Adult Neurology Residency

Adult Neurology Residency

Stroke

Introduction

This is a two-week rotation on the inpatient stroke service at the UW Hospital and the William S. Middleton Memorial VA Hospital. Residents rotate on this service during their PG2 and PGY-3 years. The rotation emphasizes inpatient care of acute stroke patients.

The inpatient stroke team consists of an attending neurologist who specializes in cerebrovascular disorders or neurocritical care, the neurology resident rotating on service, an advanced practice provider (nurse practitioner or physician’s assistant), several medical students, and at times the stroke program administrative coordinator. Occasionally there are neurosurgery interns, internal medicine interns, or other off-service interns pursuing elective rotations. Pharmacy interns and other observers sometimes rotate on the service as well.

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.

Goals

The goal of this rotation is for 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. Residents will learn how to admit, care for, and discharge such patients as a member of an interprofessional team.

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 . . .
#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
3Manage inpatients with cerebrovascular disease according to current evidence and guidelinesPC3, PC5, MK2, PL1
4Appropriately select and interpret neuroimaging studiesPC8
5Lead morning interdisciplinary rounds, interacting respectfully with the other team members while advocating for appropriate patient careSP3, SP4, PR1, PR2, IC3, IC4
6Lead family meetings regarding goals of care and negotiate conflicts among family members and the treatment teamSP4, PR1, IC1, IC2
7Discharge patients in a manner that ensures smooth transitions from inpatient to outpatient careSP3, SP4, PR2, IC3, IC4
Milestones
Please grade the resident on any of the following milestones you were able to evaluate during this rotation:
PL2, PR3, IC2

Schedule

During the week, the resident on the Stroke service receives sign-out from the night float resident around 7 – 7:30 am daily M-F and pre-rounds on service patients. Interdisciplinary rounds begin at 0900 each weekday except for Wednesdays, when they begin at 09:30 am due to the neuropathology conferences. These take place in the work room next to the D6/4 nursing station. Teaching rounds follow thereafter, usually ending around 11:00 am (depending on service volume).

After rounds, the resident will write notes and enter orders on current patients. The Stroke service resident is also on call for new stroke consults (including stroke codes) in the UW and VA emergency departments from 8:00 am until 4:00 pm. At 4:00 pm, the night float resident takes over the call pager and will receive in-person sign-out from the service resident shortly thereafter.

The Stroke service resident is expected to attend regularly scheduled educational lectures at 12:00 pm (Monday – Friday) and 8:00 am morning report (Friday) unless addressing urgent or emergent clinical issues for service patients. Resident are also expected to attend Neuropathology conferences on Wednesday mornings at 8:30 am (on the 1st, 3rd, and 5th Wednesdays of the month) and Neuroradiology conference on Wednesday morning at 7:30 am (on the 4th Wednesday of the month).

The Stroke attending covers ED and inpatient stroke codes as the primary stroke team responder from 12:00 pm to 1:00 pm to facilitate attendance at lectures.

On Sunday, the Stroke service resident will receive sign-out from the overnight call resident around 7:30 am and will round with the attending on the team patients at 8:00 am. The stroke service resident will also hold the call pager and cover new general and stroke consults (including stroke codes) and cross-cover issues on service patients until 4 pm.

Saturday is the service 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 60-70. Residents will have at least one day off each week, free from any and all clinical responsibilities.

The resident will be responsible for tracking work hours and reporting any risk of violation immediately to their attending physician and/or Dr. Sattin.

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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