During your one-year fellowship training, you will be primarily at Hartford Hospital. The remainder of the time will be spent at UConn Health in Farmington.
Inpatient Rotations: Hartford Hospital Stroke Inpatient Service and UConn John Dempsey Hospital
Stroke Rehabilitation: Inpatient Rehab Unit
Electives in neurosonology/radiology, neurocritical care, neurosurgery, other electives considered based on fellow interest
Outpatient Clinics: Half a day per week at Hartford Hospital/UConn Health
VASCULAR NEUROLOGY INPATIENT CARE (STROKE SERVICE)
Location: Hartford Hospital
The neurovascular fellow will lead the inpatient stroke team consisting of neurology residents, vascular APRN’s, rotating medical/psychiatry residents and medical students and oversee the care of inpatients on the stroke service under the supervision of a vascular neurology attending. The fellow will respond to any acute stroke beeper call on the inpatient service as well as triage possible acute stroke transfers from outside community hospitals on weekdays, from 7 a.m. to 5 p.m.
During these inpatient months the fellow will sharpen their clinical skills in the rapid assessment and management of acute ischemic/hemorrhagic strokes. They will be responsible for overseeing the implementation of treatment recommendations as well as the standard secondary prevention protocols outlined in the stroke clinical pathways at Hartford Hospital.
The fellow will also be familiar with all selection criteria for ongoing stroke clinical trials at Hartford Hospital and be an active participant in the clinical trials including screening and enrolling patients.
Stroke call will be limited to two weeks in a four week block. Fellow will take call from home and precept the residents and/or advanced practice providers. Graded supervision is provided to the fellow based on the performance and review from the faculty. Fellows are expected to come in at their discretion to provide the best patient care.
INPATIENT STROKE CONSULTATION SERVICE
Location: UConn John Dempsey Hospital
During this rotation the fellow will function as a junior attending at UConn John Dempsey Hospital. Under the guidance of a vascular attending, they will be responsible to triage calls from the emergency department and/or the inpatient service and manage all stroke patients. Part of the responsibility will be educating rotating medical residents and students on the management of acute stroke.
They will be on call for stroke admissions and consults with a vascular attending one weekend (Saturday/Sunday) per month.
The vascular fellow will be part of the neuro critical care team, rounding daily on all inpatients in the critical care unit and under the guidance of the neuro critical care attending, be responsible for the care of all acute neuro patients assigned in the unit.
The fellow will learn how to manage acute strokes that require critical care. They should attain an in-depth understanding in the work-up and the management of elevated intracranial pressure and post-surgical management of craniotomy following cerebral edema, other neurovascular malformations, management of SAH and vasospasm.
The neurosonology rotation focuses on developing a proficiency in the use of ultrasound techniques for the evaluation of extracranial or intracranial large vessel cerebrovascular disease. During the one month neurosonology rotation, under the supervision of a vascular attending, the fellow will perform transcranial doppler’s on patients with subarachnoid hemorrhage and ischemic stroke in the neurocritical care unit as well as on the techniques of insonation and the interpretation of the transcranial Doppler data.
The fellow will spend time in the vascular lab for hands-on experience of carotid duplex scan under the guidance of a lead ultrasound technician. They will also sit with a vascular surgeon to interpret the findings on the carotid duplex studies.
The neuroradiology rotation is designed to allow the fellow optimal experience to develop a proficiency in the interpretation of neuroimaging. This will include an understanding of MRI/MRA/MRS, CT/CTA/CTP of the brain, and cerebral angiography. Fellow will also gain proficiency in interpreting images developed by software using artificial intelligence such as RAPID AI.
Typically the vascular fellow will spend the mornings in either the Interventional Suite with a neuro-interventional radiologist reading cerebral angiography and interpreting MRI/MRA/CT/CTA/CTP with a neuroradiologist in the afternoon.
The fellow will acquire a fundamental understanding of various types of endovascular procedures used to treat acute ischemic stroke, cerebral aneurysm, or vascular malformations.
Under the guidance of the multidisciplinary team on the inpatient neuro-rehabilitation unit at the Hartford Hospital campus, the fellow will have one-on-one experience in the delivery of post-stroke rehabilitation, rounding daily on patients in the acute rehab unit. Participation in the outpatient stroke rehab clinic at Hartford Hospital one morning per week, the fellow is expected to gain fundamental understanding for assessing the need for continuity of PT/OT/speech/ cognitive therapy for those with mild to moderate strokes and the use of BOTOX® to treat spasticity. The fellow will gain a fundamental understanding of neuronal recovery after an ischemic stroke or intracranial hemorrhage and may have some hand-on experience in neuronal restorative therapy with either medical (e.g., dopaminergic drugs) or technological (e.g., robotics; focal transcranial magnetic stimulation) means.
A block is dedicated for research, typically done earlier in the fellowship. This protected month of research is expected to be used for development of a research proposal either in clinical or in basic science will have been delineated in the first two months of the fellowship. The month is designated strictly for research and will allow the fellow enough time to gather all information needed to write an IRB/data collection, or research writing/abstract that may be submitted to the national/international meeting for presentation.
NEUROVASCULAR OUTPATIENT CLINICS
Location: Hartford Hospital/UConn John Dempsey Hospital
One half day per week.
Fellow rotations are tailored according to the career pathway they are interested in.