Overview

The fellowship curriculum is designed to develop expertise in the recognition, diagnosis, treatment, management, and rehabilitation of inpatients and outpatients with Multiple Sclerosis and related immune-mediated disorders of the central nervous system. The fellow will be trained in the clinical, multidisciplinary management of multiple sclerosis and neuroimmunological central nervous system disorders. The training will be composed of direct MS outpatient care at UF Health’s Fixel Center for Neurological Diseases and the Malcolm Randall VA Multiple Sclerosis Clinic and will also entail inpatient neuroimmunology consults at the UF Health Neuromedicine Hospital and the Malcolm Randall VA Medical Center under the supervision of MS / Autoimmune Neurology fellowship-trained faculty (Torge Rempe, MD, PhD, Mayra Montalvo, MD).

A specific fellowship focus will be to recognize and address health disparities in Multiple Sclerosis and individual socioeconomic barriers to adequate clinical care will be addressed in biweekly clinic meetings. For further exposure to comprehensive MS care, 20 percent of the fellowship will be focused on rotating with the different specialties involved in our center’s multidisciplinary MS treatment. This will entail specific training in neuro-ophthalmology by our center’s neuroophthalmologist (Bryce Buchowicz, MD) and rotations with our in-house MS neurorehabilitation team including physical (Chanel Stokes, PT, DPT), occupational (Nicole Tester, PhD, MOT, OTR/L, MSCS) therapy and speech language pathology (Nicole Herndon, MS, CCC-SLP). Furthermore, our multidisciplinary training plan will include pain management, neuropsychology, rheumatology, neuropathology, neuroradiology and psychiatry. The fellowship will also entail botulinum toxin injection training for MS patients with migraine headaches and spasticity.

With this broad exposure to our center’s multidisciplinary treatment approach with access to both inpatient and outpatient experiences, our program is designed to provide education in all facets of comprehensive clinical care of persons with MS. The fellow will also be introduced to knowledge and competence in clinical and translational research and conduct hypothesis driven research projects.

Weekly schedule

 ~60% Direct Multiple Sclerosis patient care under the supervision of multiple sclerosis / neuroimmunology-fellowship trained faculty (Torge Rempe, MD, Mayra Johana Montalvo Perero, MD)

a. Multidisciplinary outpatient care at the UF Health Multiple Sclerosis Program at the Fixel Center for Neurological Diseases and the Malcolm Randall VA Multiple Sclerosis Clinic

b. Inpatient neuroimmunology consultations for acutely sick patients with MS and related disorders requiring inpatient care at UF Health’s Neuromedicine Hospital and Malcolm Randall VA Medical Center (no weekend or night coverage)

c. Training in MS-specific scores including Expanded Disability Status Scale and Multiple Sclerosis Functional Composite

d. Training in health disparities and inequities due to race, ethnicity, and socioeconomic status

e.Biweekly clinic meetings to discuss and address socioeconomic barriers to adequate MS care in individual patients

2. ~20% Multidisciplinary MS patient care rotating with UF’s multidisciplinary MS care team

a Neuro ophthalmology (Bryce Buchowicz, MD) – specific training in neuro-ophthalmological examination techniques, outcome measures and ocular coherence tomography

b. UF Health Multiple Sclerosis Program multidisciplinary care team (on-site at the Fixel Institute for Neurological Diseases)

i.  Rehab medicine

1. 1. 1. 1. Chanel Stokes, PT, DPT – Physical therapy
         2. Nicole Tester, PhD, MOT, OTR/L, MSCS – Occupational therapy
         3. Nicole Herndon, M.S., CCC-SLP – Speech language pathology

ii. Nutrition (Emily Truscott, MS, RD, LD)

iii.  Social work (Alana McKay, LCSW)

iv. Neuropsychology (Dawn Bowers, PhD, ABPP-CN)

v. Psychiatry (Gregory Pontone, MD, MHS)

vi. Genetics (Lee Kugelmann, NMSc, CGC)

c. Pain management

i. Sanjeev Kumar, MD – Director, Springhill Pain Clinic

ii. Mustafa Yehya, MD – botulinum toxin injection training for migraine headaches with headache fellowship trained faculty

iii. Adolfo Ramirez-Zamora, MD – botulinum toxin injection training for spasticity with movement disorders fellowship trained faculty

d. Urology (Thomas Stringer, MD)

e. Pulmonology (Divya Patel, DO)

f. Rheumatology (Eric Sobel, MD, PhD)

g. Neuropathology (Marie Rivera-Zengotita, MD)

h. Pharmacology (Rawlins Campbell, PharmD, BCNSP, BCSCP, CNSC)

i. Neuroradiology

i. John Rees, MD

ii. Ibrahim Tuna, MD

iii. Mehmet Albayram, MD

3. ~5% Academic activities

a. Weekly Grand Rounds

b. Weekly multidisciplinary UF Health Multiple Sclerosis Program meeting

i. Discussion of neuroimmunology cases presented by the fellow

ii. Presentations of different multiple sclerosis topics by the fellow

iii. Rotation of weekly topics

• • • Week 1: MS Business Meeting
    • Week 2: Monthly Multiple Sclerosis & Neuroimmunology Fellowship Lecture Series by UF faculty; MS Pharmacology
    • Week 3: Radiological case conference (led by neuroradiology)
    • Week 4: Journal Club with presentation of different hallmark MS journal articles by the fellow

c. Quarterly neuroimmunology conferences with other divisions / departments

i. Neuropathological conference (Marie Rivera-Zengotita, MD)

ii. Immune-mediated cerebellar ataxias with the Movement Disorders Division (Adolfo Ramirez-Zamora, MD)

iii. Neurosarcoidosis conference with pulmonology (Divya Patel, DO)

d. ACTRIMS Didactic Webinar Series (twice a month)

e. Department of Neurology Joint Fellowship Curriculum (2^nd Friday of the month)

f. Teaching of UF’s residents in MS care in departmental lecture series

g. Attendance of a national (ACTRIMS or CMSC) or international (ECTRIMS) MS Conference

4. ~15% Research

a. Design, execution, and publication of a fellow-led research project

b. Exposure to clinical trials participation and methodology

c. Training in blinded rating for clinical trials

d. Scholarly writing activities