Neurology Residency Information

It’s an exciting time to be a neurologist, and the University of Cincinnati Department of Neurology is an exciting and fun place to learn how to be a neurologist.  The overall mission of our department is to take discoveries in the neurosciences and translate them to the treatment of the patient with neurologic disease.  This “bench to patient” approach is highlighted by our outstanding clinical faculty, clinical research, and translational basic neuroscience research.  We expect our residents to be compassionate, scholarly clinical neurologists when they have completed their training at our program.  The guiding philosophy of our clinical and educational program is that “the patient is the most important person.”

As part of our residency program, you will be exposed to a vast array of neurologic problems and diseases with an exceptional and expanding group of world-class faculty.  As of 2008, the Department of Neurology has 35 very active full-time faculty, and the Division of Pediatric Neurology has 22 full-time faculty. Our Department is part of the larger, multi-departmental University of Cincinnati Neuroscience Institute at the UC College of Medicine and University Hospital, which ranks among the top US hospitals according to US News & World Report.  The UC Neuroscience Institute has been formally in existence since 1998 and is one of the major reasons for our success and growth.    

Our program also has exceptional, subspecialty programs in cerebrovascular disease, epilepsy, epilepsy monitoring, neurocritical care, movement disorders, neuromuscular disease, Alzheimer’s disease, multiple sclerosis, behavioral neurology, and electrophysiology.  Our pediatric neurology program is one of the largest in the United States, with major strengths in epilepsy, movement disorders, headache, inherited disorders of metabolism, tuberous sclerosis and neurofibromatosis.  Although these programs are described in detail in the following sections, it is helpful to mention a few highlights.  

Our clinical and basic multi-disciplinary research program has been consistently ranked in the top 10 of all Departments of Neurology in the United States and in the top 5 of public universities.  Our translational research program in the laboratory has also expanded with 10 well-funded Ph.D. scientists in cerebrovascular disease, cell and growth factor therapies for neurodegenerative disease, neuro-immunology, neuro-imaging, genetics, and animal models of neuromuscular diseases.

Our cerebrovascular research program has received funding from the National Institute of Neurologic Diseases and Stroke (NINDS) since the mid-1980’s, with extensive federal funding for both basic and clinical research.  Our program was the first to test and explore the use of tissue plasminogen activator, the only current approved therapy for acute ischemic stroke.  Examples of our continued leadership include:

            1) we are the coordinating center for a randomized, 50-plus-center study in North America of combined intravenous and intra-vascular treatment of ischemic stroke sponsored by the NINDS;

2) we were one of the first centers in the country to be awarded a program project grant by the NIH for acute stroke (SPOTRIAS); the project includes a multicenter pilot trial of low-dose t-PA and a GIIbIIIa platelet reception blocker and the use of rFVIIa in subjects with ICH as well as some of the first work in the genomics and proteomics of acute stroke;

3) we are the coordinating center for a 26-center international study to identify the genes associated with intracranial aneurysms;

4) we lead several NIH-funded interventional studies of recovery following stroke. 

Our multi-disciplinary research program spans the entire gamut of stroke, from population-based studies of environmental and genetic causes of stroke, to acute medical and interventional treatments for stroke, to the very latest and most exciting research in recovery after stroke. Residents in our program are exposed to the latest cutting-edge treatments of acute stroke and participate in the care of patients treated as part of these research trials.  Seven cerebrovascular neurologists participate in this program, along with three emergency physicians, three neuro-interventionalists, two cerebrovascular neurosurgeons, and six cerebrovascular and neurocritical care fellows.

The adult epilepsy research program, headed by Dr. Michael Privitera, has been involved with much of the testing of the new antiepileptic medication over the past 10 to 15 years. The pediatric epilepsy program, headed by Dr. Tracy Glauser at Cincinnati Children’s Hospital Medical Center, has been a leader as well. The adult and pediatric programs enjoy a collaborative relationship and have been well supported by NINDS. In 2003 Dr. Glauser was awarded a $15 million grant from NINDS for a large multi-center, randomized treatment trial of childhood epilepsy. Residents are exposed not only to ongoing epilepsy treatment trials, but also to a monitoring unit in a surgical treatment center (University Hospital) whose results are among the best in the country. A separate epilepsy monitoring program is located at Cincinnati Children’s. The addition of a 4 Tesla Research Magnet at University Hospital and combined EEG/fMRI several years ago has accelerated ongoing research studies headed by Dr. Jerzy Szaflarski. For example, an ongoing study uses functional MRI to select patients for epilepsy surgery. The epilepsy monitoring program, headed by Dr. David Ficker, is one of the busiest and most successful in United States and continues to grow.

The James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, directed by Dr. Fredy J. Revilla, has one of the busiest neurosurgical programs for Parkinson’s disease.  The Gardner Center has an active clinical research program that includes five full-time neurology faculty (four adult and one pediatric), an active neurosurgical program headed by Dr. George Mandybur, and the Davis Phinney/Donald Krumme Fellowship in movement disorders. UC, along with Stanford University, was the first national Davis Phinney Research Center.  We have six outstanding scientists who work in animal and cell culture models of Parkinson’s disease and movement disorders and are mapping out some of the most exciting new potential cell and growth factor therapies for Parkinson’s. A well-funded, active clinical research program in pediatric movement disorders focusing on Tourette’s and other movement disorders of childhood is a unique part of our program. 

The Department of Neurology also showcases  the endowed $5 million Waddell Center for Multiple Sclerosis.  Dr. Istvan Pirko, Director of the Waddell Center, heads an active translational research group whose research foci include neuro-immunology and neuro-imaging.  Dr. Aaron Johnson investigates various animal models of MS.  Dr. Maria Melanson, the Waddell Center’s Clinical Director, directs several important clinical trials.  Dr. Brendan Kelley joined the group this year as a specialist in cognitive issues in patients with MS. 

Our Neuromuscular group, headed by Dr. John Quinlan, has recently expanded over the past year with six adult and one pediatric neuromuscular-fellowship-trained specialists.  This group of physician/investigators is conducting clinical and basic research in ALS, spinal muscular atrophy, muscular dystrophy, and other neuromuscular disorders in adults and children. The researchers work with other neuroscientists in the medical center, using a well-defined mouse model of muscular dystrophy.

We have one of the most active clinical and research programs in the U.S. for childhood headache. The program, headed by Andrew Hershey in the Division of Pediatric Neurology at Cincinnati Children’s, features separate headache treatment centers for adults and for children. 

Finally, Dr. Brendan Kelley joined us from the Mayo Clinic as the Director of Behavioral Neurology in 2008. He will be working closely with gero-psychiatrists and geriatricians at UC in the assessment and treatment of patients with cognitive disorders, with a special focus on Alzheimer’s disease.

Dr. Ronnie Horner, who was recruited (from NINDS) as the new Director of the Institute of Health at UC, has a secondary appointment in neurology. 

Additional faculty recruitment in neuro-oncology, sleep, and clinical neurology are ongoing.

Residents have excellent role models for career development in research.  Seven adult and pediatric neurology faculty currently hold or are completing K23 "Career Development and Clinical Research Awards" from the NIH.

The education of residents and fellows has a high priority in our department.  To this end, we have extensive didactic teaching, including...
     1)    Grand Rounds
     2)      a clinical neuroscience course
     3)      difficult case conferences and Chairman's Rounds
     4)      journal club
     5)      a neuro-pharmacology course
     6)      a neuro-ophthalmology lecture series
     7)      three specialty conferences
     8)      mortality and morbidity conferences, and
     9)      practice oral board examinations, including the first-ever Standardized Patient oral exam.

Perhaps more importantly, our faculty are easily accessible for curbside consultation for patients of the residency in the hospital or in the clinic.  

Finally, we have ACGME-approved fellowships in Neurophysiology (EEG, EMG or combined), Cerebrovascular Disease and Neurocritical Care, and we have available a fellowship in Movement Disorders.

Our faculty work closely with groups of scientists and neurobiologists and other clinical departments at the University of Cincinnati.  We have ongoing research collaborations with multiple members of departments of molecular biology, cell biology, physiology, environmental health, molecular genetics, and neuropathology in the basic sciences, and neurosurgery, neuro-radiology, emergency medicine, internal medicine, physiatry, and psychiatry among the clinical departments. 

Yet, I am most proud of the clinical efforts of our faculty, who are compassionate, outstanding clinicians who love to teach and, more importantly, care about the patients they treat.  They are also clinicians who are frustrated by the current state of the art and seek to improve it by doing clinical research and collaborating with basic scientists within and outside of the Department of Neurology.  

Our department is a fun, friendly, and exciting place to learn how to be a neurologist.  We look forward to meeting you in person.

Yours truly,

Joseph P. Broderick, M.D. 

Chairman

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Thank you for your interest in the Residency Training Program at the University of Cincinnati.  We are seeking motivated, mature individuals with superior performance in medical school and beyond who are committed to a career in neurology.  As a faculty, we are dedicated to training high-quality clinical neurologists who will practice evidence-based medicine in a scholarly fashion.  We will provide a pleasant working atmosphere in which you will be treated as a colleague, an excellent physical environment (including a new office building that was completed in 2007, a new and updated resident clinic space, and an updated resident call room), plenty of research opportunities, and a reasonable balance between service and education. 

 Our program has grown in size and has translated into less call and more elective time for our trainees.  We continue to make periodic changes to enhance the educational experience of our residents.  Program highlights include:

1.)    A busy three team structure, with University Hospital ward and consult teams as well as the VA Hospital team.  This structure allows in depth teaching at the bedside, with small team sizes.

2.)    A revised clinical neurosciences didactic lecture series includes neuroradiology, neuro-ophthalmology, neurophysiology, and neuropathology.  Teaching in the neuroscience is supplemented by a neuropharmacology and neuroanatomy lecture series.

3.)    A live patient practice exam that utilizes standardized patients (SP’s).  To our knowledge, we are the first program in the country to use SP’s for this exercise—an innovative approach that we feel will be useful since SP’s are trained to provide feedback to residents in regards to their performance.  The use of the SP “laboratory” allows each encounter to be recorded in a digital format,  so residents can review their interaction with the faculty evaluator. 

4.)    Each resident spends 2-4 weeks per year in a dedicated outpatient clinical rotation with time spent in each of the subspecialty clinics in the Medical Arts Building.  Residents will be working one on one with subspecialty attendings to obtain a cross-sectional view of various neurologic diseases.

5.)    A resident clinic at University Hospital in a newly renovated space in the Hoxworth Building—a move that has provided the residents superb clinic space.  Clinic improvements also include a part-time nurse practitioner and a full time second attending in clinic.

6.)    An interactive teaching program in regards to End of Life/Palliative Care, Patient/Physician Communication Skills, and Ethics.  We have also been adding Academy-derived lectures with Evidence-Based Medicine as the focus.

7.)    A Pediatric neurology rotation that includes 2 months of hospital admissions and consults, followed by 1 month of outpatient clinics in subspecialty areas of pediatric neurology.  We feel that this is the best way to expose the resident to the depth and breath of pediatric neurology.

8.)    EEG and EMG are dedicated 2 month blocks each.  These are both now supplemented by a monthly EEG Neurophysiology lunch lecture series, as well as a monthly EMG Neurophysiology lunch lecture series.  Each will include technical skill teaching and with “hands-on experience”, combined with patient care in our Epilepsy Monitoring Unit and Muscular Dystrophy Association Clinics.  An intensive four-month block of Neuromuscular Care can be taken in the final year.  This elective provides substantial hands-on experience (on top of the two month block in PGY-3) that can lead to eligibility for Neurophysiology certification.

9.)    All residents are certified in the NIH Stroke Scale.

We continue to work with our residents on issues that may arise with a monthly Educational Committee Meeting, where residents, nurse practitioners, and attendings may bring educational and systems issues that need to be addressed.  This is another way that we are committed to our residents, providing another vehicle for feedback and problem solving as a group.  We also provide individual evaluations every 6 months with the Program Directors, as well as monthly feedback sessions with individual attendings, and a yearly closed-door session with critique of attendings.  Monthly Mortality and Morbidity sessions help us also deal with practice-based and systems-based issues that arise in the care of our patients.

Furthermore, the UC Neurology program has become an integrated, four-year program.  Residents matching with us will do their Internal Medicine training at The University Hospital.  This has several benefits:

1.) Residents matching with us will not have to seek an Internal Medicine Preliminary Year--it will be provided without requiring a formal interview.

2.) During internship, the resident will have neurology continuity clinic rather than an Internal Medicine continuity clinic.

3.) During internship, the resident will spend two months with neurology.  One month will occur in the NSICU, so that the intern will receive intensive care training while gaining exposure to neurologic disease.  This rotation will have limited overnight call.  The other month will be on the neurology consult team.  This will further exposure to neurology in a month without overnight call.

Didactic teaching is enhanced by the Visiting Professor series directed by Dr. David Ficker.  We continue to invite nationally renowned figures from all topic areas in neurology to give Grand Rounds and then spend additional time with the residents. 

We are proud of our current group of residents and the success recent classes of residents have enjoyed in obtaining high quality fellowship and practice positions.  As Program Directors, we are seeking “the best of the best” for our program and pledge to help you develop in your individualized career path should you join us.  We encourage you to apply to our program and look forward to meeting you in person.

Sincerely yours,

Brett Kissela, M.D.  and Robert W. Neel, M.D.

Residency Program Co-Directors

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Dr. Charles Aring, a leader in American medical education, founded the Department of Neurology in 1947. He previously had begun the Department of Neurology at the University of California at San Francisco (UCSF).  A friend and co-worker of many pioneers of neurology in the United States and Europe, Dr. Aring was chairman in the Department until 1974. Dr. Frederick Samaha assumed leadership of the department in 1977 until retiring as Chair in 1999. Dr. Joseph Broderick, the current Chairman, assumed leadership in 2000.

The University of Cincinnati Academic Health Center also has a long and rich history. In 1819, Daniel Drake, M.D. - later described by Sir William Osler as "the Greatest Physician of the West" - obtained a charter from the General Assembly of Ohio to found the University of Cincinnati and its College of Medicine. Today, the University of Cincinnati plays a leading role in medical research, medical education, and the care of patients within the Greater Cincinnati and Northern Kentucky community. The Department of Neurology is pleased to be an integral part of the Medical Center and to share in its rapid expansion. The University Hospital recently added a nine-story critical care pavilion and the only adult Level One trauma center in Hamilton County. The Cardiovascular Research Building and the Vontz Center for Molecular Studies, completed in the 1990s, house the department's basic research laboratories. These building projects reflect the enormous activity in both clinical and research areas at the University of Cincinnati Academic Health Center. Neuroscience is recognized as a major strength of the University and the Department of Neurology is connected to one of the six core clinical departments of the Academic Health Center that will continue to receive increasing attention over the next decade. 

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The Cerebrovascular Disease Program at the University of Cincinnati has been recognized as one of the world's leading programs in the clinical research of stroke and related disorders. The Cerebrovascular Program received over $7,000,000 in federal funding in the academic year 7/1/2003-6/31/2004. The University of Cincinnati was the pioneer in the rapid mobilization and treatment of acute stroke patients with thrombolytic therapy and continues to develop and further this field of research. Residents are directly involved in the care of these patients, who are treated at the University of Cincinnati Medical Center. There are extensive ongoing studies in the evaluation and treatment of patients with acute ischemic stroke, and patients with acute intracerebral hemorrhage, the genetics of stroke, stroke epidemiology, the prevention of stroke, and outcomes of recovery after stroke.

The patients are admitted to an acute stroke service at the University Hospital in one of two intensive care units. Emergency carotid non-invasive testing is available as well as magnetic resonance angiography and state-of- the-art magnetic resonance imaging, Difficult and challenging cases from other hospital services and from outside referrals are reviewed with a team of neurologists, neurosurgeons, and neuroradiologists at a weekly Cerebrovascular Disease Conference. Seven cerebrovascular neurologists participate in this program in addition to three emergency physicians, four neuro interventionalists, two cerebrovascular neurosurgeons, and two neurointensivist.  

Our ACGME-approved Vascular Neurology fellowship experience is one of the best in the world.

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Every resident learns to perform a complete EMG and to understand the clinical presentations of neuromuscular diseases during a two month period in the PGY-3 year.  Residents begin by covering principles of electrical safety and fundamentals of the electronics as they practice nerve conduction studies on each other. In a series of standardized oral and timed practical examinations, residents demonstrate mastery of electrical safety, machine operation, nerve conduction techniques, and muscle anatomy (nerve and root innervation, methods for activation and needle electrode examination).  Supplementing this is a separate monthly EMG neurophsyiology lecture series based on a textbook.

After testing is complete, patient testing begins, under the direct supervision of one of our five ABEM certified attending electromyographers. EMGs are performed by residents up to six half-days per week and at other times when attending supervision is available.  Residents continue to improve their techniques and clinical skills by participating in the MDA clinics. These half-days feature individual or small group discussion of reading assignments and approach common diagnostic problems.

Residents attend and present cases at the weekly Neuromuscular Conference. They are encouraged to write short articles based on these conferences.  Our residents often choose additional elective EMG rotations in the senior year to further polish their skills. 

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The Multiple Sclerosis section is one of the newest additions to the ever expanding spectrum of Neurology subdivisions at the University of Cincinnati. Through a collaboration between the University of Cincinnati and the Drake Center, a major and nationally recognized rehabilitation hospital in Cincinnati, a new MS Center was created in 2004. The Waddell Center for Multiple Sclerosis provides comprehensive care to patients with Multiple Sclerosis and other inflammatory diseases of the white matter. MS patients are followed by two neurologists with subspecialty training in neuroimmunology, Dr. Istvan Pirko and Dr. Maria Melanson, as well as a dedicated nurse practitioner. The MS Center also includes a nurse practitioner and a MS trained physical medicine and rehabilitation specialist.

Besides the clinical activities, basic science neuroimmunology research is also being conducted at the University of Cincinnati. The neuroimmunology laboratory is the newest section of the neuroscience group located at the Vontz Molecular Science Building. The main areas of research include the role of CD-8 lymphocytes in demyelination, fulminant attacks of demyelination in transgenic animal models, and experimental neuroimaging of animal models of MS.

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