Curriculum

During your one-year fellowship training, you will be primarily at Hartford Hospital. The remainder of the time will be spent at the UConn Health in Farmington.

Rotation Site Number of Months
Impatient Stroke Service Hartford Hospital 4
Neuro-radiology Hartford Hospital 2
Neurosonology/Neurocritical Care Hartford Hospital 2
Inpatient Stroke Service UConn John Dempsey Hospital 2
Neuro-Rehabilitation Hospital for Special Care 1
Research Hartford Hospital/UConn John Dempsey Hospital 1

Inpatient Rotations

Four months at Hartford Hospital Stroke Inpatient Service
Two months at Hartford Hospital Neurocritical/Neurosonology
Two months at UConn John Dempsey Hospital

Outpatient Clinics

Twice a week x 12 months at Hartford Hospital
Once a week x 12 months at UConn John Dempsey Hospital

Stroke Rehabilitation

One month at the Hospital for Special Care

VASCULAR NEUROLOGY INPATIENT CARE (STROKE SERVICE)

Location: Hartford Hospital

The neurovascular fellow will lead the inpatient acute stroke consult 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 his/her clinical skills in the rapid assessment and management of acute ischemic/hemorrhagic strokes. He/she will be responsible for overseeing the implementation of treatment recommendations as well as the standard secondary prevention protocols outlined in the stroke critical pathway 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.

There will be one weeknight home call per week and one weekend call per month during these months.

INPATIENT STROKE CONSULTATION SERVICE

Location: UConn John Dempsey Hospital

During these two months the fellow will function as a junior attending at UConn John Dempsey Hospital. Under the guidance of a vascular attending he/she 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.

He/she will be on call for stroke admissions and consults with a vascular attending one weekend (Saturday/Sunday) per month.

NEUROCRITICAL CARE

The vascular fellow will be part of the neurocritical care team, rounding daily on all inpatients in the critical care unit and under the guidance of the neurocritical care attending, be responsible for the care of all acute stroke patients in the unit.

The fellow will learn how to manage acute strokes that require critical care. He/she should attain an in-depth understanding in the work-up and the management of elevated intracranial pressure and hypertensive emergencies.

NEUROSONOLOGY

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 all the transcranial dopplers 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. He/she will also sit with a vascular surgeon to interpret the findings on the carotid duplex studies.

INTERVENTIONAL NEURO-RADIOLOGY

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. He/she will also be exposed to the use of nuclear scans such as PET and SPECT in the setting of acute ischemic stroke.

Typically the vascular fellow will spend the mornings in either the Interventional Suite with a neuro-interventional radiologist performing an reading cerebral angiography and interpreting 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.

NEURO-REHABILITATION

Under the guidance of the multidisciplinary team on the inpatient neuro-rehabilitation unit at the Hospital for Special Care, 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.

RESEARCH

This protected month of research will be assigned in November during the fellowship year since 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 abstract that may be submitted to the national meeting for presentation.

NEUROVASCULAR OUTPATIENT CLINICS

Location: Hartford Hospital
Duration: 12 months

The fellow will spend one-half day per week at Hartford Hospital under the guidance of a multidisplinary team that includes an interventional neuroradiologist, a vascular neurologist, a neurosurgeon, and a neuropsychologist to evaluate complex neurovascular cases. He/she will coordinate the outpatient workup and the follow-up of disease entities such as cerebral aneurysm, vascular malformations, extra- and intracranial vascular diseases.

Location: Hartford Hospital and UConn John Dempsey Hospital
Duration: 12 months

The fellow will have another half-day clinic every week, twice per month, in a stroke prevention clinic supervised by a vascular neurology attending which is held at both locations.

During clinic time, the fellow will oversee the treatment and counsel patients regarding the risk factors that could lead to stroke such as hypertension, atrial fibrillation, smoking, diabetes, and nutritional modification.

The Hartford Hospital clinic also serves as a continuity clinic for acute stroke follow-up at the 6-week, 3-month, and 12-month visit where functional outcome measures are obtained and entered into the longitudinal stroke database.