The Status of Multiple Sclerosis and Neuroimmunology Fellowship Training in the United States: A Pilot Study

Background: The number of neuroimmunology/multiple sclerosis (NI/MS) training programs in the USA has increased over the past decade.  However, the extent of structural and curriculum similarity across programs remains unknown

Objectives: We aimed to highlight major aspects of NI/MS training programs offered in the USA.

Methods: A web-search was performed to identify NI/MS training programs in the USA. A questionnaire was developed addressing: diseases covered during training, rotations offered, tracks/duration of training, number of fellows accepted, visa sponsorship, status of approval by the institution graduate medical education (GME) office, and call schedule. Frequency tables were prepared. Statistical analysis was done using STATISTICA program

Results: We identified 52 fellowship programs.  An electronic-copy of the questionnaire was sent to program directors.  A total of 23 questionnaires (44%) were returned.  All reported that MS/demyelinating disorders are covered during training. Other frequently covered areas included paraneoplastic syndromes (71%), neuro-rheumatology (67%), vasculitis (67%) and encephalitis (67%). However, exposure to peripheral immunology and autoimmune epilepsy was less common (29% and 33%, respectively).   Most programs reported opportunities in neuro-ophthalmology (65%), neuroradiology (65%), neuro-rehab (61%), and urology (57%). Exposure to neuropathology (43%), neurophysiology (22%), and neuropsychology (22%) was less common.   All programs reported the ability to accommodate clinical/research needs of the applicant.  A 1-2-year program was most common (47%) while others offered variable durations. Most programs (42%) reported accepting 2-fellows per year (ranged: 1 – 5) and 67% guaranteed first-year funding. Finally, 38% reported the possibility of visa sponsorship

Conclusions: We identified many similarities between programs.  A variety of relevant disorders are being covered and rotations in other disciplines are available.  However, neuropsychology and neuropathology maybe underrepresented in most programs which could be related to the availability of MS dedicated neuropsychologists and neuropathologists.  Finally, the chances for International medical graduates (IMG) to successfully obtain NI/MS fellowship are limited which may affect their subspecialty choice