A Reflection on Movement Disorders Fellowship Training in Deep Brain Stimulation: Past and Future.

Deep brain stimulation (DBS) has been an integral part of movement disorders care for decades. However, differences exist in techniques for surgical implantation of DBS and clinician experience with DBS systems, including use of new software, programming approaches, and postsurgical management of patients. DBS technologies have been rapidly advancing, and indications for DBS are increasing, including for psychiatric symptoms and epilepsy. The heterogeneity in the scope and utility of DBS is perhaps mirrored in education and training, despite efforts to develop competency measures for trainees. These advancements in DBS and the varying opportunities offered at each fellowship contribute to challenges for program directors to establish and implement consistent expectations. Similar challenges have been observed in other fields using neuromodulation. In this review, we seek to discuss the history and evolution of DBS therapy for movement disorders and in parallel, fellow training in DBS, particularly for movement disorders. The goal is to identify specific discrepancies in training that exist to ensure proficiency in the care of people with movement disorders and neuromodulation in general.