Fellows’ clinical responsibilities include patient evaluation and management, call-backs, communication with patients and referring physicians and preparation for conferences. The fellows are also trained to develop skills in various clinical rating scales, interpretation of genetic testing including exome and genome sequencing, botulinum toxin (BoNT) injections, and programming of patients with deep brain stimulation (DBS). Fellows take part in initial and follow-up programming sessions for a variety of movement disorders, utilizing all available DBS devices. They are also directly involved in teaching medical students and neurology residents and participate in a variety of outreach programs.
Although fellows spend nearly all their time in the Parkinson’s Disease Center and Movement Disorders Clinic on the ninth floor of McNair building, they also attend an outpatient Smith Clinic in Harris Health System, where they perform further botulinum toxin injections under the direct supervision of one of the PDCMDC faculty.
Fellows who obtain a Texas medical license receive faculty appointments as instructors in neurology. This allows them to have their own half-day follow-up clinic in which they develop independent clinical judgment and decision-making, skills necessary for future practice as movement disorders specialists. The follow-up evaluation of new patients provides each fellow the opportunity to see how their conditions changed based on the treatment initially prescribed in close consultation with the attending. The fellows also review patients’ laboratory tests and respond to their questions posted on MyChart or by telephone. This positive training experience by the fellows during their MDFTP was reviewed in an article, authored by some of the past fellows: Adam et al. Education Research: Patient telephone calls in a movement disorders center: Lessons in physician-trainee education. Neurology 2009;73:e50-2.
Didactics
Weekly video rounds are held discussing patient presentations and phenomenologies and often include a wide variety of movement disorder pathologies. Uniquely, pediatric cases from Texas Children’s Hospital are frequently discussed as well. Separate weekly didactic sessions are held with the fellows on Fridays. Additional educational opportunities including one-on-one mentoring, monthly DBS journal clubs, deep brain stimulation consensus conferences, genetics meetings, and many other teaching conferences help the fellows to acquire skills in phenomenology, pathophysiology, and therapeutics of all types of movement disorders.
Research
The fellows are encouraged to participate in the ongoing research projects, including serving as sub-investigators in the many clinical trials currently conducted at the PDCMDC.
The MDFTP is designed to inspire the fellows to pursue research in the area of movement and neurodegenerative disorders. They work with individual faculty and are mentored to develop their own research projects. In the process, they are trained to conduct clinical research closely adhering to the Good Clinical Practice (GCP) and to uphold the highest scientific standards.
In addition to their daily training in the clinic and through various educational meetings, the fellows are trained and certified in various rating scales, including the MDS-UPDRS (Parkinson's disease), UHDRS (Huntington's disease), TETRAS (essential tremor), BFMDRS (dystonia), TWSTRS (cervical dystonia), and YGTSS (Tourette syndrome). These and other rating scales are often used as outcome measures in the various clinical trials.
The fellows are encouraged to take courses and learn about the scientific method and trial design, as well as acquire skills in grant writing. Fellows may choose to enroll in Baylor's Clinical Scientist Training Program. Fellows are also taught critical scientific thinking by reviewing and evaluating published and yet unpublished scientific reports. To facilitate their research projects, the fellows have full access to various databases that are constantly being updated, including the Patient Database, DNA Bank Database, DBS Database, Video Library, video log, and EPIC.
Curriculum Objectives
- Evaluating primarily new patients in the clinic and in the hospital and providing follow-up information to referring physicians, describing our findings and therapeutic recommendations.
- Gaining an understanding of the biochemical, pharmacologic, genetic, and physiologic mechanisms of the various movement disorders.
- Learning about therapeutic approaches used to alleviate these disorders, including developing skills in botulinum toxin injections and programming patients after deep brain stimulation surgery.
- Becoming familiar with various clinical rating scales and videotape protocols; developing and managing a computer database for various movement disorders and research projects.
- Participating in ongoing clinical research projects conducted in the BCM Movement Disorders Clinic.
- Reviewing literature, participating in, conducting, and preparing educational material (e.g. videotapes), for video rounds, movement disorder conferences, journal clubs and other educational activities.
- Preparing abstracts and scientific papers and presenting research data at scientific meetings; preparing research grant proposals for funding by NIH and other agencies and foundations.
- Analyzing, summarizing, and critiquing published articles; working with the movement disorder nurse coordinators and other research staff in facilitating various research studies.
- Videotaping patients and participate in specimen collections (CSF, blood, urine).
- Performing pre-operative and post-operative assessments on patients undergoing surgical interventions.