The Marlene and Paolo Fresco Clinical Fellowship award provides support to Italian neurologists and related specialists who are interested in developing a career in movement disorders. Successful applicants participate in the international fellowship program between NYU Langone and a funded partner institution in Italy. The fellowship includes two years of support for training, with the first year at NYU Langone and the second at a partner institution, nominated by the applicant, in Italy. Learn more about the clinical fellowship for Italian neurologists and related specialists.

The first year of training takes place at NYU Langone and includes coursework and hands-on clinical experience. Fellows are expected to treat patients under the supervision of a U.S.-licensed physician, complete research, and publish results. After the one-year mentored clinical phase in New York City, fellows will be eligible for an additional year of support to conduct independent research and clinical work in one of the centers in the Fresco Network in Italy.

Clinical Training

The objective of the curriculum is to develop expertise in diagnosing, treating, and managing patients with movement disorders. We provide comprehensive exposure to the following specialties within the movement disorders as recommended by the American Academy of Neurology (AAN):

• clinical neurology: adult and pediatric movement disorders
• psychiatry for interface of movement disorders in primary psychiatric conditions, drug-induced movement disorders, and psychogenic movement disorders
• neuroimaging: MRI, CT, PET patterns in movement disorders
• neuroepidemiology: epidemiological issues relative to movement disorders and clinical trial design
• molecular biology, neuropharmacology, neurochemistry, and neurophysiology
• neurosurgery in the context of interventions for movement disorders
• neurological education: teaching experience for physicians, health professionals, patients, and the public in movement disorders
• neurorehabilitation

Fellows see patients with a variety of movement disorders at the Fresco Institute for six half-day sessions per week. All patients seen by fellows are also seen by a supervising movement disorders attending. The fellow is responsible for answering calls from patients they see and to only make recommendations under the supervision of an attending physician.

Fellows also see patients at NYU Langone’s Center for Neuromodulation, where they learn how to assess candidates for deep brain stimulation (DBS) for the treatment of a variety of movement disorders. The fellow discusses all the programming changes with the attending. By the end of the fellowship, the fellow should be very familiar with the postoperative management and long-term programming of the stimulators. There is ample opportunity to observe in the operating room and learn the basics of intra-operative monitoring if interested.

Research Training

Fellows have four half-day sessions per week dedicated for research. They also have the opportunity to engage in the Parkinson’s Outcome Project, where they can conduct hypothesis-driven data analysis to generate pilot data for abstracts and papers. Fellows may be asked by faculty to assist with preparing case reports, case series, and review articles for publication. Timely completions of such projects are expected.

Fellows are expected to submit an abstract to at least one national or international conference during their fellowship. Fellows are also expected to review the Essentials of Clinical Research edited by Stephen P. Glasser, available in NYU Langone’s virtual library, and present chapters during the monthly journal club.

Fellows also participate in the biannual International Fresco Symposium and present any ongoing research or clinical projects.

Clinical Staff

The following staff will provide clinical training for our fellows:

• Steven J. Frucht, MD
• Andrew S. Feigin, MD
• Un J. Kang, MD
• Christine M. Stahl, MD
• Patrick Drummond, MD
• Michael H. Pourfar, MD

Clinical Education

The Fresco Institute places a high value on continuing education in order to optimize the care delivered to patients. To this end, fellows have the following opportunities:

• Fellows are sponsored to attend at least one meeting per year and are strongly encouraged to attend the annual meetings of the American Academy of Neurology or the International Congress of the Society for Movement Disorders.
• Fellows are sponsored to attend any meeting at which they are presenting, if funding is available.
• Fellows join the Fresco Institute clinical team for weekly meetings.
• Fellows join the Fresco Institute research team for weekly meetings to monitor and review research projects.
• Fellows are expected to attend the following teaching conferences:

Weekly Video Rounds

Weekly video rounds occur every Tuesday from 5:00 to 6:00PM. Hosted by Dr. Frucht, interesting video case vignettes are presented by the fellows from the previous week’s patient encounters. Review of phenomenology, differential diagnoses, and treatment approaches are discussed in an open forum with movement disorder’s faculty, residents, fellows, and students.

Journal Club and Basic Principles of Research

Journal club is a weekly meeting takes place to revise and critically discuss written material provided in advance. This modality will include a journal club and Basic Principles of Research. For the journal club, fellows study and present pivotal and seminal paper publications in high-impact journals. Journal club helps build and solidify confidence in fellows’ skills to critically evaluate medical literature.

Basic Principles of Research also include written educational material and cover introduction to clinical research methods and ethical conduct of research.

Fellows are required to complete the Collaborative Institutional Training Initiative (CITI) tutorial in human subject research. Fellows are also expected to effectively contribute to their research group’s projects to warrant a lead author abstract submission to a regional/national meeting.

To reinforce knowledge in their field of study or interest, fellows are encouraged to do at least one of the following: write a curated literature review paper, write an abstract for an international meeting, or prepare an original manuscript for publication.

Incorporating research experiences and additional research methods coursework into the fellowship will encourage fellows to explore and define their interest in clinical and translational research while building their skills and enhancing their confidence.

Core Competencies

Patient Care

Fellows demonstrate competency in the following areas:

• obtaining an accurate and comprehensive history in patients with Parkinson’s disease or other movement disorders
• performing the movement disorder exam
• understanding the differential diagnosis, laboratory and imaging investigations, and management of Parkinson’s disease and other movement disorders
• determining the appropriate candidates with Parkinson’s disease, tremor, and dystonia, for DBS
• understanding the basic principles of rehabilitation of the Parkinson’s disease patient
• developing and implementing independent clinical plans for patients with Parkinson’s disease and other movement disorders

Clinical Evaluation of Movement Disorders

Fellows gain the following skills (adapted from AAN guidelines):

• recognize and document patterns of clinical findings in movement disorders when the patient is at rest
• perform a complete general neurological examination
• perform a focused examination for movement disorders including turning, rest, assuming a posture, performing a task
• recognize and document patterns of clinical findings in movement disorders when the patient maintains a posture
• recognize and document patterns of clinical findings in movement disorders when the patient executes a task
• evaluate tone
• evaluate walking
• understand and apply standardized rating scales for movement disorders
• recognize and document non-neurological findings typical of movement disorders
• use the Unified Parkinson’s Disease Rating Scale (UPDRS) and other relevant movement disorders scales

Practice-Based Learning and Improvement

Fellows participate in the following activities:

• research pertinent literature on interesting cases
• present cases of educational value at weekly video rounds
• participate in clinical, research, and educational conferences of the Fresco Institute
• prepare one to two lectures that will presented to neurology residents on specific topics in movement disorders
• prepare lectures for medical students
• write consultation letters and other notes as needed in the electronic medical record
• become familiarized with the scope of Fresco Institute research activities and make appropriate referrals for studies
• present Parkinson’s disease–related information to patient groups

Professionalism

Fellows adhere to the following guidelines:

• demonstrate respect for patients and all center personnel, as well as ethical behavior, integrity, honesty, compassion, and confidentiality in the delivery of care
• respond to communication from patients and health professionals, order and follow-up on appropriate laboratory and diagnostic tests, and document the patient’s course in the medical records, all in a timely fashion

Interpersonal and Communication Skills

Fellows will:

• Communicate effectively with the Fresco Institute staff of physicians, nurses, social workers, and administrators
• Communicate effectively with referring physicians
• Interact appropriately and compassionately with patients

Monitoring of Fellows

Formal evaluations occur every six months following direct observations of the fellow and discussions with other teaching staff involved in the fellowship. Review of the faculty evaluations are conducted one-on-one between each fellow and Dr. Feigin and Dr. Frucht to reaffirm basic knowledge, patient management skills, understanding of research methodology and the academic process of writing for peer-reviewed journals, lecturing, and teaching.

Constructive performance feedback is provided to the fellows. Evaluations are reviewed by faculty and the trainee. A permanent record of the evaluation is maintained and is accessible to the trainee and authorized personnel. Fellows are given the opportunity to review the program and faculty through New Innovations on a semiannual basis. This feedback is shared with faculty in an effort to promote transparency and ongoing programmatic growth.

Application Details

This fellowship program accepts applications on a rolling basis with applicants evaluated upon submission and qualified applicants receiving awards until the annual budget is exhausted. Successful applicants will be able to start the fellowship on or after January 1, 2020, and receive support for clinical and research training at the Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Health.

This program is designed to support talented and motivated Italian citizens who have completed an MD and have completed a four-year residency program in neurology, physical medicine and rehabilitation, neurophysiopathology, geriatrics, or related specialties.

Successful candidates benefit from state-of-the-art research facilities at NYU Langone as well as from the extensive and thriving clinical research community in New York City. Fellows receive a salary commensurate with standard compensation and taxation levels between the two countries.

How to Apply

• CV, using NYU Langone’s format
• A one-page cover letter with a summary that includes a description of the following:
  • your history and commitment to a clinical or research career in movement disorders
  • your potential to develop a successful career in movement disorders
  • your expectations about the training to be obtained with this fellowship
• letters of references from at least two previous or current mentors (and up to four mentors) that include information on your qualifications and previous experience
• a copy of all degree certificates with grades and clinical licensures
• information about the center in Italy that will host you upon your return
• evidence of English language proficiency, as determined by one of the following:
  • Test of English as a Foreign Language (TOEFL^®) score of at least 65 or International English Language Testing System (IELTS^®) score of at least 5.5 (not more than 5 years old)
  • signed documentation from an academic institution or English language school

If none of the above documents are available, English language proficiency will be determined during an interview conducted by the sponsor either in-person, by videoconferencing, or by telephone.

Prospective applicants should send all the above documentation to fi-nrp@nyulangone.org or Monica Norcini, PhD, at monica.norcini@nyulangone.org, with a copy to Luis Duarte at luis.duarte@nyulangone.org, by September 1, 2019, in order to start by January 1, 2020. Applications received after September 1, 2019, will be eligible to start the fellowship at least five months after their application is received. For any questions, please contact Dr. Norcini.

Review Process

All applications undergo a preliminary administrative review. Candidates who meet the eligibility criteria will be asked to interview with members of the selection committee via Skype or another teleconferencing system.

Selected Applicant Work Requirements

Selected applicants are required to work with the administration of NYU Langone to ensure proper administrative and U.S. immigration processing. Clinical fellows are required to comply with all NYU Langone, departmental, and division rules and regulations.