Educational Goals and Objectives

The primary site for the fellowship is Rush University Medical Center, where fellows rotate through the EMG lab, Neuromuscular clinic, EEG lab, inpatient video/EEG monitoring unit, Epilepsy clinic and Sleep Center. Evoked potential interpretation is also performed at Rush. Affiliated institutions are the John H. Stroger, Jr. Hospital of Cook County, where fellows have an opportunity to perform EMG studies on patients who present to a large public hospital. Single fiber EMG (SFEMG) experience is supplemented at the University of Illinois at Chicago (UIC).

Through the course of training, fellows are expected to demonstrate progressive improvement in diagnosis and treatment of neuromuscular disease and epilepsy as well as the continued acquisition of skills in EEG and EMG/NCV techniques and test interpretation. Each fellow will be responsible for a research project, which may consist of either participation in a clinical research trial under faculty supervision or a written report of an interesting patient case or series of cases with a review of the pertinent medical literature.

Didactic teaching is a strong component of the program. At Rush, the following conferences are held weekly except where indicated:

• Neurology Grand Rounds
• EMG Conference
• Muscle and Nerve Biopsy Conference (monthly)
• EEG/Epilepsy Didactic Sessions
• Epilepsy Surgery Conference
• Epilepsy Research Meeting
• Polysomnogram Rounds
• Sleep Didactic Sessions
• Journal club

Clinical neurophysiology fellows are also actively involved in teaching students of Rush Medical College. Each Spring, fellows will assist in discussions of clinical patient cases during the neurobiology lab sessions for the second year medical students. While on the EEG/Epilepsy B service, fellows are responsible for leading Epilepsy teaching sessions with the medical students rotating through neurology at Rush. These occur weekly, three times during the students' clerkship month.

EMG/Neuromuscular (NM) Rotation
During the EMG rotation, trainees alternate weeks performing EMG studies at John H. Stroger Hospital and Rush University Medical Center. On a rotating schedule, fellows attend the SFEMG clinic at UIC to supplement their experience at Rush. Fellows also actively participate in the Muscular Dystrophy Association clinic (three Thursday mornings per month) and neuromuscular clinic each Thursday afternoon.

By the end of the EMG/Neuromuscular rotation(s), fellows should understand the clinical presentation, diagnostic evaluation and treatment of anterior horn cell disease, radiculopathy, peripheral neuropathy, disorders of the neuromuscular junction and myopathies. They will also be proficient in performing and interpreting EMG studies.

EEG/Epilepsy Rotation
During the EEG/Epilepsy rotation, fellows alternate weeks on the A and B service. The A fellow works with the A attending and is responsible for the clinical evaluation and follow up of all patients admitted to the epilepsy video/EEG monitoring unit. During the week on the A service, fellows are on call in the evenings and make rounds with the attending on Saturday and Sunday.

Fellows rotating on the B service read all routine EEG studies and review them with the B attending. Evoked potential studies are reviewed with one of the neurophysiologists. Additionally, the B fellow will read all STAT EEG recordings emergently, evaluate and follow all patients on the epilepsy consult service, and attend a weekly morning outpatient clinic with the B attending.

By end of the EEG/Epilepsy rotations, fellows should understand the principles and applications of EEG recording and interpretation (adult and pediatric) and video/EEG monitoring. Fellows will be competent to recognize and interpret the significance of EEG patterns (normal, abnormal and variants) and epileptiform activity as well as understand the principles, indications and diagnostic utility of video/EEG monitoring. Fellows will also be able to recognize, understand and diagnose various epilepsy syndromes. Additionally, they will understand the mechanism of action and pharmacology of antiepileptic drugs and their side effects, and be able to choose the appropriate drug therapy and discuss the non-medical therapies available. Notably, fellows will recognize the progressive course of epilepsy and understand its comorbidities, including the social impact and psychiatric complications of the disease.

Sleep Rotation
Fellows are assigned to the Sleep Center for a one month block during which they participate in clinic, weekly didactics and polysomnogram readings. Fellows do return to the MDA and neuromuscular clinic on Thursdays.

By the end of the Sleep rotation, fellows should be able to discuss the pathophysiologic basis, presentation, evaluation and management of common sleep disorders such as insomnia, obstructive sleep apnea and narcolepsy.