Stroke Fellowship Description
Four fellows are accepted each year. A clinical fellowship can be completed in one or two years.
The faculty includes Kunal Agrawal, MD, Branko Huisa, MD, Thomas Hemmen, MD, PhD, Dawn Meyer, PhD, Alexander Khalessi, MD, Navaz Karanjia, 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.
The Stroke Code system generates about 12 calls (Stroke Codes) per week among the participating UCSD hospitals. 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. Additionally, around ten telestroke codes are generated each week. Faculty and fellows log in remotely and provide expertise consultation in our various spoke sites.
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.
Fellow rounds 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 fellows meet each week with Dr. Huisa to discuss overall progress. They also meet with an assigned senior faculty and mentors on a weekly basis to discuss independent projects to develop career plans. Recurring monthly events include Stroke Journal Club, Endo-vascular conferences and resident stroke teaching conference.
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.
Faculty have weekly clinics at UCSD and VA. Roughly 5-8 new patients per week are presented by each Fellow to one of these attendings.
The fellows will each have their own continuity clinic. 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.
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.
Transcranial Doppler (TCD) trainings are available in Dr. Huisa's clinics and inpatient services. TCD certification can be attained after Neurosonology examination at the annual Society for Neuroimaging meeting.
The curriculum for the fellowship follows AAN guidelines.