2.  Goals and Objectives
 
The University of Colorado Department of Neurology has continuously provided
structured and comprehensive training for neuromuscular fellows for the past 40
years.  The goal of the neuromuscular fellowship at the University of Colorado is to
train neurologists to gain subspecialty expertise in neuromuscular disorders.
Graduates of the program will serve to advance the science and understanding of
nerve and muscle abnormalities. They will also provide state-of-the-art diagnoses and
care for patients with nerve and muscle disorders and will educate other physicians
(including internists, family practitioners, neurology residents, general neurologists
and other neuromuscular subspecialists), other healthcare personnel and the public
about these disorders.
 
Fellows who complete the program will acquire expertise in the evaluation and
management of patients with nerve and muscle pathology. This includes skill in the
interview and examination of patients with neuromuscular complaints, knowledge of
the appropriate laboratory investigations for diagnosis of neuromuscular disorders,
knowledge of the differential diagnoses for the various clinical presentations of nerve
and muscle problems and expertise in the management of these conditions. Fellows
will also become proficient in the performance of nerve and muscle biopsies;
interpretation of nerve and muscle biopsies; performance and interpretation of
electrodiagnostic studies (including electromyography, nerve conduction studies
and autonomic studies).
 
3.  Definitions
Neuromuscular disorders are a subsection of neurology that includes abnormalities
of the anterior horn cells, nerve roots, peripheral nerves, neuromuscular junction
and muscle, including disorders that affect adults and children.
 
4.  Content of Subjects to be Taught
Fellows will be provided with an advanced and extensive background in
neurophysiology, neuroanatomy and neuropathology of these conditions. They
will also be exposed to the clinical presentation, laboratory investigation and
management of a wide-range of neuromuscular disorders.
 
5.  Prerequisites for the Trainee
Applicants for the neuromuscular fellowship program must have completed an
accredited residency program in either child neurology or adult neurology before
the fellowship begins.  The University of Colorado offers one fellowship position
each year.
 
6.  Personnel Needed for the Training
The University of Colorado fellowship program has six-full time faculty members
who each have expertise in adult and pediatric neuromuscular disorders.
 
7.  Qualifications of the Trainers
The Program Director, Dianna Quan, MD has eight years of experience practicing
and teaching neuromuscular medicine and electrodiagnostic medicine.  Other faculty
members include Steven Ringel, MD, Hans Neville, MD, Yvonne Rollins, MD, PhD,
Bjorn Oskarsson, MD and Julie Parsons, MD.  These faculty members have over
75 years of combined experience in neuromuscular practice and education.
 
8.  Facilities Needed for the Training
This neuromuscular medicine fellowship program is ACGME approved and is offered
under the auspices of the University of Colorado Department of Neurology, which
also has its own ACGME-approved residency program.  The University of Colorado
is a regional tertiary referral center with state of the art medical and educational
facilities to support its training programs. Fellows have ready access to the Dennison
Medical Library, which has a collection of 271,833 bound volumes and access to
57,915 journal titles, a large selection of monographs, and a wide variety of computer
databases.  The library provides searching on MEDLINE, PubMed, and other
databases from within the library or from home or office, 24 hours a day, seven days
a week.
 
9.  Set-Up for the Training
The fellowship program provides a clinical experience in which the fellow develops
expertise in the evaluation and treatment of patients with a variety of neuromuscular
disorders. The program design and structure are approved by the University of
Colorado’s Graduate Medical Education review committee.  Dr. Quan is responsible
for the overall coordination of the program and the selection of fellows for
appointment to the program in accordance with University of Colorado and
Department of Neurology policies and procedures. Dr. Quan is also responsible for
selection and supervision of the teaching staff and personnel at each institution
participating in the program. Dr. Quan and other faculty members have
responsibility for the instruction and supervision of fellows in the program.
 
10.  Methods of Training
The fellow receives instruction and practical experience sufficient to develop
diagnostic and therapeutic skills to provide care for patients with neuromuscular
disorders.  The clinical experience includes opportunities to observe, evaluate, and
manage patients with a wide variety of disorders of muscle and nerve. Clinical
experience includes inpatient care and outpatient care.   Supporting services in
pathology, radiology, and electrodiagnosis are available. Fellows receive training in
the performance and interpretation of nerve and muscle biopsies, motor and sensory
nerve conduction studies, electromyography and single-fiber electromyography
and testing of autonomic function.
 
The fellowship program conducts formal lectures and teaching conferences. These
conferences include discussions of neuropathology, neurophysiology, and the
clinical diagnosis and management of neuromuscular disorders.
 
Clinical assignments include progressively increasing responsibilities for patient
care with direct supervision by appropriate faculty.  Subspecialty experience can be
provided to accommodate a fellow’s individual interests.
 
The neuromuscular fellow takes an active role in the teaching and training of
neurology residents.
 
11.  Timetable for Training
The University of Colorado’s ACGME accredited neuromuscular medicine fellowship
program is 1 year long.  Fellows who are interested in additional training in clinical
research methods are encouraged to pursue an additional year of non-ACGME
accredited training.
 
12.  Methods of Evaluation of the Trainee
Dr. Quan, with participation of members of the teaching staff, will:
·  Quarterly evaluate the knowledge, skills and professional growth of the fellow,
using appropriate criteria and procedures.
·  Communicate each evaluation to the fellow in a timely manner.
·  Provide a written final evaluation for each fellow who completes the program. This
evaluation will verify that the fellow has demonstrated sufficient professional ability
to practice competently and independently. This final evaluation will become part of
the fellow’s permanent record retained by the University of Colorado.
 
13.  Methods of Evaluation of the Training Process
The educational effectiveness of the neuromuscular fellowship is evaluated in a
regular and systematic manner. The quality of the curriculum and the extent to which
the educational goals have been are formally assessed once a year. Regular
evaluations by fellows are utilized in this process.
 
14.  Mechanisms for Feedback
Fellows are given the opportunity to complete evaluations of the faculty and
curriculum every 3 months during the fellowship. In addition, Dr. Quan is available
to meet with the fellow on a weekly basis to discuss any concerns that the fellow has
regarding the program. Dr. Quan is also available on a weekly basis to discuss
concerns that the faculty may have with regard to the conduct of the fellowship.
 
15.  Methods of Constantly Upgrading Knowledge
The faculty and fellow participate in continuing education in order to expand their
knowledge base and remain up-to-date in their understanding of neuromuscular
disorders. In recent years, these activities have included:
·  Weekly participation in clinical discussions, rounds and conferences
·  Monthly journal clubs or research conferences.
·  Presentations at regional or national professional and scientific societies, such as
the American Academy of Neurology, American Association of Neuromuscular and
Electrodiagnostic Medicine, International Symposium on ALS/MND, and
International Congress of Clinical Neurophysiology
·  Participation in clinical research in the areas of health services, ALS, neuropathy,
and critical illness neuropathy and myopathy.
 
16.  List of References/Resources
·  Neuromuscular Diseases, General
Brown WF, Bolton CF, Aminoff MJ. Neuromuscular Function and Disease. Philadelphia. W.B. Saunders Co, 2002
 
Jones HR, DeVivo DC, Darras BT. Neuromuscula r Disorders of Infancy, Childhood,
and Adolescence. Philadelphia. Butterworth-Heinemann, 2003.
 
Pourmand R. Neuromuscular Diseases. Expert Clinicians’ Views. Boston. Butterworth-
Heinemann, 2001
 
·  Muscle Pathology
Dubowitz V. Muscle Pathology: A Practical Approach. 2nd Ed. Baillière Tindall, 1985
 
Carpenter S, Karpati G. Pathology of Skeletal Muscle. 2nd Ed. Oxford University Press,
2001.
 
Karpait G, Hilton-Jones D, Griggs RC. Disorders of Voluntary Muscle. Cambridge
University Press, 2001
 
·  Nerve Pathology
Midroni G, Bilbao JM. Biopsy Diagnosis of Peripheral Neuropathy. Butterworth-
Heinemann, 1995
 
Richardson EP Jr., De Girolami U. Pathology of the Peripheral Nerve. WB Saunders
Co, 1995
 
Vital C, Vallat J-M. Ultrastructural Study of the Human Diseased Peripheral Nerve. 2nd
Ed. Elsevier, 1987
 
·  Electrodiagnosis
Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 3rd Ed. Oxford
University Press, 2001
 
Oh, S. Clinical Electromyography. 2nd Ed. Williams & Wilkins, 1993
Preston D, Shapiro B. Electromyography and Neuromuscular Disorders. Butterworth-
Heinemann, 1998
 
Dumitru D, Amato a, Zwarts MJ. Electrodiagnostic Medicine. Philadelphia. Hanley
& Belfus, Inc., 2002
 
·  Disorders of Peripheral Nerve. 
Griffin J, Low P, Poduslo J. Peripheral Neuropathy. 3rd Ed. W.B. Saunders Co., 1993
 
·  Disorders of Muscle
Engel A, Franzini-Armstrong C. Myology. 2nd Ed. McGraw-Hill, 1994
 
 Griggs R, Mendell J, Miller R. Evaluation and Treatment of Myopathies. Philadelphia:
F.A. Davis Co., 1995
 
Walton J, Karpati G, Hilton-Jones D. Disorders of Voluntary Muscle. 6th Ed. Churchill
Livingstone, 1994
 
17.  Continuing Medical Education Needed
At least 20 hours of category 1 of continuing education in neuromuscular disorders
must be completed by the neuromuscular specialist every five years to maintain
certification.