Movement Disorders Fellowship

This fellowship has both clinical and research components. The clinical component allows the fellow to see a vast array of movement disorders of all types. In addition, the fellow will be able to get expertise in botulinum toxin injections, duodopa pump treatment, Apomorphine titration and administration, deep brain stimulation programming and all clinical aspects of diagnosis and treatment of movement disorders. Research is integral to the
fellowship. At least one clinical project is required including completing the ethics submission, recruitment of patients and conduct of study, analysis of data and writing manuscripts as required. All necessary guidance and supervision will be provided as required.

Entry Requirement

A competent neurologist with knowledge of anatomy of the brain and the peripheral nervous system.

The fellowship program is not accredited.

Fellowship Objectives

  • 1. Conducts a focused and relevant consultation in the Movement disorders clinic for simple (e.g. early Parkinson disease, Ataxia), moderate (e.g. Advanced Parkinson disease, Huntington disease) and high (e.g. Non-motor symptoms, DBS, Duodopa, Apomorphine, botulinum toxin) complexity diagnoses.
    • a) Performs a directed history and physical examination (medical expert)
    • b) Accurately localizes within the nervous system, demonstrating appropriate knowledge of central and peripheral nervous system anatomy (medical expert).
    • c) Develops an appropriate differential diagnosis, considering the referral question and other diagnostic considerations that may change management (medical expert)
    • d) Demonstrates knowledge of established and evolving movement disorders such as non-motor symptoms in PD and the implications for patient health care and quality of life (medical expert, health advocate)
    • e) Plans the appropriate investigational studies (medical expert)
    • f) Communicates the plan to the patient in a compassionate, appropriate and effective manner (communicator)
    • g) Documents the consultation and results of the investigations, conveying the impression, plan, required investigations and management to the patient, family and referring physician in a timely manner (collaborator, communicator)
    • h) As appropriate, initiates management of medical condition and/or ensures appropriate referral for the patient (medical expert)
  • 2. Proficiently performs and interprets deep brain stimulation requirements fort all patients, injection parameters for botulinum toxin and all other advanced therapies including psychiatric management.
    • a) Describes the normal anatomy and physiology of the basal ganglia, neurochemistry, pharmacology of drugs including the abnormalities. (medical expert)
    • b) Describes the abnormal physiology and pathology that occurs in movement disorders such as genetics, neurochemistry, varieties of phenomenology, adjusting the plan of study accordingly (medical expert)
    • c) Explains the proposed testing to the patient in easy to understand language, obtains informed consent and ensures patient comfort (communicator)
    • d) Apply the principles of physiology, anatomy and pathophysiology to fulfill the unmet diagnostic and therapeutic need (scholar, advocate)
    • e) Troubleshoot expected clinical and technical issues of DBS programming, use of EMG for toxin injection and duodopa pump therapy (scholar, advocate)
    • f) Maintain appropriate infection control practices and universal precautions as outlined in occupational health and safety institutional policies and procedures (leader, professional).
  • 3. Proficiently performs and interprets complex pharmacological interactions, genetics, neuroradiological differential diagnosis such as deposition syndromes.
    • a) Describes the normal anatomy and physiology of the nervous system (medical expert)
    • b) Describes the abnormal physiology and pathology that occurs in movement disorders, adjusting the investigations and analysis as required (medical expert)
    • c) Explains the proposed testing to the patient in easy to understand language, answers questions and ensures patient comfort (communicator).
    • d) Apply the principles of physiology, anatomy and pathophysiology to fulfill the unmet diagnostic and therapeutic need (scholar, advocate)
    • e) Troubleshoot expected clinical and technical issues of DBS programming, Apomorphine administration, use of EMG for toxin injection and duodopa pump therapy (scholar, advocate)
    • f) Maintain appropriate infection control practices and universal precautions as outlined in occupational health and safety institutional policies and procedures (leader, professional).
  • 4. Performs assessment and generates a plan for Apomorphine, DBS, duodopa, botulinum toxin injections.
    • a) Identifies and utilizes appropriate surface anatomic landmarks for needle examination of muscles of the bulbar, cervical, thoracic and lumbosacral segments for toxin injection (medical expert)
    • b) Understands, performs and interprets on-off assessments in PD (medical expert)
    • c) Identifies and accurately interprets DBS programming parameters and localization of electrodes, and side effects (medical expert)
    • d) Identifies and accurately interprets Duodopa pump programming parameters and localization of catheters, and side effects (medical expert)
    • e) Recognizes absolute and relative contraindications to studies, modifying study plan accordingly (medical expert)
    • f) Explains the proposed management to the patient in easy to understand language, obtains informed consent and ensures patient comfort (communicator)
  • 5. Effectively manages a movement disorders practice.
    • a) Supervise trainees and junior fellows/students/residents as appropriate in the movement disorders clinic (leader).
    • b) Participates in life-long learning through continuing professional development and maintenance of competence opportunities (leader, professional)
    • c) Participates in and systematically assesses their practice using quality improvement methods, incorporating change as necessary to ensure high quality movement disorders practice (leader, professional).
    • d) Practices movement disorders in an ethical and cost-effective manner for the benefit of society and containing health care costs (health advocate, professional)
  • 6. Curriculum
    • a) Clinical teaching in clinic,
    • b) Two full days a week,
    • c) Twice a month movement disorders rounds, weekly journal club,
    • d) Weekly lab meetings.
    • e) Fellows can do clinical or basic research that is ongoing in the laboratory and submit abstracts to meetings. one meeting will be funded for a reasonable cost.
  • 7. Service Expectations:
    • a) Ambulatory clinics, three times per week. No call.
  • 8. Academic Expectations:
    • a) Complete at least one case report type paper,
    • b) Review article and a small clinical or basic research project with a publication in a peer reviewed journal.
    • c) For a two-year fellowship (expected) a full research project will be assigned to the fellow that will involve all aspects from concept design to writing of the manuscript.
  • 9. Assessment: Formal assessment is done every 3 months as per the Schulich School requirements. Fellows are also assessed informally in every clinic and feedback is provided with respect to diagnosis, treatment and management of patients. In terms of research, presentations are evaluated, and the research and data are presented at lab meetings where the entire lab group does informal evaluation.
  • 10. Detailed Budget Salary: $60,000 inclusive of benefits

Selection Criteria

Application and letters of reference and CV review, followed by an interview with the applicant performed by the Director and senior fellows.

Application Deadlines

1 year prior to when they can start. This is variable.

Application Process

To apply for this fellowship, interested applicants should send the following documents to the Fellowship Director:

  • A current CV
  • Copy of medical degree (with English translation if applicable)
  • Copy of specialty certification (with English translation if applicable)
  • Three letters of reference
  • Proof of citizenship (copy of passport or birth certificate)

*If you are a sponsored international fellow, your sponsor must submit your application on your behalf directly to the PGME Office.

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