Stroke Fellowship Description

Usually two fellows are accepted each year. A clinical fellowship ordinarily can be completed in one or two years.

The faculty includes Thomas Hemmen, MD, PhD, Director of the UCSD Stroke Center, Dawn Meyer, PhD,  Alexander Khalessi, MD, Navaz Karanjia, MD, Thilo Hoelscher MD, Scott Olson, MD and Brett C. Meyer, MD.
 
Fellows are supervised by the stroke faculty at all times, during clinics and Code Stroke emergencies. Over time, the fellows assume increasing independence in decision making, but are never unsupervised.

In addition to daily supervision, the Fellows report weekly to the Clinical Treatment Team meeting, Thursdays at noon in the UCSD Stroke Center Conference room. Each Code Stroke from the previous week is presented by the fellows and all aspects of the case are discussed, including data acquisition, diagnostic assessment, decision-making, and outcomes.

Note that this state-of-the-art conference room is equipped with 1.0 gbs Internet access, a PACS server, two 50-inch plasma screen displays, and seating for 12. We are able to access not only the UCSD PACS, but also the on-line Radiology server at our affiliated sites using secure log in and encrypted communication.
 
The fellows meet for one hour each week with Dr. Hemmen to discuss overall progress, and 1 hour each week with a rotation faculty member to discuss readings and other issues. Examples from the literature are provided to supplement texts.

The fellows attend VA Stroke clinic weekly; Stroke Clinic at the San Diego VAMC is a referral clinic serving approximately 800 currently enrolled veterans who are either at risk for or recovering from stroke. Five to 8 new patients are seen each week and the range of disorders seen spans the gamut from routine stroke prevention to exotic causes of stroke in young patients.

Drs.Hemmen and Meyer have weekly, or several times weekly, clinics at UCSD. As at the VA, roughly 5 to 8 new patients per week are presented by each Fellow to one of these attendings.

The fellows will each have their own continuity clinic on Wednesday afternoons. The clinic may be held weekly or bi-weekly depending on the number of fellows in the program. New patients are staffed but the fellows have primary responsibility for decision making.
 
The Stroke Code system generates about 10 calls (Stroke Codes) per week among the participating sites. The fellows are generally the first neurologist to evaluate the patients. About 20% of the Stroke Code activations result in randomization of the patient into a clinical trial. For the first several months faculty respond along with the fellows to all Codes at all sites—primary and affiliated—but the fellows eventually assume full responsibility.
 
In addition to seeing clinic patients and Stroke Codes, the fellows are trained in clinical investigation. The primary goal of training in clinical investigation is to develop skills that enable a trainee to organize and participate in clinical investigations of new methods for stroke therapy.

At any given time, the stroke group at UCSD is participating in a variety of multicenter clinical trials. Recent examples include: acute therapy for stroke with hypothermia, prevention of stroke recurrence with atorvastatin and treatment of acute stroke with Transcranial LASER Therapy. These studies vary in their general objectives including primary or secondary prevention of stroke or acute treatment after the onset of ischemia. The fellows will be expected to assist in patient recruitment, conduct of the study, and compliance with all UCSD, FDA and NIH regulations to assure patient protection, privacy, and accuracy of the data.
 
Fellows round daily on the inpatient service with the attending and neurology resident. During these rounds opportunity for teaching will be given, both by the attending to all and the fellow to the residents so that the fellow can learn how to teach and supervise junior house officers under the guidance and supervision of the attending.

An opportunity to perform transcranial ultrasounds and read these with Dr. Thilo Hoelscher (Department of Radiology) is available. We provide an opportunity to attend the annual Society for Neuroimaging meeting at which time the fellows may take the competence examination in Neurosonology. This is the only vascular ultrasound certification examination available for neurologists.

In addition fellow round on Neurological ICU (NCC) patients with the NCC team and receive teaching by Dr. Karanjia and her colleagues. Endovascular teaching is performed by Dr. Khalessi who attends the monthly Neurovascular Conference and teaches the fellows during acute and elective endovascular stroke interventions.

The curriculum for the fellowship follows AAN guidelines.