Westwood & West Los Angeles VA
Marc Nuwer MD PhD, James WY Chen MD PhD, Inna Keselman, MD PhD, and Claude Wasterlain MD, are primary preceptors for these training tracks. David Naylor MD PhD and Nasheed Jamal MD PhD conduct EMG training. Most fellows train for two years. The EEG-EMG training is one year. The fellows cover both hospitals (WLA VA and RRMC) during their first-year fellowship. The two hospitals are about one mile apart.
Learning: During the first year, the fellows rotate by quarter between Westwood and WLAVA. In a typical week at Westwood, the fellow participates in routine daily EEG readings for adult and pediatric inpatients and outpatients. The fellow is assigned several primary reading days with responsibility to review EEGs and present them to a senior attending for confirmation prior to report dictation. The fellow learns IOM including remote monitoring as well as in-room testing such as for language localization in awake patients during craniotomy. Weekly IOM Book Club reviews a traditional IOM introductory textbook and other teaching materials. For additional EEG learning, he or she also attends EEG teaching sessions when another fellow is the first reader. The fellow may train in other areas of clinical neurophysiology during elective time. Evoked potentials are reviewed on Thursday at Westwood.
While at Westwood the fellows participate in patient care on the UCLA RRMC inpatient Epilepsy Monitoring Unit, and often attend daily video-EEG ward rounds and reading sessions. Epilepsy Monitoring Unit includes special procedures such as grid stimulation and depth electrode recordings.
When rotating at the VA, the fellow participates in VA site’s Epilepsy Monitoring Unit, reads daily EEGs, and interprets ICU EEG monitoring. Elective time is available. Fellows provide patient care at the weekly half-day Neurology Clinic at the WLAVA.
The fellows organize the weekly WLAVA Neurology Grand Rounds and orient neurology residents who rotate there. Fellows are provided with office space, telephone, and pager. There may be funds to cover certain amounts for books or travel, depending on availability of funds.
Call: The fellow is on-call one week out of every three. Call is from home. The call covers problems with patients on the inpatient Epilepsy Monitoring Units as well as for stat EEG requests and off-hours procedures. After hours EEGs can be read on-line from home.
Second Year: Some fellows advance to a second-year training in Epilepsy and EEG Monitoring at the WLAVA. Other fellows spend the second-year training in Intraoperative Monitoring (IOM) at RRMC in Westwood. The first year in each case is a PGY-5 position. The second year Epilepsy track is a PGY-6. The second year Intraoperative Monitoring track fellow is a Clinical Instructor appointment. The EEG-EMG fellow trains only for one year.
The second-year Epilepsy training differs between two tracks: Epilepsy and Intraoperative Monitoring. Epilepsy fellows at the WLAVA work with James Chen and Claude Wasterlain. The fellow works on the Epilepsy Monitoring Unit, sees outpatients in one half-day weekly, helps triage patients for admissions, presents patients at the surgery conference, and participates in teaching and training of the junior fellows and residents. The fellow continues to take call one week out of every three from home. Typically, the fellow participates in research as arranged with Drs. Chen, Wasterlain or other faculty members. As part of the Epilepsy ACGME program, one month is spent rotating to the Pediatric Epilepsy service in Westwood.
The second year Intraoperative Monitoring (IOM) fellow is appointed as a Clinical Instructor in Westwood. He or she focuses on IOM for the full year with Marc Nuwer, Inna Keselman, and Lara Schrader. This includes time in the operating rooms participating and understanding how procedures are performed and interpreted in neurosurgery, orthopedics, cardiothoracic, vascular, head and neck, and other disciplines. The fellow monitors over a thousand IOM cases over two years, both at our major university hospital in Westwood and telemonitoring remotely for cases at our Santa Monica UCLA Medical Center. Services provided in the OR include localizing eloquent language and motor cortex as well as IOM clinical and technical problem solving. The fellow provides radiology procedural monitoring and testing for intracarotid amytal and balloon occlusion testing.
EEG-EMG training: This one fellow trains for one year. Each fellow learns about EEG, video-EEG monitoring, EMG, and nerve conduction testing. The fellows rotate by quarter between training on EEG and EMG rotations. On Tuesdays throughout the year the fellow attends the program two-hour didactic teaching conference in Westwood.
In a typical EEG training week, the fellow participates in routine daily EEG readings for adult and pediatric inpatients and outpatients. This includes continuous ICU EEG and neonatal EEG monitoring. The fellow reviews EEGs and presents them to a senior attending for confirmation prior to dictating a report. The fellow also cares for inpatients admitted for video-EEG monitoring. In a typical EMG training week, the fellow participates in routine EMG and NCV training several days each week.