Outcomes and future directions for neuroimmunology/multiple sclerosis fellowship training: Survey of recent trainees

Abstract

Background: Neuroimmunology/multiple sclerosis is a rapidly evolving, but still poorly defined subspecialty. Fellowship training is not standardized, and there is substantial variability across sites. Outcomes of fellowship training have not yet been studied. We therefore examined early career choices of neuroimmunology/MS fellowship program graduates and solicited the perspective of current and recent trainees on their fellowship experience as well as opportunities to improve neuroimmunology education.

Methods: We developed a questionnaire to collect information about fellowship training experiences and current medical practice. We identified recent graduates based on records from US training programs and the National MS Society and electronically sent the survey to current trainees and recent graduates (within the last 5 years).

Results: We identified 179 current/recent trainees and successfully reached 157 with survey distributions. Ninety-five individuals (60.5%) returned surveys. Most graduates assumed an academic practice (68%) focused mostly or exclusively on MS and other CNS neuroimmune diseases (55%), and practiced in regions where there were ≥5 other neuroimmunology specialists (51%). Graduates felt well-prepared to manage diagnoses of MS and neuromyelitis optica spectrum disorders but their comfort with rarer CNS neuroimmune diseases varied substantially. Basic immunology, neuro-rheumatology, grant writing and neuro-rehabilitation were identified as high impact areas for cross-disciplinary didactic training. The majority of recent trainees (57%) favored standardizing a core neuroimmunology curriculum, and 48% favored developing a subspecialty certification.

Conclusions: This is the first study to examine practice outcomes and trainee experiences for neuroimmunology training programs. We anticipate that these data will help educators define a core curriculum for the subspecialty and identify complementary skill sets that enhance the traditional clinic-based model of teaching.

Keywords: Graduate medical education; Multiple sclerosis; Neuroimmunology.

Fig. 1.

Supplementary curricular options. Respondents were asked to identify areas where additional training would have enhanced their education. n = 88 completed surveys.

Fig. 2.

Self-reported exposure to neuro-immunologic diagnoses during fellowship training. n = 82–84 respondents. Med complications was defined as “neurologic complications of biologic drugs”. MS: multiple sclerosis, NMO: neuromyelitis optica, MOG: myelin-oligodendrocyte glycoprotein, AI: autoimmune, PNP: paraneoplastic, ID: infectious disease.