The University of Michigan Epilepsy Fellowship is a 12-month ACGME accredited program devoted to assisting trainees in developing expertise in the diagnosis and management of seizure disorders including the interpretation and implementation of many neurodiagnostic evaluations that are used in treatment of epilepsy. Most of our candidates apply for an Epilepsy fellowship and we offer 6 epilepsy positions per year. For candidates interested in learning other neurophysiological techniques as well (Intraoperative monitoring, Sleep, etc.), we offer training in Clinical Neurophysiology. The fellowship includes rigorous training in electroencephalography, corticography, decision making in all types of epilepsy surgery, intraoperative and extraoperative mapping, intraoperative monitoring, understanding imaging and cognitive modalities, as well as medication management. There are opportunities to teach, and several basic science mentors with exciting research opportunities. Upon completion of the fellowship, trainees are eligible to sit for the American Board of Psychiatry and Neurology added qualification in Epilepsy examination or the American Board of Clinical Neurophysiology examination depending on the track that they have chosen. Interested trainees may elect to do a second year of advanced epilepsy fellowship for additional training in surgical techniques, or mentored research in our basic science or clinical areas. Rotations in the first and second years are tailored to the needs and interests of the individual fellows.
Fellowship Clinical Experience
The University of Michigan epilepsy clinic is a tertiary referral center, commonly drawing patients from the metropolitan Detroit area, the state of Michigan, Ohio, Indiana and other out of state areas. Our inpatient Long term video monitoring services care for over 1000 adult and over 600 pediatric patients yearly, with diagnoses including presurgical evaluation, intensive care monitoring, treatment of status epilepticus and diagnosis of non-epileptic paroxysmal disorders. The primary responsibility for fellows on the inpatient adult and pediatric services is reading the EEG studies and multidisciplinary communication of these results, and there is also an adult and pediatric epilepsy consultation service where our fellows can assist more directly with management of complex cases. Fellows have no in house call, but do rotate through EEG reading call at home. We are putting a great effort in to managing the workload with careful attention to fellow satisfaction. In fact, fellows are directly involved in decisions and discussions about how best to accomplish their work, and have a monthly fellows’ education conference to discuss customization of their education, call schedule, and any challenges that arise.
Our fellows rotate through both pediatric and adult clinics and pediatric and adult inpatient monitoring during the fellowship. We have a weekly presurgical multidisciplinary conference that fellows participate in. All fellows are expected to rotate through training in intraoperative monitoring and we are proud of having an accredited IOM program at our institution. Electives in psychological management, speech and language evaluation and mapping, neuroimaging in epilepsy, and quantitative analysis of EEG are available. There is also the opportunity to participate in funded basic science research in several areas.
Our program provides:
- Over 3000 total epilepsy visits yearly, including faculty and fellow visits
- 60-80 epilepsy surgeries yearly, with 1-2 intracranial cases per month, and roughly 10-15 pediatric surgeries per year
- Over 2000 EEG studies yearly in adult and peds
- Over 1600 long term monitoring admissions with adult and peds combined
- SPECT, PET, quantitative EEG, fMRI and combined studies that aid with presurgical localization
- An average of 5 daily intraoperative monitoring studies, interpreted by faculty, which are simultaneously reviewed by fellows on the IOM rotation
Electrodiagnostics and Procedures
Fellows are given intensive early instruction in EEG and ECoG interpretation. For the first 3 months of fellowship, every tracing is reviewed simultaneously by a fellow and an attending. After a self-assessment examination with successful demonstration of electrodiagnostic skills, fellows may choose to call an attending while on call or to review the studies with the attendings the following day. Instruction is provided on Wada test interpretation, intracranial EEG, motor and language mapping, routine and intraoperative evoked potentials, and the use of quantitative EEG.
Throughout the year, there is a didactic conference weekly on Wednesday mornings, with several extra early lectures in the first month on emergent topics. There is a presurgical conference each Thursday afternoon where fellows participate in presurgical decision making. The fellows lead monthly journal club discussions. These three sessions are mandatory. Bimonthly evoked potential and intraoperative monitoring lectures and monthly NICU-EEG conferences are also provided with expected attendance when possible. We also offer a twice yearly workshop in vagus nerve stimulation and intraoperative mapping.
The program has a monthly fellow education conference where fellows participate directly with evolving plans and feedback for their education. Fellows attend 2-4 quality and safety meetings per year between hospital and lab staff and trainees and faculty to discuss operational issues. Our fellows are encouraged to participate in quality projects. Fellows are also given the opportunity to present 1-3 didactic lectures to residents per year, depending on interest in teaching and receive feedback and mentoring for teaching.
Our fellows attend one national meeting per year. All fellows are also mentored through a research project and put up a research poster at the University of Michigan Neuroscience Research Day each year. Fellows take a self-assessment examination in the fall and the American Board of Clinical Neurophysiology shelf exam each spring. Fellows receive outstanding teaching from epilepsy faculty with a variety of clinical and research interests.
Work and Living Environment
Ann Arbor, MI is family friendly city renowned for its cultural offerings. Ann Arbor is home to the University of Michigan Health System, a leading clinical and research medical facility. It has been ranked highly as a preferred city because of its sporting, music and active cultural life and welcoming natural setting. The department of neurology is a highly ranked, academic department with a residency training program of 21 residents and internationally renowned faculty.
Fellows are given ample private storage and work spaces in several areas, administrative support and continuous faculty support. Call is only from home reading EEG tracings but there is a call room in the hospital available to the fellows if needed.
Epilepsy Fellowship application requirements: CV, personal statement, 3 letters of recommendation (one of which is from a program director or chair), and an application.
Regarding visa issues, you must be one of the following: a US citizen, permanent resident (green card holder), or have a J-1 visa sponsored through ECFMG. We do not sponsor any other visas.
For more information or to apply for a position in the fellowship, please contact Holley Comiskey at 734-936-4457 or at firstname.lastname@example.org or Dr. Temenuzhka (Nusha) Mihaylova at email@example.com.