The fellowship program encourages early differentiation into a customized career paths. The incoming fellows choose either the clinician training track with 75% time devoted for clinical training or the clinician-investigator training track with at least 75% protected time for research. Trainees accepted in our program will work with the program director and section chief to identify clinical and research mentors that align with the candidate’s career goals. This process begins during the interview process and continues throughout training.
First year
The first year focuses on a well-rounded clinical training and identifying a particular research interest. Clinical training opportunities include attendance in the Movement Disorders Clinic; participation in deep brain stimulation (DBS) surgeries, DBS programming and focused ultrasound (FUS) procedures; botulinum toxin injections for multiple indications in both the adult and pediatric population and inpatient consultations.
All fellows are expected to engage in research during their fellowships. During the first year, fellows in the clinician-investigator training track identify a research interest and begin background work in that particular area. Others who already have identified an area of research interest will begin and develop work in a particular lab or research group. Each fellow presents once per month in the Movement Disorders journal club on a range of topics including literature reviews, clinical trials and recent publications pertinent to their research. Fellows are also expected to publish annually during their fellowship.
Second year
In their second year, fellows will gain greater depth of understanding about less common movement disorders and significantly enhance clinical skills in the technical aspects of movement disorders. Fellows in the clinician training track can individualize clinical training to focus on certain areas according to their specific career goals. Fellows in the clinician-investigator training track must continue their research activities with the expectation of producing at least one peer-reviewed journal publication. Fellows will learn how to write grants, develop research protocols and design experiments working closely with their research mentor. Most fellows choose to write a training grant during this year to support additional research. This can be either a foundation or a NIH grant.
Optional third year
Some fellows choose to continue their fellowship for a third year. These are usually fellows in the clinician-investigator track that are focusing on research and need the extra time to hone their skills, complete specific projects, publish additional manuscripts and prepare NIH grant applications.
Program features
Scope of diseases: Clinical goals include education in a broad range of movement disorders including PD, Huntington disease (HDSA center of excellence), dystonia, Tourette syndrome, essential tremor, cerebellar ataxias, functional movement disorders, and pediatric movement disorders. The wide exposure in our clinics along with a large volume of patients, opportunities to learn from and participate in multiple clinical trials creates a unique learning experience. Our vast repository of clinical videos categorized by phenomenology and diagnoses provides another excellent educational resource. The goals of training include in-depth understanding of clinical manifestations, pathophysiology, etiology, treatment and social issues for each condition. This includes a basic understanding of the pathology and relevant genetics for each disorder.
Advanced therapeutics: A second goal is to gain experience and expertise with FUS and DBS including selection of appropriate candidates, stereotactic mapping of implantation coordinates, programming stimulator devices, and managing medication changes associated with these treatments.
Botulinum toxin injections: A third goal is to develop expertise identifying proper candidates for botulinum toxin injections, understand the limitations of these procedures, gain technical expertise, and comfort with respect to different populations including adults and pediatric patients.
Presymptomatic testing: Understand the role of presymptomatic testing of relevant neurologic disorders, including the role of a multidisciplinary approach. Gain experience in evaluating people for these tests and learn about relevant societal factors.
Pediatric movement disorders: Another goal of the program is to comprehensively understand common movement disorders affecting children.
The Department of Neurology is currently ranked in the top tier of NIH funding among all neurology departments in the U.S. In our American Parkinson Disease Association (APDA) Advanced Center for Research Excellence, the majority of Movement Disorders faculty have active NIH R01 funding and others are current or recent K-awardees.
Research not only encompasses patient-oriented clinical/translational aspects but also basic science spanning a broad range of scientific areas including neuroimaging, motor physiology, motor control, genetics and epidemiology, molecular pathogenesis and neuropathology. There are several ongoing large-scale, single-center longitudinal studies involving neuroimaging and other biomarkers of gait impairment, dementia and neuroinflammation in Parkinson disease (PD) and dystonia. We also have a large repository of postmortem brains enabling histopathologic and novel ELISA based assays of protein aggregation and neurotransmitter deficits in PD. This creates a mélange of research opportunities for our trainees to leverage existing data and the infrastructure of parent studies to carve out independent research questions under individualized guidance of highly successful and experienced mentors.
Our strategy paves the path for successful training grant applications with multiple prior AAN clinical research training fellowships and Parkinson Study Group mentored research training awardees from our section, most of whom have transitioned to NIH K-awards. The meticulously designed training program instills the solid foundation necessary to excel as a physician-scientist and future leaders in the field.
Location: In-patient and out-patient training occurs at the Washington University School of Medicine Medical Center, including Barnes-Jewish Hospital and St. Louis Children’s Hospital.
Clinical facilities: Clinical facilities include the NeuroClinical Research Unit, Center for Advanced Medicine, Huntington’s Disease Center of Excellence and the American Parkinson Disease Advanced Research Center within the Department of Neurology at Washington University School of Medicine.
Research facilities: All fellows are provided with adequate space and computer access for clinical and research activities. Depending on the research project, fellows have access to state-of-the-art imaging facilities through the Neuroimaging Laboratory Research Center (NIL-RC) and the Center for Clinical Imaging Research (CCIR); animal models and appropriate animal care facilities; specialized equipment for cellular and molecular neurobiology research.
Diversity, equity and inclusion
Our dedication to diversity, equity, and inclusion (DEI) is woven into the fabric of our mission and practices. We firmly believe that a diverse and inclusive environment is essential for advancing our understanding of movement disorders and delivering optimal care to our diverse patient population. As part of our commitment, all fellows undergo mandatory and comprehensive four-part diversity training, empowering them to recognize and address implicit biases. Our commitment extends beyond initial training. Through our recurring journal club series, we continuously engage our fellows in discussions that emphasize relating with the diverse communities affected by movement disorders. Washington University serves a large and diverse catchment area. We actively seek to create a welcoming and supportive environment for individuals from all backgrounds, ensuring equitable opportunities for growth and success.
Our patients hail from our backyard neighborhoods that include marginalized and minoritized populations as well as suburban and rural population from multiple states around and beyond. Partnering with this diverse patient base requires faculty, trainees and staff that are not only trained in DEI but are also committed to creating an equitable working environment where patients and partners alike are welcome. The fellows have the opportunity to get involved in ongoing, funded community-engaged research to understand factors that influence engagement in research and clinical care among people of color with PD in St. Louis. By integrating diversity into our fellowship program and organizational framework, we strive not only to nurture exceptional expertise in movement disorders but also to foster compassionate and culturally competent leaders who champion diversity in research, patient care and throughout their professional careers.
Our School of Medicine
Our students learn from master clinicians and researchers while pursuing their studies in a wide array of academic departments and programs. Students select Washington University for the culture of camaraderie and support, a flexible curriculum and outstanding opportunities after graduation. Our programs are considered to be among the very best in the nation.