Neurocritical Care Fellowship
Stanford Stroke Center Neurocritical Care Fellowship
Since its inception in the year 2001, the Stanford neurocritical care program has provided unparalleled care for patients with critical neurologic illness. The neurocritical care team provides 24 hour clinical coverage of the neurocritical care unit, the emergency room, and the other inpatient units at Stanford, caring for patients with primary neurologic illness, neurological complications of systemic illness, and neurological emergencies. The diseases treated by a neurocritical care physician are broad, and include stroke, intracerebral hemorrhage, traumatic brain injury, brain injury after cardiac arrest, seizures, spinal cord injury, neuromuscular disorders, and many others.
In addition to the breadth and depth of the clinical activities, the Stanford neurocritical group has a long history of experience and success in performing clinical trials and basic science research. As one of the leading neurocritical care research groups in the country, there are numerous ongoing clinical trials in neurocritical care and robust basic science and translational research programs. Recognizing that the treatments of tomorrow are rooted in the research of today, all of the neurocritical care faculty members participate extensively in this research mission.
The Stanford neurocritical care group is committed to rigorously training future generations of neurointensive care and vascular neurology physicians. The faculty work closely to focus on neurocritical care training for the neurocritical care fellows, vascular neurology fellows, surgical and medical critical care fellows, and Stanford neurology and neurosurgery residents and medical students as well. Graduates from our two year UCNS certified neurocritical care fellowship have gone on to work in a variety of practice settings and make significant contributions to the field.
Goals and Objectives of the Neurocritical Care Fellowship
- Understand how to treat acute neurological emergencies and manage all patients in the intensive care unit who are neurologically critically ill or have a neurological complication
- Learn the principles of general critical care medicine
- Gain proficiency in procedural skills related to critical care medicine
- Learn to prioritize and triage competing care needs
- Develop expertise in the diagnosis, management, and prevention of vascular neurological disorders
- Learn from the diverse neurological disorders seen in various patient populations
- Gain an understanding of the process of clinical research and the critical evaluation of the literature
- Acquire skills to teach neurology to medical students, interns, neurology residents, and physicians of other disciplines
- Develop a sense of purpose with regard to ethical and humanistic aspects of care, with an emphasis on compassion and respect for patient-centered values
Fellows learning objectives follow the ACGME core competencies of patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal and communication skills, and system-based practice.
The Stanford Neurocritical Care Fellowship program is a UCNS certified two-year education curriculum. While fellows care for neurologically critically ill patients throughout their two years of training, the first year of education is primarily focused on general critical care medicine principles and in the second year neurocritical care principles are emphasized. The majority of clinical rotations occur at Stanford University Hospital; however, fellows also spend time at Santa Clara County Medical Center. Fellows have in-house call during their first year that is shared with the critical care medicine fellows (anesthesia, pulmonary, EM, CCM). During the second year fellows share home call with the vascular neurology fellows, but are expected to come in to the hospital to assist the residents and for potential endovascular acute ischemic stroke cases. Duty hours are tracked in MedHub and strictly follow UCNS and ACGME policies.
|5 Medical-surgical- neuroICU blocks
2 NeuroICU blocks
1 Surgical trauma block
1 Anesthesia block
1 Neurosurgery block
3 Elective/research blocks
|6 NeuroICU blocks
2 Medical-surgical- neuroICU blocks
1 Vascular Neurology block
1 Neurosurgery block
3 Elective/research blocks
*(Total of thirteen 4-week block rotations)
Throughout the two-year fellowship, fellows receive education through daily bedside teaching rounds and weekly didactic lectures. Lecture topics by faculty reflect the below core curriculum. Examples include: ventilator management, sepsis, post-cardiac arrest care, intracerebral hemorrhage, EEG in the ICU, acute ischemic stroke endovascular trials, and transcranial doppler, among many others. During the fellows first year of training, fellows receive bedside transthoracic ECHO teaching and quarterly simulation teaching on communicating difficult news to families. Fellows are expected to present at conferences including journal club, difficult case conferences, morbidity & mortality (M&M) conferences, and ECHO conferences. Fellows also receive a copy of the UCNS core curriculum for self-study.
General Core Curriculum
Obtain understanding of the following:
- Cerebrovascular anatomy
- Physiology of cerebral blood flow, metabolism and intracranial pressure
- Pathophysiology and treatment of increased intracranial pressure, altered cerebral blood flow states and coma
- Neurological examination techniques, including examination techniques for a comatose patient
- Neurosurgical and neurology imaging techniques
- TCD monitoring and interpretation
- EEG application in the ICU
- EVD management and sampling
- CSF diagnostics
- Various neuro-monitoring techniques and their use in guiding hemodynamic therapy
- Ventilator management for brain injured patients
- Hemodynamic management for patients with brain or spinal cord injuries including fluid resuscitation and vasopressor therapy
- Airway management with special focus on patients with reduced level of consciousness, cranial nerve impairment and patients with traumatic brain, facial and cervical spine injuries
- Sedation regimens, scores, weaning and special considerations in neurocritical care patients
- Special considerations of pain management in neurocritical care patients
- Management of fluid, acid-base, and electrolyte disturbances
- Management of nutrition including routes, indications and ability to create basic nutritional plan
- Basic infection control risks, strategies to prevent and treat ventilator associated pneumonia, urinary tract infections, central venous line infections and surgical wound infections; demonstrate basic knowledge of antibiotic therapy, groups of antibiotics, neuro-specific considerations e.g. CSF-penetration
- Specific considerations for patients with coexisting critical illness, e.g. ARDS, and intracranial pathologies
- Endocrine consequences of pituitary tumors
- Brain death
- Ethical considerations for end-of-life decisions
- Exhibit safe order writing and closed-loop communication
Apply the above knowledge for the diagnosis and treatment of patients with:
- Coma, including post cardiac arrest
- Herniation syndromes
- Acute hydrocephalus
- Moderate and severe traumatic brain injury (Subdural and epidural hematomas, hemorrhagic contusions)
- Ischemic and hemorrhagic strokes
- Administration and management of intravenous thrombolysis or intra-arterial therapies with Neurointerventional team
- Cardiogenic brain embolism
- Large vessel cerebral atherosclerosis
- Management of patients pre and post CEA or stenting
- Aortic arch cerebral and spinal embolism and spinal infarctions
- Small cerebral artery occlusive disease
- Hemodynamic brain ischemia
- Hereditary and acquired hypercoagulable states, including antiphospholipid antibody syndromes
- Disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, other hematological disorders
- Substance abuse and drug toxicities
- Hypertensive encephalopathy/Posterior Reversible Leukoencephalopathy Syndrome
- Cervical and intracranial artery dissection
- Vasculopathies including genetic (i.e. Moya-moya), inflammatory (i.e vasculitis), and infectious
- Cerebral venous thrombosis
- Genetic and metabolic disorders
- Aneurysmal subarachnoid hemorrhage and vasospasm
- Vascular malformations (AVM, cavernous malformations, fistulas,etc)
- Indications for surgical management of brain ischemia and hemorrhage
- Encephalitis/meningitis/brain abscess
- Acute neuromuscular illness
- Peri-operative care after neurosurgical or interventional neuroradiology procedures
- Concurrent critical medical or surgical illness
- Complications of vascular disease, including raised intracranial pressure, sepsis and venous thrombosis
- Management of extra-ventricular drains and multimodal monitoring
- Seizures and status epilepticus
- Neurological complications of pre and post organ transplant patients
Stanford Neurocritical Care program currently has five faculty neurointensivists:
Karen Hirsch, MD, Stanford Neurocritical Care Program Director
Anna Finley Caulfield, MD, Neurocritical Care Fellowship Director
Marion Buckwalter, MD, PhD, Associate Professor
Chitra Venkatasubramanian, MBBS, MD, Clinical Associate Professor
Prashanth Krishnamohan, MBBS, MD, Clinical Assistant Professor
Fellows receive training and education in a multi-disciplinary method not only from neurointensivists, but also anesthesia and pulmonary intensivists, vascular neurologists, neurosurgeons, epilepsy neurologists, trauma-surgical intensivists, neurointerventionalists, and neuroradiologists.
How to Apply
We are participating in the San Francisco Match - www.sfmatch.org - process. All applications should be submitted through the SF Match approximately two years prior to the applicants anticipated residency graduation date. Applications start at the beginning of October. Interviews occur the following spring and the match occurs mid-June.
Applicants must be graduates of an ACGME-accredited residency and eligible for medical licensure in the state of California. Stanford University is committed to increasing representation of women and members of minority groups and particularly encourages applications from such candidates.
General inquiries about the fellowship should be sent to our Fellowship Coordinator, Valerie Berland at firstname.lastname@example.org.
Salary and Benefits
In summary, the salary amount will be reflective of your level of post-graduate training. More information on salary and benefits may be obtained from the Stanford Graduate Medical Education website.
Kassi Kronfeld, MD
Neurocritical Care Fellow
Dr. Kassi Kronfeld is currently a Neurocritical Care Fellow with academic interests in quality improvement, medical education, subarachnoid hemorrhage, and stroke imaging. She completed her internship and Neurology residency at Stanford. She also is active in the Neurocritical Care Society, serving as a member of the Resident-Fellow committee and education subcommittee.
Nick Murray, MD
Neurocritical Care Fellow
Dr. Nick Murray is a neurocritical care fellow with research interests in predictors of ischemic stroke and traumatic brain injury acute outcomes, artificial intelligence in stroke imaging, and inpatient neurosciences quality improvement. He completed medical school at the University of Iowa, with additional research training in serotonin and neuronal control of breathing at the Mayo Clinic and the Howard Hughes Medical Institute, followed by internship in internal medicine at CPMC in San Francisco and then Stanford for Neurology Residency. Dr. Murray plans to continue as an academic neurological intensivist after fellowship.
Sandeep Walia, MD
Neurocritical Care Fellow
Dr. Sandeep Walia is a Neurocritical Care fellow with significant interest in the effects of substance abuse on ischemic and hemorrhage stroke, stroke imaging, and quality improvement. He completed both his medical degree and internship in internal medicine at Georgetown University School of Medicine. This was followed by neurology residency at University of California Davis.
Jack Tzu-Chieh Wang, MD, PhD
Neurocritical Care Fellow
Dr. Jack Wang is a Neurocritical Care fellow with significant translational interests in identifying novel therapeutic targets and drug delivery systems to attenuate nerve degeneration and promote functional recovery in stroke and traumatic brain injuries. He obtained both MD and PhD from Stanford, and completed neurology residency at UCLA, where he received an NIH grant to investigate the cellular basis of axon degeneration and attempted regrowth in stroke. He has been the recipient of national research awards & grants with several publications in high-impact journals, and is an active member in the Society of Neuroscience and the American Academy of Neurology. As a physician-scientist, he plans to continue an academic career combining his clinical and translational interests into finding new treatments for patients with ischemic or traumatic brain and spinal cord injuries.
NCC Fellowship Alumni
Basit Rahim, MD
Prashanth Krishnamohan, MD
Kyle Hobbs, MD
Gracia Mui, MD
Pablo Bravo, MD
Reza Pirsaheli, MD
Mohamed Teleb, MD
Edgar Samaniego, MD
Duane Campbell, MD
Anna Finley Caulfield, MD
Chitra Venkatsubramanian, MD