Introduction
This is a week-long rotation on the acute stroke code / stroke consult service at the UW Hospital and the William S. Middleton Memorial VA Hospital. Residents mostly rotate on this service during their PG2 and PGY-3 years. The rotation emphasizes emergency care for hyper-acute stroke patients.
The stroke consult team consists of an attending vascular neurologist, the neurology resident, one or two medical students, and at times a neurosurgery or other off-service intern.
Following are the goals and objectives of this rotation as they relate to the overall training program in neurology and the ACGME-defined competencies. Please refer to the separate stroke service orientation manual for more comprehensive and specific information about the UW Comprehensive Stroke Center and the acute care of stroke patients.
This is an accordion element with a series of buttons that open and close related content panels.
Goals
PGY-2 Residents: The goal of this rotation for junior residents to develop skill in the hyper-acute management of stroke patients, including differentiation of true strokes from mimics and determining eligibility for tPA, endovascular, and other therapies.
PGY-3-4 Residents: Senior residents will become more adept at making thrombolysis and endovascular treatment decisions in challenging situations, such as where relative contraindications may exist. They will advance their skills in neuro-imaging, especially multi-modal CT for the purpose of endovascular case selection.
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 for the list of milestone abbreviations).
Rotation Objectives
Upon completion of the curriculum, resident will…
| # | Description | Milestones |
| 1 | Lead the stroke code team, quickly and accurately determining whether the diagnosis is stroke versus a mimic | PC1, PC2, PC3, PC5, PC6, PC8, PC12, MK1, MK2 |
| 2 | Appropriately select and interpret neuroimaging studies | PC8 |
| 3 | Quickly and accurately determine eligibility for tPA, endovascular, and other hyper-acute treatments | PC1, PC2, PC3, PC5, PC6, PC8, PC12, MK1, MK2, PL1 |
| 4 | Explain to patients and families the rationale for lytic therapy and its risks and benefits, and obtain informed consent to treatment | SP4, PR1, IC1, IC2 |
| 5 | Clearly communicate the acute stroke team’s assessments and treatment recommendations to ED and inpatient colleagues | SP4, PR1, IC3, IC4 |
Schedule
The stroke consult resident works Monday – Saturday. During the week, the resident is on call with a dedicated stroke consult attending between 0800 and 1600. The team makes rounds on the consult follow-up patients beginning in the morning, breaking off as needed to respond to stroke codes.
From 1200 – 1300, the attending covers the stroke code pager so that the resident can attend their required didactic conferences.
At 1600, the day float resident assumes responsibility for new stroke codes, while the stroke consult resident signs out any cross-cover items to the night float resident.
On Saturdays, there is one stroke attending for both the admitted patients and the codes and consults. The post-call night float resident rounds on the inpatient service patients and then goes home, while the stroke consult resident works 0800 – 1800, partnering with the general neurology inpatient resident to address new consults.
Sunday is the stroke consult resident’s day off.
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 50. Residents will have at least one day off each week, free from clinical responsibilities.
The resident will be responsible for tracking work hours and reporting any risk of violation immediately to their attending physician and/or the Program Director.
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: 09-14-2024
