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Department of Neurology

 


Vascular Neurology Fellowship


Goals and Objectives of the Fellowship


The Vascular Neurology Fellowship at University Hospitals Cleveland Medical Center/ Case Western Reserve University School of Medicine is a one year, ACGME-accredited, comprehensive training program that is designed to develop expertise in the diagnosis, management, and prevention of vascular neurologic disorders while caring for a diverse population of patients with a wide variety of neurovascular conditions. The Vascular Neurology Fellowship is aligned with our University Hospitals and Neurological Institute mission To Heal. To Teach. To Discover. and to deliver Innovative, Integrated and Individualized Care. The program aims to train our future leaders and directors of stroke centers that will deliver the highest quality care to their patients, like we would wish for our own families.


Our faculty is committed to identify the specific career goals of our trainees to help them meet those goals. Completion of the Vascular Neurology fellowship prepares the candidate for an academic career as a Stroke Center Director. Upon receipt of the American Board of Psychiatry and Neurology board certification in Neurology, fellows successfully completing the program are eligible for certification in Vascular Neurology. For those pursuing a career in epidemiology or clinical trials Case Western Reserve University School of Medicine offers a Graduate Certificate and a Masters in Science through the Clinical Research Science Program (CRSP). For those wishing to pursue further training in Endovascular Surgical Neuroradiology, this fellowship fulfills the prerequisite of one year of Vascular Neurology in an ACGME-approved program.
 


University Hospitals Cleveland Medical Center, affiliated with the Case Western Reserve University School of Medicine

Training takes place at University Hospitals Cleveland Medical Center, a comprehensive care academic medical center with 1032 beds, including the Reinberger Neuroscience Intensive Care Unit. Founded in 1866, this renowned academic medical center is intricately linked to the history of Cleveland and nurtured and supported by the city’s great industrial families of the late 19th and 20th centuries. It is the hub of the University Hospitals Health System of 18 hospitals and over 40 ambulatory centers employing 4700 physicians and over 25,000 employees, which makes it one of the most integrated health care systems in the nation. University Hospitals has been recognized for its clinical excellence as an academic medical center by the US News and World Report, Healthgrades, Vizient, Ethisphere, and Most Wired. It is a Magnet Award and Beacon Gold Award winner and has achieved the highest Get With the Guidelines-Stroke awards since they were first offered. http://www.uhhospitals.org.


The Comprehensive Stroke Center within the University Hospitals Neurological Institute

The University Hospitals Neurological Institute, established in 2006, highlights our commitment to multidisciplinary care through a structure that combines faculty in the departments of Neurology, Neurosurgery and Psychiatry into Centers of Excellence that deliver individualized treatment, innovative techniques and access to some of the most innovative research designed to advance the science of neurological medicine.

 http://www.uhhospitals.org/services/neurology-and-neurosurgery/institute

The Comprehensive Stroke Center at University Hospitals Cleveland Medical Center is the largest Center of Excellence within the Neurological Institute and one of the earliest hospitals to be certified by the Joint Commission at its highest designation since certification was Primary Stroke Center certification was offered in 2004 and Comprehensive Stroke Center Certification was offered in 2012. Through the University Hospitals System Stroke Program Clinical Practice Guideline for Acute Stroke, we triage and transfer patients within the health system with the goal for patients to receive the right care at the right location.

 http://www.uhhospitals.org/services/neurology-and-neurosurgery/institute/our-centers/comprehensive-stroke-center


Vascular Neurology Training Curriculum

The Vascular Neurology Fellowship program curriculum is designed to develop proficiency in the emergent and urgent treatment of vascular neurologic conditions, comprehensive care throughout the continuum, and preventive care. Experience in administration, an understanding of stroke systems of care and the importance of conducting quality initiatives are essential to future roles in stroke center management. Fellows begin their training taking an introductory course on epidemiology, outcomes and statistics and as a Cleveland StrokeNET center, gain experience in conducting clinical research, clinical trial design and participate as co-investigators in ongoing clinical trials in vascular neurology. https://www.nihstrokenet.org/research.


There are ample opportunities to further physician-educator skills of curriculum development and public speaking working closely with the University Hospitals Cleveland Medical Center Neurology Residency program, the Neuroscience Nursing Program and the University Hospitals Emergency Medical Systems Training Institute.

Fellows receive comprehensive training in the diagnosis and treatment of ischemic and hemorrhagic stroke, transient brain ischemia, occlusive and hemorrhagic diseases as relevant to mastery required of the American Board of Psychiatry and Neurology Vascular Neurology board examination, such as: : https://www.abpn.com/become-certified/taking-a-subspecialty-exam/vascular-neurology.

• Cardiogenic brain embolism
• Large vessel extra-cranial cerebral atherosclerosis
• Large vessel intra-cranial cerebral atherosclerosis
• Aortic arch cerebral and spinal embolism
• Lacunar strokes and microangiopathic white matter disease
• Hemodynamic brain ischemia
• Hereditary and acquired hypercoagulable states, including antiphospholipid antibody syndromes, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura
• Substance abuse and drug toxicities
• Reversible Vasoconstriction Syndrome/ Posterior Reversible Encephalopathy Syndrome
• Cervical artery dissection
• Non-atherosclerotic vasculopathies including those that are genetic, inflammatory, or infectious
• Radiation vasculopathy
• Cerebral venous thrombosis
• Genetic and metabolic disorders
• Migraine and stroke mimics
• Intracerebral hemorrhage
• Aneurysmal subarachnoid hemorrhage
• Subdural hematomas/epidural hematomas
• Spinal cord infarction
• Complications including raised intracranial pressure, infections, pneumonia, and deep venous thrombosis
• Surgical management of brain ischemia and hemorrhage
• Vascular malformations
• Air/fat embolism
• Stroke in malignancy, immunosuppression, and as a consequence of systemic illnesses/conditions
• Spasticity and neurorecovery after stroke

The core curriculum consists of training in the inpatient setting on the Stroke Service (4 blocks) and the Neuroscience Intensive Care Unit (2 blocks), in acute rehabilitation at the UH Rehabilitation Hospital (1 block), and in several Stroke Prevention Clinics (2.5 blocks with longitudinal experience) as well as Research (1 block) and Electives (2.5 blocks).

There is flexibility in the curriculum to provide some customization to reflect the fellows’ prior experience during their neurology or other training and to ensure that fellows gain that experience and training that will be comprehensive but optimized to meet the challenges of their future career goals.


Conferences and Seminars

All fellows regularly attend conferences and seminars in neurology, neurocritical care, neurosurgery and neuroradiology as well as periodic special seminars, journal clubs, lectures in basic science, didactic courses and regional and national conferences. In addition, fellows are welcome to attend an extensive list of conferences in general neurology to assist in preparation for the neurology board examination, often taken during the beginning of the fellowship year 

Conference and Committee Schedule:
 
   Stroke & Neurocritical Care Conference Tuesday 12-1p, weekly
   Neurology Grand Rounds Friday 8-9a, weekly
   Vascular & Skull Base Conference Wednesday 3-4p, weekly
   Stroke Quality Committee Wednesday 11-12p, monthly
   Stroke Operations Meetings Wednesday 4-5p, quarterly
   UH Systems Stroke Committee Wednesday 5:15-6:30p, quarterly
   
   Morbidity and Mortality Conference Thursday 4-5p, monthly
   Clinical Pathological Conference Thursday 4-5p, monthly
   General Service Conference Wednesday 12-1p, weekly
   CDC Prion Center CPC Friday 3-4p, monthly
   Epilepsy Grand Rounds Monday 8-9a, monthly
   Neuromuscular Grand Rounds Friday 9:30a, monthly
   Neurology Boot-Camp Various, beginning of academic year
   Neurosciences Journal Club Monday 12-1p, weekly
   Neurosciences Seminar Thursday 12-1p, weekly

Vascular Neurology Program Director and Neurological Institute Faculty

Cathy Sila MD
Program Director of the Vascular Neurology Fellowship
Director of the Comprehensive Stroke Center and Vice Chair of Neurology
George M Humphrey II Endowed Chair and Professor of Neurology

Anthony Furlan MD
Chair of Neurology and Co-Director of the Neurological Institute
Gilbert Humphrey Endowed Chair and Professor of Neurology

Michael DeGeorgia MD
Program Director of NeuroCritical Care Fellowship
Director of the Neurocritical Care Center
Maxeen Stone & John Flower Endowed Chair and Professor of Neurology

 Sophia Sundararajan MD PhD
Director of the Clinical Trials Unit
Associate Professor of Neurology

Ciro Ramos Estabanez MD PhD
Research Director, NeuroCritical Care
Assistant Professor of Neurology

Wei Xiong MD
Director of the Neurology Core Clerkship
Assistant Professor of Neurology

Warren Selman MD
Chair of Neurosurgery and Co-Director of the Neurological Institute
Harvey Huntington Brown Jr Endowed Chair and Professor of Neurosurgery

Nicholas Bambakidis MD
Program Director of Neurosurgery, Vice-Chair of Neurosurgery, Director of the Neurological Institute
Professor of Neurosurgery and Radiology

Jeffrey Sunshine MD PhD
Vice Chair of Radiology and Chief Medical Information Officer
Professor of Radiology

Robert Tarr MD
Past Director of Neuroradiology
Clinical Professor of Radiology

Seth Hoffer MD
Co-Director of the Neurocritical Care Unit
Assistant Professor of Neurosurgery

Yin Hu MD
Vascular Neurosurgeon and NeuroInterventionalist
Clinical Associate Professor of Neurosurgery

Stefan Dupont MD PhD
Clinical Assistant Professor of Neurology

Abhishek Ray MD
Vascular Neurosurgeon and NeuroInterventionalist
Clinical Assistant Professor of Neurosurgery and Radiology

Julie Fussner BSN RN CPHQ SCRN Stroke Operations Manager
Kelly Montgomery BSN RN SCRN UHCMC Stroke Coordinator
Kathleen Vickers RN Cerebrovascular Nurse
David Korosec RN Clinical Nurse Research Specialist
Valerie Cwiklinski RN Clinical Nurse Research Specialist
Colin Beilman MHA Operations Analyst, Neurological Institute
Tinatin Gumberize Operations Analyst, Neurological Institute


Evaluation Policy

Evaluation of progression to competency in the areas of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice are based on the Vascular Neurology Milestones. http://www.acgme.org/Specialties/Milestones/pfcatid/37/Neurology
 

You will be asked to evaluate yourself on these milestones at entry into the fellowship- to determine where you think you are and identify gaps which would become areas of focused study, mid-way through your training- to see how far you have progressed and reevaluate your goals, and near the end of your training to ensure your preparation for graduation and the next phase of your career. The Portfolio is an important tool to guide mentoring and coaching, evaluating your academic resume and planning the next phases of a successful career. In addition, you will be asked to evaluate your attending faculty as well as the Vascular Neurology program and participate in the formal review and performance improvement activities of the training program as an appointed member of the Vascular Neurology Program Evaluation Committee


Administrative Tasks and Other Policies

In accordance with AGCME policies, administrative duties are similar to those required during your residency, such as timely submission of duty hours and evaluations and monitoring for fatigue as well as participation in quality activities as an appointed member of the Stroke Quality Committee and University Hospitals System Stroke Program Committee. Moonlighting is permitted during the fellowship and available within the Medicine department at UHCMC, as consistent with ACGME policies on respecting duty-hours and avoid interfering with your primary training.


Opportunity for Additional Training The CRSP-401- Introduction to Clinical Research Course is provided at the beginning of the Vascular Neurology Fellowship program in audit form, not for course credit. If you are interested in pursuing a Graduate Certificate in Clinical Research or a Master of Science in Clinical Research following your Vascular Neurology fellowship, you will need to take the course for credit to qualify. The Graduate Certificate in Clinical Research Science Program (CRSP) at Case Western Reserve University School of Medicine. This program combines knowledge from biostatistics, epidemiology and study design with training in ethical, legal and regulatory issues in patient-oriented research. To earn the certificate, students must complete 4 courses totaling 11 credit hours (CRSP 401- Introduction to Clinical Research, CRSP 402- Study Design & Epidemiologic Methods, NURS 630- Advanced Statistics: Linear Models, and CRSP 603- Research Ethics and Regulation, as well as the online CITI Basic Course in the Protection of Human Research Subjects. This Certificate Program provides an alternative to the Master of Science Program in Clinical Research. It is geared toward clinicians and other health-science professionals who are interested in conducting clinical research or collaborating with other clinician-scientists who do so. Applicants submit an online Application to the Center for Clinical Investigation at Case Western Reserve University School of Medicine. http://casemed.case.edu/CRSP/Certificate.cfm


Opportunity for Additional Training: the Cleveland NINDS StrokeNET Clinical Research Award

he Cleveland NINDS StrokeNet site offers a Clinical Research and Training Award each year that focuses on training in research methodologies and conduct of research related to cerebrovascular diseases (both hemorrhagic and ischemic conditions). The Cleveland StrokeNet is comprised of 8 Core Hospitals and 31 Satellite Facilities including the stroke programs at University Hospitals Cleveland Medical Center, Cleveland Clinic, MetroHealth Medical Center, and Louis Stokes Cleveland VA Medical Center and is funded by the National Institute of Neurological Disorders and Stroke (NINDS).
This Clinical Research and Training Award is open to clinical and/or research fellows, postdoctoral fellows and faculty within 5 years of training who wish to devote a significant portion of their career to methodologically rigorous research. It is designed to provide training and research support to allow the investigator to obtain external grant funding in an area of cerebrovascular research, which could include (but are not limited to) primary prevention, acute management, mechanisms of cellular damage from ischemia or hemorrhage, genetics, rehabilitation and recovery, and secondary prevention. The award may be used to support salary, coursework in clinical research or to provide direct support for research activities. 


Opportunity for Joining the University Hospitals Faculty

Consider a career with us- your training in excellence in patient care, focus on patient safety and best outcomes will be valued as healthcare challenges foster continued consolidation of health systems and prioritization of high-value care. https://www.uhdoctor.org/why-uh


For more information, please contact:
 
Tarrika Allen
Academic Education Coordinator
Vascular Neurology Fellowship
Department of Neurology

216-844-3100
Tarrika.Allen@UHhospitals.org