Clinical Curriculum

Overview

A central goal of the UCSD Vascular Neurology Fellowship is to deliver a rigorous, yet balanced, clinical experience across inpatient, outpatient, and telemedicine settings. Our thoughtfully structured rotations ensure fellows encounter a wide spectrum of cerebrovascular pathology and patient populations, emphasizing clinical depth and versatility. Our stroke faculty represent diverse subspecialty interests (including acute and preventive stroke care, telestroke systems of care, Neurosonology, post-acute care and stroke rehabilitation) from which fellows will benefit from a rich, multifaceted education in stroke management. Our faculty are deeply committed to mentorship, and creating a collaborative training environment with strong faculty-fellow engagement throughout the year.

Fellowship rotations are organized into one-week blocks, distributed across the academic year to maximize breadth of experience. These rotations span key clinical domains, including inpatient stroke services, outpatient subspecialty clinics, and telemedicine consultations. Rotations are carefully balanced among our four fellows to ensure equitable exposure and individualized learning opportunities, as outlined below:

Fellows will spend a total of 12 weeks in each rotation and will have 4 weeks of vacation time.

The clinical curriculum is meant to treat our fellows as junior faculty and develop significant autonomy in managing cerebrovascular disorders. The curriculum is also flexible to the fellows' career goals and provides significant time to develop their research projects and manuscripts to provide the most well-rounded educational experience.

Inpatient Rotations

The inpatient experiences will occur at bedside (UCSD sites, VA site) and in a remote setting via Telemedicine. All inpatient rotations are designed to provide exposure to various clinical cases to prepare the fellow to be confident in medical decision-making relating to cerebrovascular disease. Each rotation also allows adequate time for fellows to review stroke literature and develop their research projects to provide the most well-rounded educational experience.

Rotations are designed to provide clinical exposure to a variety of pathologies and patient populations. Ultimately, the role of the vascular neurology fellow is to be the junior faculty on the inpatient service. This role requires making important inpatient clinical decisions (with the supervision of the stroke faculty) and guiding the residents through inpatient admissions/consults and stroke codes. Fellows play an important role in creating a productive learning environment for every team member on the inpatient rotations. They are expected to gain progressive autonomy in stroke clinical decision-making that will lead to significant confidence in managing patients with cerebrovascular disorders upon graduation.

UC San Diego Sites 

Inpatient wards rotations will occur at our two comprehensive stroke centers: UC San Diego Hillcrest Medical Center and UC San Diego La Jolla Medical Center. Fellows will lead rounds, perform bedside neurological examination teaching, and will supervise and guide the neurology residents in managing stroke codes, admissions, and inpatient consultations. They will also assist with stroke quality metrics and will be involved in improving stroke processes of care.

During stroke codes, fellows are expected to manage patients quickly and efficiently, read and assess relevant neuroimaging accurately, guide neurology residents through the decision-making process of acute stroke treatment, and work collaboratively with various healthcare providers (e.g. nursing, ED team, ICU team, endovascular team, pharmacy, imaging technicians). Faculty directly supervise the fellows during each stroke code either at bedside with the fellow or via telephone. In addition, fellows will have frequent opportunities to practice performing TCD evaluations (under stroke faculty supervision) while rotating on the inpatient service (see Neurosonology Curriculum below for more detail).

San Diego VA Site

During the San Diego Veterans Administration (VA) Medical Center rotation, fellows will oversee management of acute stroke code activations, working closely with UC San Diego neurology residents as first-responders. This rotation is uniquely structured to allow fellows to focus on high-impact clinical decision-making and systems-level stroke care. Fellows also participate in one half-day Neurosonology clinic and one half-day stroke clinic, gaining valuable experience in cerebrovascular diagnostics and outpatient stroke management. This rotation fosters autonomy, scholarly productivity, and a deeper understanding of institutional stroke care delivery by providing dedicated time for research and opportunities to engage in VA stroke quality council meetings.

Telemedicine Rotation 

UC San Diego offers a nationally recognized telemedicine experience that equips vascular neurology fellows with the skills to deliver high-quality remote stroke care across a broad geographic region. Fellows participate in a robust telestroke program that ensures rapid access to acute stroke evaluation and treatment for hospitals without immediate access to Comprehensive Stroke Centers.

During the rotation, fellows manage telestroke code activations under direct faculty supervision, with stroke attendings joining each consultation to provide real-time feedback and teaching. Through the academic year, fellows transition toward independent management of telestroke cases (with progressively minimal assistance from the stroke faculty), gaining confidence and autonomy in remote decision-making.

Our telemedicine curriculum trains fellows to remotely distinguish stroke mimics, administer intravenous thrombolytics, and coordinate urgent transfers for endovascular therapy—all within a sophisticated telestroke system of care. Fellows will gain insight into the operational logistics of delivering efficient stroke care via telehealth. By the end of the academic year, fellows will have completed approximately 300–350 telestroke consultations, reflecting the depth and breadth of their experience in remote stroke evaluation and acute management.

Outpatient Clinic 

Outpatient stroke clinics are thoughtfully integrated across inpatient rotations to reinforce and expand the clinical knowledge gained on the wards (see table above for clinic frequency by rotation). Fellows rotate through the clinics of multiple stroke faculty, gaining exposure to a variety of approaches in outpatient stroke management. These clinics offer hands-on experience in Neurosonology, as well as focused training in stroke prevention, rehabilitation, and recovery. This diverse outpatient curriculum ensures fellows develop a comprehensive understanding of longitudinal stroke care across multiple subspecialty domains.

Facilities in which fellows would be attending outpatient stroke clinic include the following:

• UC San Diego Hillcrest Medical Center at McGrath Outpatient Pavilion
• UC San Diego Sulpizio Cardiovascular Center
• San Diego Veterans Administration (VA) Medical Center

The following outlines the types of clinics our fellows will rotate through during their training:

Outpatient Stroke Clinic

This clinic is a cornerstone of our fellowship, offering fellows a robust experience in longitudinal stroke care. Under the supervision of expert stroke faculty, fellows manage a diverse patient population with complex cerebrovascular conditions, including (but not limited to) secondary prevention, cryptogenic and ESUS workup, and post-hospital follow-up. This clinic emphasizes evidence-based management, patient-centered care, and exposure to cutting-edge clinical trial enrollments to enhance the understanding of stroke pathophysiology and clinical outcomes.

Multidisciplinary Stroke Rehabilitation Clinic

This clinic offers fellows a unique environment to advance their knowledge in post-stroke recovery through close collaboration with expert rehabilitation therapists and stroke faculty. This clinic focuses on individualized rehabilitation strategies, integrating functional assessments, goal-directed treatment, and surveillance for cutting-edge rehabilitation trials. Fellows will also gain hands-on experience with botox administration for spasticity management. This setting offers a holistic approach to stroke recovery, blending clinical care, research opportunities, and interprofessional teamwork to provide a solid understanding of the principles of stroke rehabilitation.

Neurosonology Clinic

This clinic offers fellows specialized training in the performance and interpretation of transcranial Doppler (TCD) ultrasound studies, a critical tool in the evaluation of cerebral hemodynamics. Fellows gain hands-on experience conducting TCDs to assess intracranial stenosis, emboli detection, vasospasm monitoring, and cerebral autoregulation. Under expert stroke faculty supervision, they develop proficiency in both technical acquisition and diagnostic analysis, enhancing their understanding of stroke pathophysiology and vascular reactivity. This clinic serves as a gateway to advanced neurovascular diagnostics and supports research initiatives in cerebral blood flow and stroke prevention.

The various outpatient clinics described above provide our fellows with an amazing and well-rounded education that will prepare fellows to lead in any combination of academic and community settings.

On-Call

Vascular neurology fellows participate in a well-balanced call schedule, typically covering one weeknight per week and every fourth weekend. Call is taken from home, ensuring a manageable work-life balance while maintaining high clinical engagement. Fellows play a pivotal role in acute stroke care by triaging stroke codes for thrombolytic and endovascular therapy, conducting telemedicine consultations across a broad regional network, and coordinating time-sensitive stroke transfers. While on-call, our fellows gain valuable insight into stroke systems of care across diverse hospital settings and provide consultative expertise for patients requiring neurocritical care. This experience fosters rapid clinical decision-making and prepares fellows to lead stroke care delivery in any combination of academic, community, and telehealth environments.

Electives

Vascular neurology fellows at UCSD have the opportunity to personalize their training through specialty elective rotations that complement the core curriculum and support individual career development. Fellows may choose up to three weeks of elective time, selecting any combination of rotations from the options listed below. Elective rotations are distributed in one-week blocks throughout the academic year, allowing for flexibility and integration with clinical responsibilities. All elective selections are subject to approval by the fellowship program director to ensure alignment with each fellow’s educational and professional goals. Electives are optional—fellows who feel the core curriculum provides sufficient breadth for independent practice may opt out. Current elective offerings are designed to enhance subspecialty expertise and academic growth, and are listed below:

• Neurocritical Care
• Endovascular Neurosurgery
• Neuroradiology
• Research Elective

Neurosonology Curriculum

The UC San Diego Neurosonology curriculum offers vascular neurology fellows comprehensive training in Transcranial Doppler (TCD) and Carotid Ultrasound, combining foundational lectures, case-based reviews, and hands-on instruction led by our expert stroke faculty. This curriculum is designed to build expertise in cerebrovascular ultrasound imaging and its clinical applications across inpatient and outpatient settings.

Fellows learn to interpret gray-scale, spectral Doppler, and color flow imaging, recognize normal and abnormal waveform patterns, and apply diagnostic criteria for both TCD and carotid studies. Advanced applications include bubble studies for PFO screening, emboli detection, vasomotor reactivity testing, brain death confirmation, subclavian steal identification, and vasospasm monitoring in subarachnoid hemorrhage. The curriculum provides structured monthly didactics relating to these foundational and advanced concepts in TCD and Carotid Ultrasound (see “Didactics” section for more information).

Inpatient Neurosonology evaluations are performed by designated fellows rotating at UCSD La Jolla Medical Center and UCSD Hillcrest Medical Center sites under direct supervision, while outpatient studies are conducted during Tuesday morning TCD clinic as part of the VA rotation (see table and outpatient description above). This allows frequent opportunities to engage in Neurosonology studies through the various core rotations throughout the year. All fellows maintain a log of their ultrasound examinations to track progress and competency.

NOTE: The curriculum aligns with the Neurosonology Certification Examination, but participation in this exam is optional. Fellows interested in pursuing certification will coordinate clinical coverage (with approval of the fellowship program director) and cover associated costs independently. Examination readiness is determined in consultation with stroke faculty, ensuring fellows are well-prepared should they choose to pursue this credential.