Fellowship in Clinical Neurophysiology at North Shore-LIJ Health System
The Department of Neurology at the North Shore-LIJ Health System offers a one-year clinical neurophysiology program to study elect neurologic disorders involving the central, peripheral and autonomic nervous systems. Under the leadership of S. Murthy Vishnubhakat, MD, this ACGME approved program provides fellows with extensive training and expertise in the core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice.
The program includes two tracks: EEG/Epilepsy and EMG/neuromuscular disease. During the year of training nine months are spent in the fellow’s respective area of concentration and the remaining three months in the other discipline. Trainees are also exposed to sleep medicine, pediatric clinical neurophysiology, and intra-operative methods.
Long Island Jewish Medical Center is a NY State Certified Level 4 Comprehensive Epilepsy Center serving nearly 7 million people in the Queens, Long Island, and New York Metropolitan area and one of the most ethnically and culturally diverse regions of the world. LIJMC is the highest volume surgical epilepsy center in the Long Island region. The Epilepsy/EEG division at LIJMC houses a clinic, a testing laboratory, reading stations, routine EEG machines, and equipment for visual and auditory evoked potentials used for both inpatient and outpatient testing. Between the two locations, the adult divisions have four hardwired inpatient VEEG beds, equipment for intracranial monitoring, and a dozen portable units for the continuous VEEG monitoring of ward and ICU patients. North Shore University Hospital is planned to become the future home for surgical implantation and monitoring.
The Cohen’s Children Hospital has four hardwired inpatient VEEG monitored beds, and additional portable VEEG monitoring units, with additional studies from the neurocritical care service at North Shore University Hospital.
The Sleep Center at North Shore University Hospital is equipped with eight rooms for overnight patient stay with sleep monitoring equipment, a control room, and a reading station.
Program director: Sean T. Hwang, MD
The role of the fellow is progressively expanded over the course of the year.
Initial clinical duties include rounds on the epilepsy inpatients, covering the epilepsy clinic and learning the basic concepts of reading and interpreting EEG. As competency is assessed by direct observation, the training advances and the fellow begins to read studies independently and to formulate reports, with faculty review and constructive critique.
Mastery of interpretation of the EEG is expected to be developed in the following areas: interictal and ictal patterns in all age groups including neonates through the elderly, diverse seizure types / epilepsy syndromes, non-epileptic attacks, patterns associated with diverse medical conditions including coma and brain death, and status epilepticus. Appropriate literature in the form of established texts and journal articles are discussed, along with a formal lecture series. Teaching responsibilities include the supervision of the neurology residents during their elective rotations through the EEG lab, and leading a weekly EEG review session.
The fellow is expected to become involved with a greater degree of resident supervision, inpatient consultations, a higher volume of routine and continuous (elective and critical care based) EEG, evoked potential studies, sleep studies, IOM, conference preparation for operative planning for surgical epilepsy cases for refractory epilepsy, invasive electrode monitoring, electrocorticography, cortical electrical stimulation mapping and to participate in decision-making for surgical resection.
The fellow is expected to gain some familiarity with commonly utilized studies such as neuropsychological testing, Wada tests, and functional imaging with PET and SPECT studies. The fellow is asked to participate in critical review of the literature, and to select an independent research project and quality control initiative of their choosing.
Duties and responsibilities are allocated progressively pending assessment of the fellow's degree of competency, based on review of reports, presentation and formulation of clinical plans for cases on daily clinical rounds, a yearly clinical examination evaluation, and on formal quarterly reviews. The fellows are expected to take the in-service examinations, sponsored by ACNS and AANEM for self evaluation.
Program director: Surya M. Vishnubhakat, MD
The role of the fellow is progressively expanded over the training period. Introductory training includes understanding basic principles of electronics, electrical safety, ethics, OHSA and HIPPA regulations.
At the beginning of the training, waveform recognition and the performance of basic studies is done under the direct supervision of the site director and other faculty. Once proficiency is noted the fellow performs all studies independently under indirect observation of the program director. Patient evaluation, diagnostic formulation, study design and accuracy, report writing and management are discussed. Methods of evaluation include direct observation, multiple choice questionnaires, literature review, and direct assessment of the fellow’s ability to teach other residents during their elective rotation. Mastery of interpretation of nerve conduction studies, reflex studies, blink reflex studies, needle electromyography, single fiber EMG, autonomic testing, and spinal, visual and brain stem auditory evoked responses is anticipated.
The fellow performs the EMG/NCS including obtaining clinical history, examination of the patient, electrode placement, needle insertion and personally interprets the results under the supervision of the program director. Each study or case is discussed by the director with the fellow in detail, with appropriate formulation, literature citation and current management. As the training advances, progressive independent responsibilities are assigned to the fellow with appropriate intensive clinical monitoring by the program director, including constructive critique. All fellows must participate in the teaching of residents during their rotation through the EMG lab.
Quarterly evaluations include all six core competencies and feedback. By the end of six months, 200 independent studies are expected from the fellow and thereafter greater responsibilities are assigned. In-service examinations are sponsored by American Association of Neuromuscular and Electrodiagnostic Medicine and the American Clinical Neurophysiology Society for self evaluation. The results are discussed with the fellows and appropriate remedial measures are taken to improve their knowledge base. Participation in clinical research is expected.
Surya M. Vishnubhakat, MD
- Chief of Division - Neuromuscular Disease of Neurology, North Shore University Hospital
- Vice Chairman of Neurology, North Shore University Hospital
- Associate Professor, Hofstra North Shore-LIJ School of Medicine
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Ronald Kanner, MD
- Chair of Neurology,
North Shore University Hospital
Chair of Neurology,
Long Island Jewish Medical Center
Chair of Neurology,
Hofstra North Shore-LIJ School of Medicine
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Scott Jordan Stevens, MD
- Chief of Division - Education of Neurology, Long Island Jewish Medical Center
- Chief of Division - Division of Education of Neurology, North Shore University Hospital
- Assistant Professor, Hofstra North Shore-LIJ School of Medicine
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Puja Naik, MD
Undergraduate education: SUNY Staten Island
Medical education: Medical University of the Americas
Clinical interests: Driving and epilepsy, psychogenic non-epileptic syndrome
Hobbies: International travel, fine dining, beaches, animals, spending time with my husband, family and my two cats: Mittens and Buttercup
Khurram Nazir, MD
Undergraduate education: Cadet College Hasanabdal, Pakistan
Medical education: Allama Iqbal Medical College, Lahore, Pakistan
Hobbies: Traveling, music, reading, trying new and different things
Applicants interested in the clinical neurophysiology training program at North Shore-LIJ Health System should submit applications to the Program Director or Coordinator. Contact information is below.
No applications are reviewed after March 1.
Essential application information includes:
- House staff application (Click to download)
- Personal/career statement
- Curriculum vitae
- Three (3) letters of recommendation
Applicants must have completed a neurology residency program by the start date of the fellowship program. They must also be board-eligible or board-certified in Neurology and must have a non-restricted NYS Medical License at the time of appointment.
Please submit applications to:
Department of Neurology
North Shore-LIJ Health System
300 Community Drive, Tower Pavilion – 9th Floor
Manhasset, NY 11030
Phone: (516) 562-2303
Fax: (516) 365-8128