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Vascular Neurology Fellowship Columbia - Curriculum

Vascular neurology educational experiences

Curriculum – 13 four-week blocks

PGY-5 Rotations
  • 6 blocks – vascular inpatient
  • 3 blocks – neuroscience ICU (NSICU)
  • 3 blocks – stroke research
  • 1 block – elective

Electives:  Vascular ultrasound lab; Research; Hematology/Oncology; Cardiology/ECHO; Neuroradiology; Neurorehabilitation

Continuity clinic

13 Block weekly: Prisma Health Neurology outpatient clinic

  • Tuesday p.m.
  • Thursday p.m.

Clinical rotations

Vascular neurology inpatient rotation (Stroke service) – PGY-5
Master principles of the diagnostic evaluation of patients with cerebrovascular disease.

  • Become skilled in the acute treatment of stroke.
  • Acquire proficiency in treatments to prevent the occurrence of stroke.

While rotating on the Inpatient Service, the Vascular Neurology Fellow will participate in morning work rounds and teaching rounds under the supervision of a faculty attending neurologist.

The VNF will supervise a team of residents caring for patients on the Neurology ward. This service admits 10–15 vascular neurology patients per week with all varieties of stoke but primarily ischemic stroke and primary intracerebral hemorrhage. Most patients are admitted acutely through the emergency room or by transfer from outlying hospitals within a day of onset. Rotation on this service will give the fellow opportunities to observe, evaluate, and manage patients of all ages with a wide variety of disorders of the cerebrovascular and nervous systems.

The fellow will provide Emergency Room coverage for acute strokes during the day and take home call every fourth night. 

In the process of caring for acute stroke patients in the ER and in the hospital, the Vascular Neurology Fellow will gain proficiency in evaluating and managing patients presenting with acute stroke (medical interviews, physical examinations, review of data, diagnostic and therapeutic decision making).

Neurosciences intensive care unit (NICU) – PGY-5
The Vascular Neurology Fellow will rotate through the Neurosciences Intensive Care Unit (NICU). The fellow will have primary care responsibility for critically ill neurological and neurosurgical patients. During that period of time, they will be supervised by a neurocritical care attending physician.

The fellow will be responsible for following and providing care for all patients admitted to the unit. During the NSICU rotation they will participate in didactic conferences, which will cover topics including principles of neurologic critical care, diagnosis and management of common diseases seen in the NICU, nutritional and pharmacological issues in patient management and a weekly Neurology Grand Rounds.

This rotation provides a structure for fellow education in all of the core competency areas; however, the rotation activities that promote growth in specific competency areas are further identified.

Interventional neuroradiology rotation PGY-5
The Vascular Neurology Fellow will spend one month on the Interventional Neuroradiology Service. The Interventional Neuroradiology program at Prisma Health is very active, treating approximately 100 cerebral aneurysms and 25 arteriovenous malformations and fistulas and performing 25 intracranial and extracranial angioplasty/stent procedures per year for atherosclerosis.

Direct intra-arterial thrombolysis or mechanical embolus retrieval is performed approximately 12 times per year. Tumor embolization, temporary balloon occlusion testing, Wada testing, petrosal sinus sampling, direct puncture sclerotherapy, needle biopsies, and microballoon angioplasty and intra-arterial drug infusion for cerebral vasospasm are also performed. The program performs over 800 carotid and 500 vertebral diagnostic and intra-operative arteriograms per year.

During this time fellows will participate in the evaluation and treatment of patients, patient rounds for post-operative care, attendance and participation in didactic and working clinical conferences. The will also call for the clinical service under the supervision of one of the two interventional neuroradiology faculty members.

Vascular neurosurgery rotation – PGY-5
The goal of the neurosurgery rotation is for the Vascular Neurology Fellow is to learn the evaluation management of common problems seen on the vascular neurosurgery service. Fellows will be part of the neurosurgery team consisting of the neurosurgery attending and surgery interns and are expected to be involved in the care of both inpatients and outpatients on the vascular neurosurgery service.

Diagnostic neuroradiology – PGY-5
During this rotation, the Vascular Neurology Fellow will participate in the review of MR, CT, and angiographic studies. These studies will be reviewed with the responsible neuroradiology faculty member and fellow.

The fellow will participate in didactic and working neuroradiology clinical conferences.

Stroke rehabilitation (PM&R) – PGY-5
This educational experience will include rotations with therapists (Neurology Service) and with the PM&R team (primarily inpatient rehabilitation care). The Vascular Neurology Fellow will learn to provide comprehensive, coordinated and family centered rehab care to stroke patients. During this rotation, the fellows will be expected to:

  • Ask any questions as they arise.
  • Participate in inpatient and outpatient team conferences, medical rounds, family conferences and discharge planning conferences.
  • Observe therapy sessions provided by therapy services (PT, OT, SLP, and RT).
  • Observe neuropsychological evaluation and counseling session.
  • Participate in bedside and ad hoc teaching sessions during clinical care.
  • Review related classic and current journal articles with the attending.

Fellows stroke continuity clinic PGY-5
The Vascular Neurology Fellow will staff a regular two ½ days per week stroke clinic. These clinics are attended by Vascular Neurology faculty. This clinic serves as a follow-up clinic for patients admitted to the in-patient Stroke Service as well as outpatient referrals. The fellow will manage at least 50 patients under supervision of the faculty.

Research rotations PGY-5
After acceptance into the residency and prior to beginning the training year, each Vascular Neurology Fellow will be assigned to one of the Vascular Faculty mentor’s who is actively engaged in stroke research. This assignment will be made after consultation with the fellow regarding his/her research interests.

 Faculty mentor responsibilities:

  • The faculty mentor will be responsible for ensuring that the fellow actively participates in an ongoing research project broadly related to the field of cerebrovascular disease.
  • The faculty mentor will work with the fellow prior to and early in the training period to design and implement a small independent research project that can be carried out during the one-year training period.
  • The faculty mentor will use this endeavor as an opportunity to teach the principles of research design and statistical analysis.

Fellow responsibilities:

  • The fellow will be expected to present the results of these projects at a national meeting and prepare manuscripts for publication.

Evaluation methods – At the end of the rotation, attending physicians are asked to complete a comprehensive evaluation form based on the core competency areas and goals and objectives. Evaluations are completed on electronic evaluation system and attending will give both written and verbal feedback to the fellow at the end of each rotation. These evaluations are compiled and reviewed with each fellow every three months with the program director.