Mission

The NCC Clinical Neurophysiology Fellowship Program operates within the Military Health System with the primary goal of training active duty medical officers (Fellows) to evolve into independent practicing Clinical Neurophysiologists supporting MHS across Air Force, Army, and Navy platforms. The fellowship combines academic and clinical residency, offering residents valuable experience in Clinical Neurophysiology to ensure their ability to practice effectively and provide care for service members and dependents.

The fellowship provides a "broad" experience, supported by faculty expertise in neuro-muscular and epilepsy fields. Fellows benefit from state-of-the-art clinical and research experiences delivered through a diverse curriculum. The program also includes military-specific training tailored for fellows practicing Clinical Neurophysiology in various areas supported by the US Armed Forces, encompassing both combat and non-combat operations.

The National Capital Consortium (NCC), serving as the sponsoring institution, stands as the premier academic, clinical, and research institution within the MHS. The NCC Clinical Neurophysiology Fellowship program aligns well with the institutional mission and collaborates with the Uniformed Services University of Health Sciences and the National Institutes of Health (Bethesda, MD).

Vision

Empowering Future Leaders in Clinical Neurophysiology: Our vision is to cultivate a fellowship that stands as a beacon of excellence, inspiring and equipping active duty medical officers to become adept, compassionate, and innovative Clinical Neurophysiologists. We envision a future where our fellows, trained within the MHS, emerge as leaders in the field, seamlessly integrating cutting-edge clinical practices and research to advance neurological care for the benefit of service members and their families. Our commitment extends to fostering a culture of continuous learning, leadership development, and a deep sense of duty, ensuring that our graduates make a lasting impact within the military healthcare community and beyond.

Aims

The Clinical Neurophysiology Fellowship program is designed to equip physicians with the skills necessary for independent practice in Clinical Neurophysiology. Our primary objective is to ensure that fellows successfully pass either the American Clinical Neurophysiology Society (ACNS) or the American Association of Neuromuscular Medicine (AANEM) examinations. The fellowship places a strong emphasis on developing military officers who are not only proficient in clinical neurophysiology but also well-versed in military health readiness. Additionally, we strive to provide opportunities for fellows to pursue their research interests during their training.

Key Learning Objectives

Our commitment is to provide fellows with a comprehensive and rigorous training experience that prepares them to excel in the complex and dynamic field of Clinical Neurophysiology while contributing meaningfully to military health care.

Clinical Skills Proficiency

Acquire and demonstrate clinical skills essential for independently evaluating and treating a wide range of patient problems in epilepsy and neuromuscular disease (Patient Care, Medical Knowledge).

Treatment Understanding

Develop an understanding of the principles, indications, contraindications, risks, costs, and expected outcomes of treatments for epilepsy and neuromuscular disease (Patient Care, Medical Knowledge, Systems-Based Practice).

EEG Interpretation

Independently interpret EEGs in all age groups accurately and safely (Patient Care, Medical Knowledge, Practice-Based Learning and Improvement).

EMG Proficiency

Independently plan, conduct, and interpret EMGs in all age groups accurately and safely (Patient Care, Medical Knowledge, Practice-Based Learning and Improvement).

Communication Skills

Continue developing effective communication skills with patients, families, peers, and healthcare personnel (Patient Care, Communication Skills, Professionalism).

Life-Long Learning

Develop skills in life-long learning and critical analysis, synthesis, and reassessment of knowledge, skills, and professionalism (Patient Care, Professionalism, Practice-Based Learning and Improvement).

Research Skills

Develop skills that enable independent clinical research (Patient Care, Medical Knowledge, Practice-Based Learning and Improvement).

Milestone Achievement

• Achieve a 4-rating (target, not representing a graduation requirement) in each of the 28 ACGME milestones by the end of training.
• This demonstrates competence for independent practice of clinical neurophysiology and systems-based competence to practice within the MHS.

The following is a list of the weekly conferences available to the fellow. The Epilepsy and Neuromuscular conferences are mandatory for all fellows. The Friday Epilepsy Resident Conference is mandatory during single-fellow years and while on the EEG month in 2-fellow years. The Tuesday Neuromuscular Case Review is mandatory during single-fellow years and while on the EMG month in 2-fellow years. The Resident didactics are optional except when the lecture is neurophysiology specific.

Monday

• 1 - 2 p.m. - Epilepsy Fellow’s Conference (Reading room): WR & NIH Staff
• 2 - 2:30 p.m. -  EEG Review (Reading room): WR & NIH Staff

Tuesday

• 12 p.m. - Neuromuscular Case Review (Small Conference Room): WR Staff

Thursday

• 8 - 9 a.m. - Morning Report (Neurology Conference Room): WR Chief Resident
• 8 -9 a.m. - EMG/Neuromuscular Conference (Small Conference Room)

Epilepsy Fellow’s Conference

The Epilepsy Fellow’s Conference is an hour-long session every Monday during which specific EEG or relevant clinical epilepsy topics will be reviewed with the rotating EEG staff. The conference is attended by the fellow, visiting fellows from the NIH CNP program, rotating residents, and the EEG staff, giving the fellow an opportunity to practice effective teaching and communication with other providers.

EEG Review

The EEG Review Session is an hour-long session every Monday following the above Fellow’s Conference. During this time, the fellow presents select routine EEG studies or portions of video-EEG monitoring to the assembled rotating EEG staff. Selected studies reflect interesting, unusual, or complicated findings and are meant to prompt discussion of the nuance of EEG interpretation, as well as highlight areas of subjectivity in the field. The conference is attended by the fellow, visiting fellows from the NIH CNP program, rotating residents, and the EEG staff, giving the fellow an opportunity to practice effective communication with other providers.

EEG Chapter Review

The EEG Chapter Review conference is an hour-long session every Friday during which the fellow reviews chapters from Current Practice of Clinical Electroencephalography with the rotating resident, although senior residents are also given time to select current literature for review. The goal is to review the following chapters over the course of their training, allowing the fellow to refine the teaching approach as mastery of the material improves. Remaining chapters are not required, but the rotating resident is encouraged to read them independently. The conference is attended by the fellow, rotating residents, and the EEG staff. Other neurophysiology topics are covered when no resident is rotating on the EEG service.

Neuromuscular Conference

The Neuromuscular conference is an hour-long session every Thursday during which the fellow leads a review of either a chapter chosen from major neurophysiology or basic neuroscience text or selected articles from peer-reviewed journals. Although the fellow leads the discussion, there is significant input from experienced neurophysiology staff. The rotating neurology residents attend this conference, giving the fellow an opportunity for didactic experience with neuromuscular material.

Neuromuscular Case Reviews

For now, this is on hold. This is a weekly or bimonthly 45-60 min session occurring Tuesday mornings (or during the lunch hour in two fellow years) in which the fellow will review a neuromuscular case focusing on the differential diagnosis and electrodiagnostic approach. The cases will be selected by the program director with input from the fellow and may come from the neuromuscular clinic, EMG lab, or textbook material.

Our one-year fellowship consists of the following rotations:

• Epilepsy/Neuromuscular - 11 blocks
• Elective - 1 block 

While the fellowship's didactic curriculum covers polysomnography (PSG) and sleep disorders, as well as neurophysiological evaluation of movement disorders, ultrasound, IOP, and Autonomics, formal experience in these areas is more limited compared to EEG and EMG. However, fellows can enhance their experience in any of these areas based on their interest through a two-week elective block. The Walter Reed Neurology Department hosts an active Autonomic Testing Laboratory, providing fellows the opportunity for additional practical experience in performing and interpreting autonomic reflex testing.

Possible electives:

• Neuromuscular
• Epilepsy
• Sleep medicine/polysomnography
• Intraoperative monitoring
• Autonomic medicine
• Ultrasound

Currently the Clinical Neurophysiology Fellowship program does not have a structured call schedule.

A Clinical Neurophysiology (CNP) fellowship within the military setting entails a unique curriculum tailored to the distinctive requirements of military healthcare. The program is designed to prepare fellows for the specific challenges and responsibilities they may encounter while serving as military neurologists. Below is an overview of the key aspects of the military unique curriculum:

Military Health Readiness Emphasis

The curriculum places a significant emphasis on military health readiness, ensuring that fellows are adept at addressing the health care needs of service members and their dependents.

Combat and Non-Combat Operations Training

Recognizing the diverse roles of military neurologists, the curriculum includes training for both combat and non-combat operations. Fellows gain insights into the unique demands of providing neurologic care in various military settings.

Integration with Military Platforms

The program integrates training experiences across Air Force, Army, and Navy platforms. This comprehensive approach ensures that fellows are well-prepared to contribute effectively to the MHS.

Partnership with Premier Institutions

The fellowship program aligns with premier academic, clinical, and research institutions within the MHS. Collaborations with the Uniformed Services University of Health Sciences and the National Institutes of Health enhance the educational experience.

National Capital Consortium (NCC) Sponsorship

The program is sponsored by the National Capital Consortium, further solidifying its alignment with the institutional mission. This partnership provides fellows with access to resources and expertise that contribute to a well-rounded training experience.

Clinical and Research Experiences

Fellows engage in clinical and research experiences that encompass a diverse curriculum. Exposure to neuro-muscular and epilepsy disciplines, along with state-of-the-art clinical and research opportunities, ensures a comprehensive learning journey.

Training for Independent Practice

The ultimate goal of the curriculum is to equip fellows for independent practice in Clinical Neurophysiology. The program emphasizes the development of clinical skills, knowledge of biomedical sciences, and applications of this knowledge to patient care.

Leadership and Innovation Training

Acknowledging the unique role military neurologists play, the curriculum includes training modules focused on leadership and innovation. Workshops and mentorship programs contribute to the cultivation of effective leadership skills.

Continuous Learning Opportunities

Beyond the core curriculum, fellows are provided with continuous learning opportunities. Updates on advancements in neurology, emerging medical technologies, and military health care practices are regularly incorporated into the training.

Fitness and Wellness Programs

Recognizing the importance of physical fitness for military personnel, the curriculum reinforces fitness and wellness programs. This holistic approach contributes to the overall well-being of fellows.

In summary, the military unique curriculum for Clinical Neurophysiology Fellowship ensures that fellows are not only proficient clinicians but also well-prepared for the distinctive roles they play within the military healthcare system. The integration of military-specific training, collaboration with premier institutions, and emphasis on leadership and innovation sets this curriculum apart in addressing the unique needs of military neurologists.

A Clinical Neurophysiology (CNP) fellow undergoes a comprehensive professional development program, which includes specialized courses and opportunities for advanced training. As part of their training, the fellow may participate in the Wake Forest Ultrasound Mini-Fellowship. This experience is designed to enhance the fellow's expertise in clinical neurophysiology, with a focus on ultrasound applications.

Wake Forest Ultrasound Mini-Fellowship

• The Wake Forest Ultrasound Mini-Fellowship is a specialized training program offered to clinical neurophysiology fellows.
• This mini fellowship is designed to provide in-depth education and hands-on experience in the application of ultrasound techniques relevant to the field of clinical neurophysiology.

Courses and Curriculum

• The fellow is required to complete specific courses as part of their professional development.
• The curriculum encompasses various aspects of clinical neurophysiology, and the Wake Forest Ultrasound Mini-Fellowship is integrated as a specialized component.

Advanced Training Opportunities

• This mini fellowship offers advanced training in ultrasound, a valuable skill in the neurophysiology domain.
• Fellows engage in practical, hands-on sessions to acquire proficiency in utilizing ultrasound for diagnostic and therapeutic purposes.

Expert Instruction

• The Wake Forest Ultrasound Mini-Fellowship is facilitated by experts in the field who provide specialized instruction.
• Fellow’s benefit from the knowledge and experience of instructors who guide them through the nuances of ultrasound applications in clinical neurophysiology.

Integration with Clinical Practice

• The skills acquired during the mini fellowship are directly applicable to the clinical practice of neurophysiology.
• Fellows learn to incorporate ultrasound techniques into their diagnostic and therapeutic approaches, enhancing their overall proficiency.

Comprehensive Skill Set

• Participation in the Wake Forest Ultrasound Mini-Fellowship contributes to the fellow's development of a comprehensive skill set.
• The goal is to ensure that fellows are well-equipped to apply the latest advancements, including ultrasound, in the diagnosis and management of neurological disorders.

In summary, the Wake Forest Ultrasound Mini-Fellowship is a crucial component of the professional development journey for clinical neurophysiology fellows. It provides them with specialized training in ultrasound applications, enriching their skill set and preparing them for the complexities of neurophysiological practice.

Clinical leadership principles are also taught and reinforced through our simulation center curriculum. The role of the Clinical Neurophysiologist as leader in operational medicine is taught and reinforced throughout our clinical curriculum.

The CNP section is actively involved in fostering research initiatives, and resident engagement in scholarly projects is a mandated requirement by the ACGME. To promote this, every effort is made to actively involve fellows in existing research endeavors and to encourage them to initiate new projects. Prior examples include: presenting at National Conferences, submitting case report and research for publication and developing curriculum standards. Although these opportunities are not required, they are however encouraged.

The growing emphasis on residents and fellows engaging in quality improvement projects reflects the importance of utilizing data to enhance health care systems, address disparities, and improve patient outcomes. Engaging in quality improvement initiatives ensures that residents and fellows contribute to the advancement of health care practices, making the field more efficient, equitable, and patient-focused. This commitment aligns with the broader goals of enhancing overall health care systems and providing optimal care to diverse patient populations.

A Clinical Neurophysiology (CNP) fellow receives professional development through a multifaceted approach designed to enhance their skills, knowledge, and overall competence in the field. The professional development process is integral to preparing fellows for independent practice in Clinical Neurophysiology. The key components of this process include:

Annual Orientation

At the beginning of each year, fellows undergo a comprehensive orientation that emphasizes specific program requirements and delves into the LIFE curriculum. This orientation serves as a foundational step in shaping the professional development journey.

LIFE Curriculum Integration

The orientation underscores the integration of the LIFE curriculum, focusing on Leadership, Innovation, Fitness, and Education. This holistic approach ensures that fellows develop a well-rounded skill set beyond clinical expertise.

Faculty Involvement

The orientation is not exclusive to trainees; faculty members actively participate. This inclusive approach ensures alignment between trainees and faculty in understanding program expectations and the broader LIFE curriculum.

Continuous Learning Opportunities

Beyond the annual orientation, fellows are provided with continuous learning opportunities throughout their training. This includes regular updates on advancements in neurology, emerging medical technologies, and evolving military healthcare practices.

Leadership Development

Special emphasis is placed on leadership development, recognizing the unique role military neurologists play within the military healthcare system. Leadership training modules, workshops, and mentorship programs contribute to the cultivation of effective leadership skills.

Research and Innovation

Professional development extends to fostering a culture of research and innovation. Fellows are encouraged to engage in research projects, present findings at conferences, and stay abreast of the latest developments in neurological research.

Fitness and Wellness Programs

The FITNESS component of the LIFE curriculum is reinforced through tailored fitness and wellness programs. Recognizing the importance of physical fitness for military personnel, these programs contribute to overall well-being.

By integrating these elements into the professional development framework, clinical neurophysiology fellows are not only well-prepared for the clinical challenges they may encounter but also equipped with the leadership, innovation, and fitness skills essential for success in their unique roles within the MHS.

Fellows exclusively rotate at WRNMMC.

The Clinical Neurophysiology fellowship program offers opportunities for medical students to observe while they are rotating through their neurology clerkship. Rotators can choose to observe EEG, EMG, autonomics or other areas of interest. Currently, medical students cannot elect to do a full, 4-week rotation in Clinical Neurophysiology.

Interviews are offered to all military neurologist or graduating neurology residents who intent in pursing a military clinical neurophysiology fellowship. Interested applicants may contact the program via email dha.ncr.walter-reed-med-ctr.list.ncc-clinneurophys@health.mil or by telephone 301-400-1782 or 301-319-7855 for more information.

Program graduates take the American Board of Psychiatry and Neurology. This exam is offered semi-annually. To become fully board certified, applicants are eligible to take board certification exam following graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Psychiatry and Neurology.

Specific Training Requirements

• Applicants for certification in clinical neurophysiology must be certified by the Board in general neurology or neurology with special qualification in child neurology by December 31 of the year prior to the examination. All applicants other than those initially admitted during the practice pathway period (1992-1999) are required to submit documentation of successful completion of one year of Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship training in clinical neurophysiology that did not begin before the time general residency training in neurology or neurology with special qualification in child neurology, including time spent in combined training programs, was completed. The exposure to clinical neurophysiology given to neurology or child neurology residents as part of their basic training curriculum does not count toward the one year of training. All licensing and training requirements must be met by July 31 of the year of the examination.
• The required one year of specialized training in clinical neurophysiology may be completed on a part-time basis as long as it is not less than half time; credit is not given for periods of training lasting less than one year except under special circumstances that must be approved by the ABPN Credentials Committee. In such cases, it is the responsibility of the applicant to provide detailed documentation from the perspective training directors, including exact dates (month/day/year to month/day/year) outlining training content, duties, and responsibilities. Each case is considered on an individual basis and documentation must be submitted to the Board prior to the start of training for special consideration.
• If clinical neurophysiology (CNP) training was used to credential for certification in epilepsy during the practice pathway, it cannot subsequently be used to credential for certification in clinical neurophysiology

The cultivation of clinical and didactic teaching skills stands as a pivotal component of the fellowship experience, emphasizing the importance of active engagement in educational opportunities. The fellow is expected to seize regular teaching opportunities, with a particular focus on neurophysiology aspects within general neurology. The training environment at WRNMMC, hosting the military's largest neurology residency program, offers a rich landscape for teaching experiences, including interactions with rotating residents and medical students on a daily basis.

Key Aspects of Resident Teaching in Clinical Neurophysiology

Regular Teaching Engagement

The fellow is expected to play a leading role in teaching neurophysiology aspects to residents. This includes one-on-one or small group teaching during EEG and EMG rotations. The teaching extends to lectures throughout the year as part of the neurology residency didactic program.

Lectures to Various Audiences

Fellows are encouraged to give lectures not only to neurology residents but also to internal medicine residents, graduate students, and medical students on relevant topics. This broadens the scope of teaching experiences and contributes to the dissemination of knowledge across disciplines.

Department Chief’s Rounds

Participation in Department Chief’s Rounds provides an additional avenue for teaching. During these rounds, interesting neurology patients are examined in a group setting. The fellow leads discussions on relevant neuromuscular or epilepsy topics, showcasing a directed clinical history and examination to highlight key neurologic findings.

Use of Video-EEG Clips

Fellows have the opportunity to bring informative video-EEG clips to Chief’s Rounds, leading discussions on relevant epilepsy topics. This multimedia approach enhances the educational experience and facilitates dynamic engagement with the material.

Proposal of Clinic Cases

Fellows may propose patients seen in the Epilepsy or Neuromuscular Clinics to participate in Chief’s Rounds. This aligns with the goal of integrating clinical experiences into the teaching process, emphasizing real-world applications of neurophysiological principles.

In essence, the fellow's role in resident teaching is multifaceted, encompassing formal lectures, small-group interactions, and contributions to rounds. This comprehensive approach aims to foster a robust educational environment and ensure the effective transmission of clinical neurophysiology knowledge to the next generation of medical professionals.

• Autonomic disorders
• Behavioral neurology
• Child neurology
• Clinical neurophysiology
• Epilepsy
• Movement disorders
• Neurointensive care
• Neurology
• Neuro-oncology
• Neuroradiology
• Vascular neurology

The mentorship program for Clinical Neurophysiologists at Walter Reed National Military Medical Center (WRNMMC) is designed to provide a comprehensive and supportive framework for fellows as they progress through their training. This program is a key component of the fellowship experience, aiming to foster professional growth, skill development, and a sense of community among clinical neurophysiologists. Below is an in-depth overview of the mentorship program:

Diverse Mentorship Panel

Recognizing the multifaceted nature of clinical neurophysiology, fellows have the opportunity to engage with a diverse mentorship panel. Mentors may include faculty members with expertise in EEG, EMG, epilepsy, neuromuscular disorders, and other relevant subspecialties.

Professional and Personal Guidance

Mentors provide guidance not only on professional development but also on personal aspects of the fellow's journey. This includes discussions on work-life balance, navigating challenges, and building resilience in the demanding field of clinical neurophysiology.

Individualized Career Planning

The mentorship program places a strong emphasis on individualized career planning. Mentors work closely with fellows to identify career goals, explore subspecialty interests, and create a roadmap for post-fellowship endeavors.

Participation in Research and Projects

Mentors actively involve mentees in ongoing research projects, case studies, and clinical initiatives. This hands-on participation enhances the fellow's research skills and contributes to a collaborative learning environment.

Integration with Didactic Education

The mentorship program is integrated with didactic education, aligning mentorship discussions with the broader educational curriculum of the fellowship. This integration ensures a cohesive and complementary learning experience.

Feedback and Performance Evaluation

Mentors provide constructive feedback on the fellow's clinical performance, research contributions, and overall professional development. Regular evaluations help track progress and identify areas for improvement.

Networking Opportunities

The mentorship program facilitates networking opportunities for fellows, connecting them with other professionals in the field. This includes participation in conferences, workshops, and events that enhance the fellow's visibility within the neurophysiology community.

Long-Term Relationship Building

The mentorship relationship extends beyond the fellowship year, aiming to build a lasting professional connection. Mentors continue to provide support and guidance as fellows transition into post-fellowship roles.

In conclusion, the mentorship program at Walter Reed National Military Medical Center is a robust and personalized initiative designed to empower clinical neurophysiology fellows in their journey toward becoming proficient and successful practitioners in the field. The structured mentorship, individualized planning, and holistic support contribute to a fulfilling and enriching fellowship experience.

• The CNP staff is attuned to the workload of the Fellow, with many members having undergone the Walter Reed Clinical Neurophysiology fellowship or similar programs. Their experience equips them to recognize signs of stress early, facilitated by the close working relationship with the fellow. Continuous faculty development, including mandatory and invited courses, ensures that the staff remains vigilant and educated on stress-related issues encountered by trainees.
• As part of the LIFE Curriculum, which is a yearly mandatory requirement for CNP staff, topics such as stress, sleep deprivation, depression, and burnout are addressed. Additionally, staff members participate in an annual mandatory Suicide Prevention seminar, emphasizing the importance of mental health within the fellowship program.
• The fellow, too, is educated on recognizing stress and related issues, undergoing the LIFE Curriculum course early in the academic year and participating in the mandatory Suicide Prevention seminar. An institution-provided "Resident Orientation" manual further guides the fellow on aspects of training, including fatigue, stress, and burnout.
• The PD maintains an "open door" policy during work hours and 24/7 phone access for serious issues.
• In case of excessive fellow stress, the staff may proactively approach the fellow offering help or escalate the matter to the CNP PD, who will engage with the fellow to identify stressors and collaboratively devise solutions. Workload-related stress may involve redistributing duties among staff while ensuring effective training, and if significant limitations are identified, adjustments to the fellow's schedule or extension of training may be considered. For personal problems or mental health conditions requiring external assistance, various resources within the facility are available, including Patient Centered Medical Home, Behavioral Health Care, primary care providers, Tricare, Military OneSource, Social Work services, and Chaplains—offering a comprehensive support network.