Vascular Neurology Fellowship
The Vascular Neurology fellowship is a one year ACGME accredited fellowship program. Two Vascular Neurology Fellowship positions are available each year. This fellowship provides extensive training in: (1) Evaluation, diagnosis, and management of acute ischemic and hemorrhagic stroke, (2) Interpretation of neurovascular imaging including neurosonology, (3) Management of intracranial and cervical vascular disease, (4) Outpatient management of stroke including rehabilitation.
Fellows will be able to train at both the University of Alabama at Birmingham (UAB) Hospital and the Birmingham Veterans Administration Hospital. The UAB stroke service manages patients in the 28 bed stroke unit as well as the 28 bed Neurocritical Care Unit. As the primary tertiary referral center in neurology for the State of Alabama as well as parts of surrounding states, our fellows will be able to be exposed to a wide range of cerebrovascular disease.
All of our faculty members are actively engaged in a wide range of research activities including acute stroke management, neurosonology, stroke systems of care, neuroimaging and pharmacology. In addition, the UAB stroke center is currently participating in several clinical trials. The fellowship provides ample opportunity to collaborate in existing research and clinical trials and initiate new research projects. Fellows are encouraged to design and execute their own research projects.
Successful completion of an ACGME accredited residency in Neurology is required prior to starting fellowship.
At the completion of 12 months of training, vascular neurology fellows must demonstrate proficiency in all core ACGME competencies.
· The University of Alabama at Birmingham is the only tertiary referral hospital for stroke in our region and provides a wide exposure both common and rare stroke pathology with over 1,000 cases admitted per year and one of the highest intravenous tPA treatment rates in the nation. In addition to becoming comfortable with managing all aspects of care for ischemic and hemorrhagic stroke, fellows will manage less common disorders including cerebral venous thromobosis, genetic and hematological clotting disorders, arterial dissection, CNS vasculitis and non-atherosclerotic vasculopathies.
· Fellows must demonstrate competence in integrating information obtained from the patient history, neurological examination, laboratory results and imaging studies to arrive at an accurate diagnosis and implement an appropriate treatment plan.
· Fellows will be able to integrate information from advanced neurovascular imaging studies including neurosonology, multi-modal MRI and CT perfusion studies and cerebral angiography.
· Fellows will be comfortable managing patients in both the inpatient and outpatient settings including the neurocritical care unit.
· Fellows will demonstrate competency in their knowledge of stroke epidemiology, basic science, neuroanatomy, clinical neurology, mechanisms of stroke, neuroimaging, critical care, endovascular surgery, neurological vascular surgery, neurosonology, cerebral blood flow and metabolism, neuro-behavior, and neurorehabilitation.
Practice-based Learning and Improvement
· Our fellows are expected to systemically analyze their care of stroke patients and implement changes for practice improvement. This includes critical analysis and assimilation of scientific evidence and literature related to their patients’ specific health problems.
Interpersonal and Communication Skills
· Fellows will demonstrate effective exchange of information with patients, families and colleagues. They will also be responsible for teaching residents, medical students and other health care providers.
· Fellows will demonstrate a commitment to carrying out all professional responsibilities and adhere to ethical principals in all clinical and research activities.
Systems Based Practice
· Fellows must be aware of and responsive to the larger context and system of health care. They must appropriately utilize various resources within the system to provide optimal health care.
The Neurovascular Fellowship includes inpatient rotations, outpatient clinics and weekly lecture series. Each fellow must complete the following rotations:
· 6 months on the Inpatient Stroke Service
· 1 month of Neurorehabilitation
· 1 month of Neurosonology
· 1 month of Neurocritical Care
· 3 Months of Electives
Inpatient Stroke Service
This service is comprised of 2-3 residents as well as medical students. The service typically has up to 20 inpatients although there may also be an additional service staffed by physician extenders. Patients may be admitted to this service through the emergency room, from UAB clinics or as transfers from other hospitals. The fellow is responsible for assisting in the management of all patients on this service as well as acute stroke patients in the emergency room. Fellows will typically not be responsible for carrying their own patient load but should function in a supervisory role over the residents.
Fellows will spend one month working on the inpatient neurorehabilitation service at the Spain Rehabilitation Hospital. Here fellows will be able to monitor the progress of patients following their acute management on the inpatient stroke service. Most stroke patients admitted to the rehabilitation service will stay in the center for 1-3 weeks. Fellows will also have the opportunity to work in the outpatient rehabilitation clinics and learn about experimental techniques.
The neurosonology laboratory adjacent to the inpatient stroke unit provides an opportunity for fellows to learn carotid and transcranial Doppler ultrasonography. Fellows may also learn
special techniques including bubble tests, emboli detection and vasomotor reactivity. Fellows will be able to read enough studies to meet requirements to sit for the ASN examination (www.asnweb.org).
The NICU is located next to the inpatient stroke unit. Vascular Neurology fellows will rotate though this service and assist in the management of stroke patients as well as neurosurgical and other neurology patients requiring intensive care.
Electives may include additional training in neurocritical care, neuroimaging or neurointerventional surgery. Fellows may also use their elective time to pursue research projects. All electives must be approved by the Program Director.
Fellows will maintain a weekly continuity clinic in stroke at the Kirklin Clinic. Patients will include post stroke hospital follow ups and new referrals from the community. Each fellow is expected to see 4-5 patients each week.
VA Stroke Clinic
When not on the inpatient stroke service or NICU rotation, fellows are expected to help staff patients in the bimonthly stroke clinic at the VA Hospital. This is an afternoon resident clinic, typically with 6-8 patients.
Protected time for education is an important feature of our fellowship. Each week residents will have the opportunity to participate in several didactic sessions covering all aspects of stroke care.
· Neuroradiology Conference- A weekly conference for neurology residents and fellows to present cases for neuroimaging review.
· Grand Rounds- A weekly lecture presented by UAB faculty and visiting professors covering all aspects of neurology.
· Neurovascular Case Conference- This multidisciplinary conference meets on a weekly basis to discuss cases on the stroke and vascular neurosurgery service. This conference is also an opportunity discuss challenging patients seen in the outpatient clinics.
· Stroke Division Conference- This is a weekly conference for faculty and staff of the stroke center with alternating topics including lectures from faculty and fellows, journal club and morbidity and mortality conference.
In addition to these conferences, fellows may be asked to give lectures for medical students as part of their neurosciences curriculum and to participate in stroke education during the UAB Neurology Residency Noon Conference Series.
Vascular Neurology Fellows should be available during the daytime to answer questions from residents at UAB or the Birmingham VA regarding management of stroke patients. They will also participate in the overnight call system for stroke on average 5 nights each month. On weekdays, call starts at 5 PM and ends at 7 AM. On weekends, call lasts from 7 AM to 7 AM the following day.
· Salary: PGY-5 Salary
· Vacation: Three weeks paid vacation per year with additional time off during holidays
· Funding for travel expenses to national conference for the purpose of research presentation
· Malpractice insurance coverage
· Low cost health, dental and vision insurance
· Group Term Life Insurance
· Pagers, lab coats and scrubs
· Discounted meals at hospital cafeterias
· Educational Stipend
· Access to the Lister Hill Medical Library (Free online access to major journals, medical texts and databases)
· American Academy of Neurology Membership
· Discounted membership at the UAB recreational facility