Massachusetts General Hospital

Program Overview

The Behavioral Neurology and Neuropsychiatry Fellowship Program at MGH is a training program established within the Departments of Psychiatry and Neurology with the purpose of training the next generations of outstanding neuropsychiatrists and behavioral neurologists. The program core faculty body includes the program director, double-boarded in neurology and psychiatry, 7 neuropsychiatrists, 5 behavioral neurologists, 5 neurologists, 3 neuropsychologists and a biostatistician. The fellowship provides a multidisciplinary training environment with access to subspecialty clinics. These include the Outpatient Neuropsychiatry Clinic, the Fronto-Temporal Dementia Unit (Memory Disorders Unit), the Cognitive Behavioral Neurology Unit, the Movement Disorders Unit, the Stroke Service, the Ataxia Unit, the Epilepsy Service, the OCD/Tourette's clinic, the Neuropsychology Clinic. All rotations will be in outpatient clinics.

You will spend time on each of these clinical services under the supervision of MGH faculty. The purpose of the rotations is to provide you with adequate experience in the evaluation, diagnosis and treatment of a wide range of behavioral neurology and neuropsychiatry disorders including geriatric and neurodevelopmental neuropsychiatric disorders, mild cognitive impairment and dementias including Alzheimer's disease, Frontotemporal Dementia and Lewy- Body Dementia, movement disorders, cerebrovascular disorders, epilepsy, traumatic brain injury and brain tumors. Fellows are expected to take part in at least 6 sessions/week face-to-face patient encounters.

In weekly clinical rounds, you will present cases to senior clinicians expanding your clinical knowledge on several aspects of behavioral neurology and neuropsychiatry from patient care and system-based practice.

As part of your educational experience, you will attend formal didactics with a diverse curriculum of 40 one hour long classes distributed over the course of the academic year. Classes will cover topics that range from principles of neurobiology, to nervous system development and aging, higher cortical functions, anatomy and function of brain systems, learning and memory, sleep, theory of attachment, culture and cognition, clinical manifestations of brain behavior disorders with specific emphasis of major neuropsychiatric diagnostic categories (e.g. neurodevelopmental disorders, neurodegenerative disorders, movement disorders, multiple sclerosis, epilepsy, mood and anxiety disorders, traumatic brain injury), the clinical assessment of patients with behavioral neurology and neuropsychiatry conditions, the neuropsychological assessment, diagnostic studies (neurophysiology, neuroimaging, sleep studies), psychopharmacology, neurotherapeutics (e.g. deep brain stimulation, vagal nerve stimulation, rapid transcranial magnetic stimulation).

As part of your clinical training, you will also learn the fundamentals of neuropsychology testing administration and interpretation attending biweekly neuropsychology seminars, which will include case conferences and lectures in the major areas of neuropsychology, and assisting neuropsychologists during evaluations.

Integral to the core curriculum is the development of in-depth knowledge of diagnostic studies through attendance of weekly neuroradiology and neurophysiology rounds and monthly neuropathology case presentations.

Through your fellowship, the faculty will strongly encourage you to develop your own clinical and research interests as you access nationally and internationally recognized clinicians and researchers within MGH and in the neighboring Harvard/MIT Schools. Current areas of research available to fellows encompass basic neurobiology, neurobiology of neurodegenerative diseases, functional neuroimaging, neurophysiology, clinical trials in all psychiatry divisions, epidemiology, and international medicine.

Individual weekly supervision with behavioral neurology and neuropsychiatry faculty will provide you with the opportunity to discuss clinical cases or specific topics more in depth. You will also meet with the program director to cover issues ranging from patient's care to career development. Emphasis will also be placed on personal well-being, academic growth as well as coping strategies to attend to the demands of training.

Your feedback on the program is crucial to the development of the training academic goals and you will be asked to provide faculty and curriculum evaluations. To maximize your learning experience, we think it would be helpful to familiarize yourself with the goals of the MGH BN-NP fellowship program, its organization and requirements, which are described on the next tab.

Specific goals of the fellowship:

Goal 1: To develop clinical expertise and competence in the treatment and care of patients with disorders associated with brain dysfunction.

Fellows will further develop the clinical skills they acquired during residency and will learn to perform a thorough clinical assessment that will combine elements of both neuropsychiatry and behavioral neurology data gathering appropriate for each individual case. Fellows will need to be proficient in the neurological and the mental status exam, the selection and administration of the appropriate neuropsychological testing, the use of diagnostic procedures with relevance to both behavioral neurology and neuropsychiatry, and the interpretation of their results.

Fellows will achieve this goal participating in supervised, direct patient care in the Core and Subspecialties Clinics at MGH. The program clinics are major referral sites for a wide range of conditions spanning from neurodegenerative disorders (e.g. Alzheimer's disease, Frontotemporal Dementia, Lewy-Bodies Dementia, Progressive Supranuclear Palsy), to developmental neuropsychiatry (including acquired and congenital developmental disorders such as Down's syndrome, Williams Syndrome, Fragile X syndrome, ADHD and pervasive developmental disorders), movement disorders (Parkinson's disease, Huntington's disease, dystonia, Tourette's), stroke, epilepsy, multiple sclerosis, traumatic brain injury, brain tumors.

Goal 2: To develop an in-depth knowledge of structural and functional neuroanatomy as they relate to behavior and cognition.

Fellows will achieve this goal through:

1. attendance of formal didactics which will include the core curriculum classes, the neuroradiology and the neuropathology rounds and the neuropsychology seminars;
2. clinical rounds and case presentations and discussions;
3. reading and discussion of textbook chapters and research articles during supervision.

Fellows will develop an operational knowledge of structural and functional neuroanatomy and will learn to integrate data gathered through the clinical evaluation and the diagnostic studies in order to identify the brain system/s affected in each individual case.

Fellows are encouraged to improve specific areas through self-learning. To this purpose the Francis Countway Library at Harvard Medical School and the Treadwell Library at MGH offer access to a wide range of tutorials and online textbooks, which can help fellows develop their neuroanatomy knowledge covering areas of relative weakness.

Goal 3: To gain broad knowledge of the diagnostic categories of behavioral neurology and neuropsychiatry.

Fellows will learn fundamentals of the major diagnostic categories of behavioral neurology and neuropsychiatry including: epidemiology, genetics, neurobiology and neuroanatomy, clinical manifestations, diagnostic procedures, psychopharmacological treatment, psychotherapy, cognitive rehabilitation, and the roles of social work assessment and support, and family counseling and assistance. This goal will be accomplished through the supervised direct patient care, attendance to the didactics core program, supervision and self-directed learning.

Goal 4: To promote advanced understanding of neuropsychopharmacology including in depth knowledge of neurotransmitter systems, how they are affected in the conditions commonly seen in the behavioral neurology and neuropsychiatry practice, and how they are modulated by psychoactive drugs.

Fellows will expand on previous knowledge on:

1. neurotransmitter systems and their function in health and disease;
2. principles of pharmacokinetics, pharmacodynamics and drugdrug interactions for the major classes of psychoactive drugs including: antidepressants, anticonvulsants and mood stabilizers, sedatives and hypnotics, first and second generation antipsychotics, psychostimulants, cholinesterase inhibitors, NMDA antagonists.

In addition they will develop expertise in the use of psychoactive drugs in patients with brain dysfunction and several medical co-morbidities. The fellows will also learn elements of pharmacoeconomics and the importance and challenge of optimal drug choice in the care of complex conditions with high personal and community financial costs.

Goal 5: To promote understanding of the functions and the importance of an interdisciplinary team in the care and management of behavioral neurology and neuropsychiatry patients.

Fellows will learn to work with and coordinate a multidisciplinary team to provide optimal care to their patients under the supervision of a faculty member. This team will most often comprise the fellow, a neuropsychologist, a psychotherapist, a social worker and at times a cognitive rehabilitation therapist, a vocational rehabilitation therapist, a genetic counselor, and a family therapist. Clinical Rounds, supervision, case presentations will offer a forum to discuss the different aspects of patient's care and the role of individual providers in a multidisciplinary team.

Goal 6: To promote and empower fellows in their respective areas of research or clinical interest as they move to build their career post-fellowship.

Fellows will have the opportunity to be mentored by world-renowned researchers at MGH to develop their research career if they elect to do so. All fellows will attend research statistics seminars in their first year of training to gain proficiency in research methods and statistical analysis.

Scheduled Rotations

1. General Neuropsychiatry Clinic and Developmental Disorders, Core - once a week
2. General Behavioral Neurology Clinic (Adult), Core - once a week
3. Geriatric Behavioral Neurology and Neuropsychiatry Clinic, Core-once a week
4. Frontotemporal Dementia Subspecialty Clinic, Core - once a week
5. Neuropsychology Assessment Clinic, Core- every other week
6. Treatment Resistant Depression Clinic, Core- every other week
7. Epilepsy Clinic - every other week
8. Stroke Clinic- every other week
9. Movement Disorders Clinic - every other week
10. OCD-Tourette's Clinic-every other week
11. Executive Function Subspecialty Clinic (ADHD and Learning Disabilities included), elective-once a month
12. Multiple Sclerosis Clinic - elective-once a month

All rotations share teaching and learning methods. These include supervised care, fellow’s individual supervision, attendance of case conferences and self-directed learning. Fellows will have access to additional educational resources including textbooks, MGH and HMS libraries, online resources, and professional meetings. At the end of each rotation fellows will receive written evaluations to assess progress. Areas of weakness will be addressed with the help of the program director. Fellows will be individually supervised on each case they will provide care for.

Additional opportunities to develop clinical competence and expertise are offered by attendance of the weekly clinical rounds, during which cases are presented and discussed in the presence of a multidisciplinary team, and individual supervision.

The specifics of each rotation are available for more in-depth review. Please let us know if you have a special interest in a given rotation and we will be more than happy to provide you with additional details.

Application Requirements

As part of your application, please include the following:

1. CV
2. Personal Statement
3. Three letters of recommendations with hard copied mailed to the program director.

Completed applications will be reviewed by the Selection Committee throughout the year.

Prospective fellows will be invited to interview from beginning of September to the end of October for acceptance into the fellowship in the July of upcoming academic year.

We thank you again for your interest and look forward to receiving your application.