Adult Neurology Residency

Adult Neurology Residency

Advanced Inpatient Stroke

Introduction and Goals

This elective rotation is designed for the senior resident desiring a fellow-level experience in managing stroke patients. The goal is to become proficient in leading the acute stroke team, determining alteplase and endovascular treatment candidacy, and assisting in peri- and post-operative management of the latter patients. Accordingly, there is associated experience in the neurocritical care unit. When on call, the advanced resident will assist in the triage of potential stroke cases referred from community hospitals via the Access Center and, if the opportunity arises, may observe telestroke cases as well.

Objectives and Evaluation Matrix

As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities (EPAs) and individual milestones listed below. Some of these are the same as for the basic stroke rotation, with the expectation that the senior resident will be trusted to practice more independently in these areas. Others are unique to the advanced elective and mirror the expectations of a vascular neurology fellow. As always, the EPAs form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).

Rotation Objectives
Upon completion of the curriculum, residents will . . .
#DescriptionMilestones
1Lead the stroke code team, quickly and accurately determining whether the diagnosis is stroke versus a mimicPC1, PC2, PC3, PC5, PC6, PC8, PC12, MK1, MK2
2Quickly and accurately determine eligibility for tPA, endovascular, and other hyper-acute treatmentsPC1, PC2, PC3, PC5, PC6, PC8, PC12, MK1, MK2, PL1
3Appropriately select and interpret neuroimaging studiesPC8
4Describe basic treatment principles for common neurovascular pathologies such as atherosclerosis, dissection, acute thrombotic occlusion, aneurysm, and arteriovenous malformationPC3, PC5, PC6, PL1
5Understand principles of peri-procedural antithrombotic and blood pressure managementPC5, PC6, PL1
6Manage inpatients with cerebrovascular disease according to current evidence and guidelinesPC3, PC5, MK2, PL1
7Lead family meetings regarding goals of care and negotiate conflicts among family members and the treatment teamSP4, PR1, IC1, IC2
Additional Milestones
Please grade the resident on any of the following milestones you were able to evaluate during this rotation:
PL2, PR2

Schedule

The advanced stroke resident will join the inpatient stroke team at daily interdisciplinary rounds (0900 each weekday, except for Wednesdays, when it begins at 0930).

The advanced resident will then lead teaching rounds, under the supervision of the faculty physician. The junior stroke resident will present cases to the advanced resident, who will examine the patient and confirm the key findings.

During stroke codes, the advanced resident will supervise the junior resident or run the code himself or herself, depending on case volume, and staff the case with the attending physician. He or she will interpret the imaging studies independently and recommend for or against thrombolytic and neuroendovascular treatments.

The advanced resident will observe or scrub for NES cases, as appropriate (determined by the NES staff) and continue to assist in the medical management of those patients in the neuro-ICU.

As with our other services, the advanced resident’s on-pager time ends at 1600. He or she will be on call with the stroke faculty one or two nights during the week, assisting with the Access Center calls and, if the opportunity arises, observing telestroke cases.

Conferences

There are two working case conferences that the advanced stroke resident will attend:

  • Neurovascular conference occurs on the 2nd and 4th Mondays of each month at 1600 in the Juhl conference room, 4th floor near the Atrium elevators. It is an interdisciplinary working conference mostly involving complex aneurysm and AVM cases.
  • Stroke Case Conference occurs on the 2nd and 4th Thursdays of each month at 1530 in the Neurology conference room (MFCB 7114). This is a working conference for complex inpatient and outpatient stroke cases, primarily involving neurology stroke faculty.

Work Hours

The number of work hours per week is estimated to be ~ 50 and will include at least one day off each week.

Suggested References

American stroke association guidelines: http://my.americanheart.org/professional/guidelines.jsp

Bogousslavsky, J., & Caplan, L. R. (2001). Uncommon causes of stroke. Cambridge, UK; New York, NY, USA: Cambridge University Press.

Mohr, J. P., Wolf, P. A., Grotta, J. C., Moskowitz, M. A., Mayberg, M., & von Kummer, R. (Eds.). (2011). Stroke pathophysiology, diagnosis, and management (5th ed.). Philadelphia, PA: Elsevier/Saunders.

Stroke Trials Registry.  This website contains summaries of many completed and ongoing clinical trials.  http://www.strokecenter.org/trials/


Latest revision:  05-14-2021

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