The Clinical Neuroimmunology Fellowship is designed to train academically-oriented neurologists and physiatrists who want to pursue a career in patient care and clinical research in multiple sclerosis. Beyond that, the curriculum is rather flexible. The specific curriculum and duration of the fellowship are tailored to the fellow’s background and career goals.
Potential components of training include:
One component of the fellowship is supervised patient care, to develop specialized expertise in the diagnosis and management of MS and related disorders. Fellows participate as a member of our multi-disciplinary team that evaluates and treats a large number of patients (we are the largest MS program in the U.S.). Medical neurology visits cover a wide spectrum of issues, including diagnostic questions, confirmation of the diagnosis of MS, disease management and implementation, management of symptoms and psychosocial issues, and evaluation for potential participation in experimental therapy protocols. We predominantly see patients with MS, a smaller number with other immune-mediated CNS diseases, and a very small amount of general neurology. It is possible to arrange time in, for example, the Neuromuscular Section of Neurology or in Rheumatology to gain expertise in other immune-mediated disorders of the nervous system.
The Mellen Center is a tertiary care center that provides consultation to health care professionals worldwide, and principal continuing care for patients in Ohio and the six surrounding states. Approximately 1000 new patients are evaluated at the Mellen Center annually with 20,000 total medical visits. The current total active patient base is approximately 10–12,000. The Mellen Center clinical staff comprises seven neurologists, two physiatrists, two-three clinical neuroimmunology fellows, clinical practice nurses, procedures nurses, social worker, clinical psychologist, cognitive psychologist, psychology fellows, neuropsychology technicians, occupational and physical therapists, a vocational counselor, and administrative support staff. Specialized programs include outpatient parenteral drug administration, multidisciplinary symptom management programs (e.g. bladder, bowel, spasticity, tremor, pain, and fatigue), a comprehensive rehabilitation program (outpatient physical and occupation therapy, power mobility assessment, and cognitive rehabilitation), health psychology, neuropsychological testing, and referral to adult day treatment programs.
Resources include a dedicated imaging center with a 1.5T scanner, a 3T scanner, high-resolution monitors for viewing images obtained on any CCF scanner, and workstations for quantitative image processing. Funding was just obtained for a 7T scanner. We also have a dedicated optical coherence tomography unit.
Experience in Clinical Trials
The other principal focus of the fellowship is training in clinical research, most often experimental therapeutics. Fellows divide their research time between participation as a co-investigator in ongoing trials, formal training as a "trialist" through coursework, and conducting independent research. We participate in a large number of clinical trials, and Mellen Center staff members often fill leadership positions in those trials. In some trials, fellows serve as an Examining Physician to develop expertise performing a standardized neurologic examination, calculating rating scales such as the Kurtzke EDSS and MS Functional Composite. In other trials, fellows function as Treating Physician to become familiar with issues involved in patient management with the constraints of a protocol. Finally, fellows gain experience in trial management and implementation by serving as the de facto Site Principal Investigator for a clinical trial under staff supervision. Responsibilities include composing the consent form, preparing IRB correspondences, reviewing the budget, coordinating contract negotiation, managing other regulatory documents, supervising patient recruitment, planning study visits, developing source documents, and working with data coordinators and study monitors to resolve queries.
The Mellen Center Experimental Therapeutics Program infrastructure includes research nurses, data coordinators, and administrative support personnel. All of the Mellen Center professional staff members participate in clinical research projects (as Principal Investigator or a co-investigator). We recently formed the CCF MS Academic Coordinating Center (an academic research organization comprising personnel in the Mellen Center Experimental Therapeutics Program, Biomedical Engineering, Neuroradiology, and Quantitative Health Sciences) to provide academically-oriented management of multicenter clinical trials (protocol development, site recruitment and management, investigator training, data management, quantitative MR image analysis, statistical analysis and interpretation, and publication).
Some fellows have focused on areas other than clinical trials, for example, rehabilitation, epidemiology, or cognitive aspects of MS.
We encourage and help arrange courses in, for example, statistics, epidemiology, and trial design. A sizable proportion of fellows complete the requirements for a Masters Degree in Clinical Research most often through the Clinical Research Scholars Program at Case Western Reserve University.
Most fellows carry out independent clinical research based on their interests. Those fellows who pursue a Masters Degree design, carry out, analyze, and report an independent research project to fulfill the requirements. For this they are mentored by graduate school faculty and members of the Mellen Center staff. The project is designed during the first year of the fellowship and carried out during Years 2–3. This experience familiarizes the fellow with formulating a research question, designing and carrying out a clinical experiment, and analyzing and interpreting the results. The opportunity exists to participate in basic research projects, although this program is not intended to be a laboratory research fellowship.
Training in MRIM
Training in MRI is obtained through reading studies as part of routine patient care and the twice-monthly Mellen MRI conference (managed by the fellows) in which studies are reviewed with Neuroradiology. MRI-related research projects also are available.
The proportions of time spent on the various activities and the duration of the fellowship vary. Fellows interested in clinical research training typically spend 1–2 days per week seeing patients and need 2–3 years to complete the requirements for the Master’s Degree. Fellows interested in focusing on clinical training typically spend most of their time seeing patients and need only one year to become competent.
Two positions per year are available, typically starting in July. Applications are reviewed 12–18 months prior to the planned start date, and fellows are selected on a rolling basis. Contact Janet Perryman, Fellowship Administrator at 216.444.8612 or firstname.lastname@example.org to get an application. Required supporting documents include curriculum vitae and three letters of recommendation. Interviews are arranged by invitation.
This is a time of rapid advances in the basic understanding of the MS disease process leading to the emergence of MS as a treatable disease. A large number of institutions are trying to recruit someone with this sort of training. We look forward to hearing from you.