AHA Scientific Session 2021: Updates in Stroke: Careers & Future Directions in Vascular Neurology

Panelists: Drs. Anjail Sharrief, Ashutosh Jadhav, Louise McCullough, Alicia Zha. Moderator: Dr. Lauren Fournier

The session kickstarted by highlighting the duration of neurology training and the timeline to consider a career path and why is it important to do a fellowship? In current times, there is rapid growth in the field of medicine, with this, there is an increase demand to have specialists and hence choosing a fellowship is important. This session discussed extensively about a career in Vascular Neurology, comprising of panelists with different yet similar background in the field of vascular neurology. There was a shocking revelation in the dearth of vascular neurologists as compared to our counterparts, cardiologists. The graduate ratio of stroke neurologist to that of cardiologist is ~1:10, however, the disease burden is not proportionate. A part of this could be attributed to the amount of exposure we get in acute stroke management during our training and hence can be inclined towards either an inpatient or outpatient setting without a formal fellowship, but wait… there is more to it; The panelists gave us an insight into post stroke care and management, which is also equally important and we don’t follow in the post discharge period. And that’s when fellowship becomes important as it gives your patient a continuity of care at a community level.

There is more to it than just the title of a vascular neurologist; There are various aspects of stroke care that we can dive into such as health equity in stroke patients, stroke in young, stroke in women to name a few. The newly evolving field of telemedicine/ tele stroke has become an important aspect of our day-to-day practices and is rapidly changing how patient care can be delivered in an effective and efficient manner. When does this become important, as Dr. Jadhav gave an instance, flying a patient from 45 minutes away and treating them acutely doesn’t end there, as a stroke neurologist, you have an added advantage of following this patient when discharged to the community especially if there is lack of a stroke neurologist with the gift of tele-medicine and training to ensure secondary care. Drs. Sahrrief and Zhao spoke about the importance of training and practicing telemedicine to stay continually in touch with the patients and communities for their betterment and managing secondary stroke prevention by providing close follow-ups, assessing with social work needs etc. As this form of medicine is becoming more popular and is now being incorporated into ACGME curriculum, it is important to look if the fellowship program can ensure proper training as this can teach us early on to triage patients and manage their care.

Neurointerventional radiology has been steadily gaining momentum in recent times as more trainees from a neurology background are interested in pursuing a career in this field. A summary of the field of neurointerventional radiology including the different training pathways and what is the formula for a successful match was made by Dr. Jadhav. Having addressed this, the panelists stressed the importance of picking a specialty that you are passionate about as this will eventually make the journey worth it.

A topic that most of us want to know and be a part of, RESEARCH. Research in one form or the other is part of our training, the question is, how do we make the most out of this and keep it consistent? Having a research foundation early on in training is important, but what brings this foundation together? The right mentor and environment are of utmost important when you are a novice. As trainees, we can start by familiarizing with clinical research methods, clinical trials, interpreting articles and carry these lessons to further build on in fellowship programs. There are multiple online resources which can help us achieve this, one such example is through AHA which offer courses on epidemiology.

Dr. McCullough discussed, Mobile Stroke Unit, and how it is changing the phase of acute stroke management in the pre-hospital setting and studies are currently looking into cost effectiveness. Stay tuned as more updates will be presented at International Stroke Conference!!!

The panelists then discussed, the “happening lytic”, TNK, and its future in acute stroke therapy.

The closing discussion was a question which we have all had at some point in our career, what are the ways to ensure a smooth transition after training; Some important take away points included, if looking for an academic opportunity, how is your support system and resources. In general, it is to understand your worth, negotiating time and money, protected time for your academic interests. The first 3-5 years in any setting is very crucial in establishing yourself and knowing how you want to shape your career. Nobody is a 100% certain, you need to have an open mind and work with the flow. It’s good to keep in mind that there is no perfect job and the trick is to learn to evolve and carve the niche for ourselves.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”