Program Highlights

• High clinical volume with large catchment area and diverse patient population
• Dedicated stroke floor and stroke unit
• Closed neurocritical care unit staffed by board-certified neurointensivists
• Call taken from home after hours with 24/7 attending back up
• Dedicated and flexible research time for 6 weeks
• Opportunity to become sub investigator on multiple clinical trials
• Dedicated telestroke time with stroke attending
• Opportunity to attend Wake Forest Neurosonology course
• Opportunity to attend International Stroke Conference
• 100% board pass rate

Curriculum

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Educational programs

Weekly Interdisciplinary Cerebrovascular Conference (Tuesday 9 AM)
Fellows participate in a weekly case discussion with Neuro IR, Neurosurgery and Radiology focusing on admitted patients who underwent endovascular therapy.  

Weekly Fellow didactics (Wednesday 12 PM)

• Lectures covering the spectrum of acute stroke management to stroke rehab, as well as historical trials and emerging data.
• Includes research meetings to discuss project ideas and progress.
• Once per month, fellows lead a “Difficult Case Discussion” where cases are presented to the stroke group to discuss complexities in diagnosis, acute treatment or prevention.

Monthly Journal Club (Friday 12 PM)

Fellows present and discuss a recent trial with the residents and stroke faculty with the aims of understanding the methodology, statistical analysis, and impact on our practice as vascular neurologists.

Rotations

Stroke Service (6 months)
The stroke service is divided into the Acute Stroke Team (comprised of an APP and a resident) and the Inpatient Stroke Team (comprised of the fellow, a senior resident, a junior resident, and occasional rotators from internal medicine). Fellows alternate months rotating on the stroke service. While on the stroke service, fellow responsibilities include:

• Decision-making regarding acute interventions for all Code Strokes seen by the resident/APP
• Reviewing imaging and management plans for admitted patients with the residents
• Rounding on the ICU patients followed by the stroke inpatient team
• Leading rounds with the assistance of the attending

Outpatient clinic (4 weeks)
Fellows have their own outpatient clinic every Wednesday afternoon, including when they are on service. In addition to this weekly clinic, each fellow will have a 1 month block of outpatient, including 3.5 full days of clinic each week.  The aim of this rotation is to gain exposure to outpatient vascular neurology, including hospital follow-up visits and new referrals from the community. The clinic provides educational opportunities to evaluate patients with complex chronic neurovascular conditions such as prior stroke, carotid and intracranial stenosis, vascular malformations, and to evaluate patients with urgent neurovascular symptoms in the outpatient setting. 

Ultrasound (4 weeks)
This rotation includes 3 weeks of neurosonology and 1 week of cardiac echo. It gives fellows time dedicated to learning the principles and techniques of carotid and intracranial ultrasound, as well as the opportunity to perform and interpret studies on inpatients. Fellows may choose to utilize additional elective time to perform additional studies with the goal of qualifying for the American Society of Neuroimaging Neurosonology board examination. Fellows will additionally have the chance to learn about techniques and indications for transthoracic and transesophageal echocardiograms with a cardiology fellow.

Neurocritical care (4 weeks) 
This rotation provides exposure to the critical care management of cerebrovascular disease, as well as opportunities for learning bedside procedures and taking part in interdisciplinary discussions of management (with close communication between the ICU, inpatient stroke, and neurosurgical services). 

Neurorehabilitation (1 week)  
Taking place at Fairlawn Rehabilitation Hospital, this four week rotation allows for fellows to evaluate and follow patients in the midst of their recovery outside of the acute care hospital setting, helping to provide a complete picture of the post-hospital course for recovery in stroke.

Telestroke (1 week)
UMass has a robust telestroke program currently covering 10 area hospitals. During this rotation, fellows will have the chance to learn about the logistics of the telestroke service and work with the stroke attending covering telestroke. It is an opportunity to master the tele-neuro exam and learn the logistics of acute decision making on telehealth.

Research/Elective (6 weeks)
Fellows are encouraged to partake in clinical research and will have the mentorship to do so if interested. Fellows are required to present at grand rounds at the end of the year on a topic of their choice. There are many other elective opportunities available, including neuro IR, neuroradiology, and shadowing telestroke.

Vacation (4 weeks)

Call Schedule 

Fellows' alternate weeks and weekends on call (see sample schedule below). When on call, fellows are responsible for acute decision-making including thrombolysis and thrombectomy, as well as triage and management of intracerebral hemorrhage. After 4 p.m., the call is taken from home. During July and August, fellows will call the stroke attending about all cases. After August, fellows can make acute decisions autonomously with the attending service available 24/7 for backup. Any non-acute cases will be staffed directly with the attending.

Sample schedule: