The objective of our clinically rigorous fellowship program is to provide fellows with clinical knowledge and experience, procedural skills, clinical judgement, professionalism, and interpersonal communication skills required as a neurointensivist.
For those interested in a career as an investigator, a specially constructed three-year training curriculum will combine the time and educational requirements of early governmental and non-governmental awards and the rigors of clinical training.
The training will prepare fellows to function as clinicians, investigators and leaders in neurocritical care when they graduate.
The majority of practice is in the Neurointensive Care Unit at Barnes-Jewish Hospital, a 32-bed ICU in a Level 1 trauma and comprehensive stroke centers. Fellows will take on stepwise responsibility and be exposed to direct and indirect learning, one-on-one mentorship, simulation for procedural competency, and rigorous bedside teaching. In addition to rotating in the Neurointensive Care Unit, fellows will gain broader exposure by rotating through the surgical and medical ICUs, and each fellow will further have the ability to personalize their training with a selection of other electives.
Throughout their training, fellows will receive frequent written & verbal feedback from faculty regarding their performance to aid them in becoming a well-rounded, competent neurointensivist.
Two-year didactic plan
Year 1
| Topic | Lectures |
|---|---|
| Neuro trauma | Traumatic brain injury (TBI) Acute SCI |
| Vascular neurology | SAH 1: Presentation, early management SAH 2: DCI/VSP management, prognosis Acute ischemic stroke |
| Cerebral edema & brain compression | ICP waves & interpretation Herniation and coma |
| Neurologic electrical problems | Status epilepticus Neuromuscular crisis |
| Neuroinfectious | Meningoencephalitis/Ventriculitis Temperature management |
| Palliative | Neurologic prognostication Brain death |
| Pharmacology | Neuro: ASMs, sedation CV/Pulm: Vasopressors, inotropes, etc. ID: Antibiotics, antifungals, antivirals |
| Cardiology | Shock Arrhythmias |
| Pulmonology | Intubation Ventilator management & waves ARDS |
| Renal | AKI, CKD & ESRD Sodium management |
| Miscellaneous | Burns Toxicity and withdrawal syndromes |
| Fellow well-being | Sleep DEI |
| Career development | How to get a job Critical care billing |
Year 2
| Topic | Lectures |
|---|---|
| Neuro trauma | Traumatic brain injury (TBI) Acute SCI |
| Vascular neurology | SAH 1: Presentation, early management SAH 2: DCI/VSP management, prognosis Acute intraparenchymal hemorrhage |
| Cerebral edema & brain compression | ICP waves & interpretation Herniation and coma |
| Neurologic electrical problems | Status epilepticus Paroxysmal sympathetic hyperactivity |
| Palliative | Neurologic prognostication Brain death |
| Pharmacology | Neuro: ASMs, sedation CV/Pulm: Vasopressors, inotropes, etc. ID: Antibiotics, antifungals, antivirals |
| Cardiology | Shock Arrhythmias |
| Pulmonology | Intubation Ventilator management & waves ARDS |
| Endo/nutrition | Endocrinology in the NICU Nutrition in the NICU (including ileus) |
| GI | GI bleeding Liver failure |
| Heme/ID | Clotting/bleeding disorders Sepsis |
| Fellow well-being | Sleep DEI |
| Career development | How to get a job Critical care billing |
Patients per year
The disease states and procedures are outlined below, highlighting the high volume and variety of disorders encountered in our busy unit (complemented by additional exposure in other ICUs).
Cerebrovascular disorders
| Ischemic stroke* | 50 |
| Intracerebral hemorrhage | 200 |
| Subarachnoid hemorrhage | 100 |
| Cerebral venous sinus thrombosis | 10 |
| Annual Total | ~400 |
Neurotrauma
| Severe closed head injury | 60 |
| Penetrating head injury | 10 |
| Subdural hematomas | 100 |
| Spinal cord injuries | 20 |
| Annual Total | ~200 |
Other conditions treated
| Status Epilepticus | 40 |
| Neuromuscular Disorders 1 | 30 |
| CNS Infections | 60 |
| Neuroendocrine disorders 2 | 40 |
| Neuro-oncology | 80 |
| Perioperative neurosurgical care 3 | 200+ |
| Brain death 4 | 60 |
2. Including pituitary apoplexy, panhypopituitarism and DI
3. Including craniotomy, third ventriculostomy, major spinal procedures
4. Evaluation of catastrophic brain injury, diagnosis of brain death including apnea testing (coverage for entire hospital)
General critical care
- Respiratory: airway management, mechanical ventilation (invasive and non-invasive) bronchoscopy, ARDS, management of chest tubes
- Cardiac/Circulatory: performance and interpretation of bedside echocardiography, cardiac output monitoring, CPR, and evaluation and management of shock
- Renal: initiation of hemodialysis, diagnosis and management of acute renal failure
- Gastrointestinal: management of GI bleeding, open abdomen, acute abdomens
- Hematologic: evaluation of coagulation status and coagulation disorders, hypercoagulable conditions, and use of transfusion products
- Infectious Disease: management of antibiotic therapy
Procedural competencies
Approximate number per year for fellow experience:
| Central venous catheter placement | 100 |
| Arterial catheter placement | 150 |
| Endotracheal intubation | 100 |
| Lumbar puncture | 50 |
| Bronchoscopy | 50 |
| Thoracentesis and chest tube | 10-20 |
| Bedside ultrasonography and echocardiography | 200-300 |
| Pulmonary artery catheterization | 5 |
| CPR / ACLS | 20-30 |
| Continuous EEG monitoring | 150 |