Introduction
Whereas all adult neurology residents obtain ample experience in acute stroke management, this senior-level subspecialty offers many learning opportunities in the outpatient setting as well. During this 1-4 week rotation, residents will attend outpatient stroke clinics at the UW and VA hospitals and may attend related clinics, such as vascular neurosurgery and physiatry.
Goals
The goal of this rotation is for residents to develop skill in the outpatient evaluation and management of patients with known or suspected cerebrovascular disease. The emphasis is on evaluating spells concerning for TIA and stroke, the rational selection and interpretation of diagnostic studies, and the development of stroke mechanism-specific secondary stroke prevention regimens.
Objectives and Evaluation Matrix
As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These 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 . . . | ||
| # | Description | Milestones |
| 1 | Evaluate a patient presenting to clinic with a spell concerning for TIA or stroke | PC1, PC2, PC3, PC4, MK1, MK2 |
| 2 | Appropriately select and interpret diagnostic imaging and other testing for the evaluation of suspected TIA and stroke. | PC3, PC8, MK1, MK2 |
| 3 | Propose a plan for secondary stroke prevention based on the patient’s stroke mechanism and current clinical evidence | PC3, PC8, MK2, PL1 |
| 4 | Counsel patients and families regarding their stroke diagnosis and the rationale for investigation and treatment | SP3, SP4, PR1, IC1 |
| 5 | Compose thoughtful notes, enter them into the EMR in timely fashion, and include patient’s primary care and other relevant physicians in the communications | IC3, IC4 |
| Additional Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PR1 | ||
Schedule
A schedule of your week will be sent to you via email at least one week in advance. If there are other areas you would like to explore with this elective, please give a minimum of 3-4 weeks advance notices so there is time to coordinates schedules. Some of these other areas are listed below, but open to other suggestions as well.
- Physiatry
- Neuro-ophthalmology
- Neuroradiology
- Neuroendovascular (Wednesday clinic)
- Vascular neurosurgery
Optional Conferences
There are two optional working case conferences that may be of interest to residents on the Stroke service.
- 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 40-50; there are no weekend or call duties.
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
