Clinical Experiences

UAB hosts the only academic MS center in the state of Alabama recognized as a Comprehensive Care Clinic by the National MS Society, and, as such, provides care to thousands of patients with MS and neuroimmunological diseases from across the state of Alabama and from adjacent states. UAB patients represent a population that ensures a breadth of both clinical and cultural learning opportunities for our trainees.

Supervised Direct Patient Care

Trainees spend the majority of their time working with UAB Neuroimmunology faculty in MS and Neuroimmunology specialty clinics. The Division of Neuroimmunology and Multiple Sclerosis is currently comprised of five MS-trained adult neurologists and one neuroimmunology and neuroinfectious disease-trained adult neurologist. In addition, we work closely with two MS-trained child neurology faculty. Most patients are seen at UAB’s Kirklin Clinic, the primary clinic facility for UAB Medicine. Kirklin Clinic also hosts a large outpatient infusion center, radiology services, and multiple specialists from other departments who help care for our patients.

In addition to seeing patients in Kirklin Clinic, our neurologists also see MS and neuroimmunology patients at the following locations:

• UAB Highlands: General Neuroimmunology and Neuro-Rheumatology clinic (Dr. Shruti Agnihotri)
• Spain Rehabilitation Hospital & Clinics: UAB Transverse Myelitis Clinic (Dr. Benjamin Jones)
• Children’s Hospital of Alabama: Center for Pediatric Onset Demyelinating Disease (Drs. Jayne Ness and Lydia Marcus)
• Birmingham VA Medical Center: Regional Specialty Program within the VA MS Centers of Excellence (Drs. John Rinker and Stephen Benesh)
• UAB 1917 Clinic at Dewberry: Neuro-HIV clinic (Dr. Shruti Agnihotri)

All clinic facilities are in walking location of the main campus and easily accessible for trainees to attend.

Trainees work one-on-one with a single faculty member for each clinic session and are expected to take the lead in seeing and evaluating patients and deciding on a course of action. In the second half of the year, trainees provide consultation and follow-up care for their own patients while working under the direct supervision of one or more MS faculty members.

In addition to making diagnostic and treatment decisions, trainees gain experience developing and implementing infusion orders, performing lumbar punctures, and managing intrathecal baclofen pumps. As part of the multidisciplinary experiences, additional skills may be developed in collaboration with subspecialists.

Multidisciplinary Clinics

Trainees spend approximately 20 percent of their time working with specialists from other divisions and departments who provide important expertise and service to neuroimmunological patients. While the amount of time spent in multidisciplinary experiences is set, trainees have the ability to tailor their experiences. Active rotations currently include the following:

• Physical Medicine and Rehabilitation (including botulinum toxin and intrathecal baclofen for spasticity management)
• Neuro-ophthalmology
• Neuropsychology
• Neuro-urology
• Neurophysiology (Evoked Potential interpretation)

Research

Advances in neuroimmunological therapeutics have transformed the treatment of MS by enabling clinicians to fundamentally alter the natural history of the disease. However, a cure for MS remains elusive, and opportunities to further subdue MS disease activity and improve the lives of patients living with the disorder remain abundant.

Exposure to research methods provides trainees with important insights into measuring disease-relevant outcomes, conceptualizing therapeutic interventions, and appreciating the difficulty in discerning objective from subjective responses to treatment. In addition, experience in clinical research prepares trainees to better approach the scientific literature that serves as a basis for clinical practice.

UAB regularly participates in a range of clinical research projects, and trainees are expected to learn how to administer the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC), and any other outcome measures relevant to ongoing clinical research projects in which we are involved. We currently participate in therapeutic trials sponsored by both industry and the federal government, as well as natural history cohort projects.

Although the training program does not require trainees to complete a research project during their fellowship, trainees are encouraged to pursue topics of interest and may receive support and mentorship from any of our MS and neuroimmunology-trained faculty.

Education & Teaching

Didactics and other educational experiences account for 20 percent of trainees’ time. In addition to clinical experience, trainees learn about the diagnosis and management of MS through directed readings on MS and neuro-immunological seminars, which extend over the course of their training.

Faculty and trainees meet weekly on Friday afternoons to participate in a sequence of conferences, which repeat monthly. These include:

Case Conferences
Twice a month, challenging inpatient and outpatient cases are presented by faculty and fellows in a roundtable format to discuss diagnostic and therapeutic challenges.

Fellows Conferences
Fellows alternate with faculty to develop presentations on topics of interest that are presented to neuroimmunology faculty and trainees.

Neuroimmunology Journal Club
Fellows alternate with faculty to present and discuss current scientific articles relevant to understanding or treating MS and neuroimmunological diseases.

ACTRIMS Webinar Series
Additional educational programming that occurs throughout the year includes the following:

Neuroimmunology/Rheumatology Joint Conference
This quarterly conference brings together the Divisions of Multiple Sclerosis and Neuroimmunology (Neurology) and Rheumatology (Internal Medicine) to present on topics that overlap systemic and CNS-specific disease processes.

Center for Clinical and Translational Science Training Academy
This voluntary program (Home - Center for Clinical and Translational Science) provides interested clinician scientists the opportunity to learn about the design and implementation of clinical research, and to develop a project of their own under the mentorship of faculty experienced in clinical research mentoring. Modules focused on epidemiology, biostatistics, ethics, and grant writing are among the topics covered.

Professional Conferences
Trainees are encouraged to attend one or more conferences featuring or focused on MS and neuroimmunological diseases:

• ECTRIMS (September/October)
• ACTRIMS (February)
• AAN (April)
• CMSC (week after Memorial Day)

Additional Opportunities
Fellows may also elect to complete coursework on campus, which augments their clinical and research endeavors. For example, Fellows may register for semester-long courses on Biostatistics or Epidemiology, offered through the School of Public Health.