Fellows should expect to partake of the following responsibilities:
VIDEO-EEG MONITORING: Serve in the Epilepsy Monitoring Unit for a maximum of eight months in the first year, six months in the second year. While in the monitoring unit the fellow will provide a history and physical exam on each patient admitted to the Monitoring Unit and write admitting orders, confer with the nursing and technical staff on the plan and montage. The fellow will interact with patients and family to help give them an idea of what to expect in the monitoring unit, in conjunction with nursing staff. The fellow will decide whether and to what extent to reduce antiepileptic medications. All of the above responsibilities will be performed under the direction of the attending.
PREPARING SEIZURE REPORTS: While participating in the Epilepsy Monitoring Unit, typically Monday through Friday and on a rotating weekend call schedule, the fellow will review the seizures and baseline EEG files and enter preliminary interpretations into the Epilepsy Monitoring Unit report. These will be reviewed daily with the staff attending. Patient orders and plans for discharge or other types of monitoring will be made after the daily review of the EEG material.
PATIENT ORDERS: Both fellows and attendings may write orders on the patients in the Epilepsy Monitoring Unit, as per agreement and unit policy. Fellows will be responsible for preparation of the final EMU report and the usual admission and discharge dictations. Faculty typically provide additional notes and daily chart notes.
INTRACRANIAL MONITORING: When patients are in the monitoring unit with intracranial electrodes, the fellow will work closely with attendings in performing procedures. Fellows will be expected to gain familiarity with placement of depth electrodes and subdural strips in seizure patients, by attending such placements in the operating room on a few occasions, and participating in the daily interpretation of the EEGs recorded from invasive electrodes.
EDUCATIONAL CONFERENCES: Fellows are invited to participate in any and all educational conferences provided for faculty and house staff in the Departments of Neurology, Neurosurgery, and related departments. Such participation will require a "common sense" allocation of time in relation to other clinical responsibilities. Typically, fellows would attend Neurology Grand Rounds, clinical case conferences, and an individualized subset of the other daily teaching conferences in the program.
EPILEPSY SURGERY CONFERENCE: It will be the fellow's responsibility to present 1-3 cases, or didactic topics, at the weekly epilepsy surgery conferences. The fellow will generate from the database a summary history, and arrange to present suitable Video-EEG segments for digital display. Discussion of the case will be the responsibility of the group as a whole, not just that of the fellow.
SEIZURE CONSULTATION: Fellows will perform seizure consultations when requested by the inpatient services or neurology service, and will present these cases to the attending on the epilepsy service.
EEG'S: On months when not in the epilepsy unit fellows will be expected to read EEGs under a schedule to be interdigitated with neurology resident EEG training.
CLINIC: Fellows typically will attend seizure clinic a minimum of two half-days per week. In clinic, the fellows will see new and return patients. Some clinics may be at affiliated programs in the Bay area. Some fellows may support their salaries with a general neurology clinic, on a schedule not to intefere with the educational functions of the Fellowship.
INTRAOPERATIVE MONITORING OF AWAKE PATIENTS: Fellows will participate in intraoperative monitoring of awake patients to map functional regions of brain prior to resection. Such cases typically arise every few months.
ROUTINE INTRAOPERATIVE MONITORING: Fellows will be expected to become familiar with intraoperative evoked potential monitoring by participating in several such studies in the operating room and interpreting the studies during the EEG reading sessions.
WADA TESTING: Fellows will participate in Wada testing, also known as intracarotid amobarbital testing. Reports will be prepared by neuropsychology.
CLINICAL TRIALS: Fellows will participate in anti-epileptic drug studies, in some cases including the design phase, in most cases by implementing the study with suitable patients.
RESEARCH PROJECT: Fellows will develop a research project after discussion with faculty. This may be a clinical research project, a research project based on electroencephalography or a basic science research project. The expectation is for abstracts, presentations at national meetings and peer reviewed publications resulting from the research projects.
EMG: Fellows may elect time on the EMG-neuromuscular service if they wish to be eligible for the AMA special expertise in Clinical Neurophysiology boards. This aspect of the program will be individualized.
SLEEP DISORDERS: Some fellows may wish to spend time in the Stanford Sleep Disorders Center. This can be accomplished by special arrangement.
