NM Medicine & Clinical Neurophysiology Fellowship Timing & Response to the AAN Position Statement

FELLOWSHIP ISSUES
In neurology and physical medicine and rehabilitation (PMR) residency programs, residents are offered fellowship positions before they are provided adequate time to experience what neuromuscular medicine or clinical neurophysiology has to offer them as a career and how they can benefit patients by specializing in this area of medicine.  In a manuscript on neurology residency training published by the American Academy of Medicine in 2002, 28% of the neurology residents reported EDX training to be the most deficient subspecialty area of education in their neurology program emphasizing the lack of exposure to this important area of medicine.¹ The current system of asking residents to choose a fellowship before their PGY3 year is unfair to the residents or the programs seeking to attract candidates in the specialty area.

AAN’S POSITION
The American Academy of Neurology (AAN) has created a position statement that encourages all neurology fellowship programs to participate in a unified determination date for neuromuscular medicine fellowship.  The AAN is seeking endorsement of their position from the AANEM.

AANEM’s RESPONSE TO AAN
The AANEM is in support of AAN’s position. The AANEM remains concerned that without any method of enforcement of the rules outlined in AAN’s statement, the position statement will not result in participation by the majority of institutions in the United Stated that have neurology fellowship programs.  Asking subspecialty training programs to voluntarily participate has been tried in the past within some neurological subspecialty fellowships without success.  The AANEM believes that the AAN should consider methods of obtaining and ensuring compliance with the suggested guidelines.  The AANEM supports the position with the following additional recommendations that must be met before moving the program forward:
 

1.	One hundred percent (100 %) of the largest neuromuscular fellowship programs must all agree to participate and at least 85% of smaller neuromuscular medicine fellowship programs must agree to participate.
2.	The list of the programs participating and not participating must be made publicly available on the AAN website and communicated publicly to incentivize programs to participate. Prior to publication of the list, the AAN must communicate with training programs any incentives or penalties associated with participation and nonparticipation in the program.
3.	AAN must communicate the plan with all neurology and physical medicine and rehabilitation residents so they are aware of the schedule. AAN should create a mechanism where residents can anonymously report programs that are approaching them prior to the deadline set by AAN.
4.	AAN should work with AANEM and other groups to create a match for neuromuscular and clinical neurophysiology fellowship programs. To keep the costs of the match system low for residents and fellows, AAN should emphasize that virtual interviews be used for the majority of fellowship interviews and only a small number of candidates be required to do in person interviews.

REFERENCES

1.	Corboy JR, Boudreau E, Morgenlander JC, Rudnicki S, Coyle PK. Neurology residency training at the millennium. Neurology 2002;58:1454-1460.

POSITION STATEMENT HISTORY
Approved by the AANEM Board on May 17, 2020, for distribution to Training Program Directors May 18-22, 2020. Reapproved by the AANEM Board on May 28, 2020.