, and PF-sponsored conferences and events. In addition, our Center coordinator (Delaney) provides social work services and support, exposing our fellows to the breadth of ancillary and support services that are so important to our patients’ well-being.
The division has a robust series of academic lectures and conferences. Fellows play a primary role in these activities, which are scheduled to avoid clinical duties. The core conference is our weekly “video rounds,” where patients’ clinical problems are discussed along with videotaped exams. In conjunction with the New York Brain Bank, we have monthly clinicopathologic conferences (CPCs), which combine clinical histories, presented by fellows, with autopsy findings and a neuropathologic diagnosis. The division also has monthly case conferences, with live presentation of patients. The DBS team conducts monthly “DBS rounds” to review challenging DBS cases. Monthly journal club is organized by fellows to discuss current research articles, emphasizing critical analysis. To start the academic year, formal sessions on fundamental topics in movement disorders are presented by faculty. Two bimonthly research conferences are held, one for the basic laboratory group and one on a translational topic that includes both clinical and basic science groups. Speakers are invited widely within Columbia and from outside. In addition, fellows are expected to present their work in progress at these conferences.
Upon starting the fellowship, fellows are assigned a faculty advisor (based on their preliminary interests) to help guide their research and overall career development. In particular, the advisor ensures that the fellow is formulating their research plans in a timely manner and assists in the selection of scientific and clinical mentors. All fellows are supported for the Aspen course in Movement Disorders, presentation at AAN and MDS meetings, and, if requested, Columbia’s summer course in biostatistics. In addition, Columbia sponsors numerous seminars on relevant topics, such as grant writing and IRB submissions.
Our division, and the larger Columbia community, provides an extensive array of potential research training opportunities. This breadth of resources is a unique strength of our program. On the clinical side, we have initiated and participated in several industry- and government-sponsored clinical trials (Fahn, Kuo, Levy, Waters), conducted research on biomarkers (Alcalay) and genetic contributions to PD (Alcalay), explored tractographic predictors of DBS response (Vanegas) and participated in WHO-sponsored public health efforts to improve global dementia care (Shah). On the basic science side, our faculty has explored several facets of autophagy in the pathogenesis of PD (Kuo, Yamamoto, Tang), delineated abnormalities, in cerebellar circuitry in ET and ataxias (Kuo), and investigated novel pathways involved in neuroprotection and mitochondrial dynamics, (Przedborski, Tang, Yamamoto).
Epidemiology training is another unique strength of the program, with two NIH-funded mechanisms for formal training: Patient Oriented Research Program; Neuro-epidemiology Training Program, one of only two such programs in the country. These programs provide 2 years of training in biostatistics and clinical research methodologies, culminating in a Master’s degree. Acceptance to these programs is competitive, and 5 movement disorders fellows have been accepted (including 3 in the last 4 years). As an alternative, Columbia offers an intensive 5-week summer course in statistics and research design.
The division, and in particular the fellowship program, works closely with the broader Columbia neuroscience community. For example, faculty from the following divisions have recently served as research mentors for fellows: Dementia (Marder, Stern, Kreisl); Epidemiology (Rauh); Psychology (Shohamy); Engineering (Agrawal). Other notable resources outside the division include The New York Brain Bank, located on site, that has autopsy material from hundreds of patients with neurodegenerative diseases. With increasing awareness of cognitive impairment in PD, we have a very close relationship with the Dementia group at Columbia, and the affiliated Cognitive Neuroscience Division.
How to Apply for the Fellowship Program
The subspecialty of movement disorders is not an ACGME accredited program.
Columbia is a member of a consortium with other movement disorder fellowship training programs in which a matching plan is utilized, and all consortium members notify fellowship candidates of acceptance on the same date. Thus, our program participates in the San Francisco Match for Movement Disorders Fellowship Match. In order to apply to our fellowship applicants should submit their application to the San Francisco Match Website. Please include your career goals, research interests and potential research mentors, if any, at Columbia University. Any additional materials should be sent directly to email@example.com.
In their letter of intent, applicants are required to specify their interests. Applicants who are interested in NETP who are invited for interviews will also be given information about applying to the Mailman School of Public Health for the Master’s Degree in Epidemiology Program. Note that application to the NETP is a separate process that typically takes place early in the applicant’s first year of fellowship. NETP is funded in collaboration with the NIH, and only open to US citizens or those holding a green card. Candidates are strongly encouraged to contact potential research mentors directly and indicate them in their letter of interest so that interviews are arranged with appropriate faculty members.
Applications should be submitted during PGY3 and must have successfully completed a neurology residency program before entering this fellowship.
Timeline of Application
- March to August of the year before the starting date (usually July 1) of fellowship: Registration and application through SFMatch(link is external). Most interview decisions are made by June.
- For fellowship starting in July 2020: SFMatch begins accepting applications on March 4, 2019. The target date for completion of applications is April 10, 2019; this is notan absolute deadline, but a goal date for having all components of the application submitted.
- May to August: Interviews (usually takes place in May-July on select Fridays)
- Rank list deadline: Early September.
- For fellowships starting in 2020, deadline is Sept 5, 2019.
- Match result announcement: mid-September
- For fellowships starting in 2020, announcement is Sept 12, 2019.
We accept international applicants and support their J1 visa. Applicants, however, should be eligible for a New York State License, which requires an ECFMG certificate from all candidates who graduated medical schools outside the USA or Canada. A New York State medical license is required to see patients.