CNS Endovascular Surgery Fellowship

The primary mission of the Westchester Medical Center CNS Endovascular Surgery Fellowship Program is to provide fellows with the training necessary to become leaders in academic neuroendovascular surgery through an intensive clinical and educational experience. Fellows will acquire knowledge and expertise to satisfy the six core competencies outlined by the ACGME.

1. Fellows acquire medical knowledge through a series of didactic and Socratic mechanisms and self-directed reading programs. Skills and knowledge are assessed by faculty on a continuous basis
2. Patient Care skills are developed by the fellows through evaluation, participation, and treatment of patients with cerebrovascular pathologies in the outpatient clinics, the emergency room, the neuroangiography suites, and by taking care of patients on the neuroendovascular service in the ICUs and ward. Neuroendovascular skills are assessed on an on-going basis by the respective faculty
3. Communication skills are developed, enhanced, and evaluated via ATLS, evaluation in the ICUs, communication with the neurosurgical, surgical and medical teams, and communications with families of critically and non-critically ill patients
4. Professionalism is highly valued and reinforced throughout the program. This is done by evaluation of the fellow’s behavior and skills by faculty and nurses, mentorship through fellow’s participation in administrative duties
5. Systems based practice is mandatory throughout these specialties. Fellows are involved in faculty meetings, retreats, PI/QA mechanisms and are actively involved in enhancement of systems-based practice throughout their fellowship. The ICU services are systems-based and this permeates all aspects of care and training.
6. Practice based learning and improvement is achieved through numerous integrated mechanisms. Fellows participate in all aspects of the neuroendovascular and critical care services to develop and maintain evidence-based “best-practice” medicine and be on the forefront of the delivery of acute care management. Fellows are involved in development and reviewing management and practice guidelines, order set development, PI/QA, educational and research initiatives that enhance knowledge, direct care and improve outcomes.

Year 1

The fellow will be assigned to the neuroendovascular clinical service at which time his/her primary responsibility will be the clinical as well as operative management of inpatients. The fellow will participate in the pre- and post-procedure evaluation of patients with attending faculty supervision. The fellow, in collaboration with the supervising attending, will ensure compliance with established neuroendovascular and institutional policies during and following interventional procedures. Case-based learning will integrate case-specific imaging modalities, including MRI, MRA, MRV, CT, CTA and CT Perfusion technologies. Instruction will include review of contribution of each modality to case management with particular attention to radiation physics and radiation biology to ensure patient safety and appropriate systems-based practice.

In addition to neuroendovascular procedures, the latter will include direct participation in rounds structured for post-operative patient care and didactic as well as working clinical conferences. The fellow will present timely, accurate pre- and post-procedure documentation that includes operative report and separate interpretive report, daily documentation of patient’s course, discharge physical examination and neurological status, inpatient medical therapies and reconciliation of physician order entries. The fellow will actively participate in daily inpatient rounds with neuroendovascular faculty on all neuroendovascular inpatients and effectively communicate neuroendovascular specific management plans with other participating services. The fellow will participate in continuity of ambulatory care of patients following discharge from Westchester Medical Center, including communication of discharge neurologic status, interventions during inpatient status, findings on serial imaging surveillance and medication reconciliation with primary care providers and referring physicians. The fellow will participate in regularly scheduled, supervised inpatient and ambulatory neuroendovascular-specific consultations with assigned attending faculty as well as related didactic/working conferences. Ambulatory assignments will be coordinated with protected time allowing scholarship activity. The fellow will complete at least one research project with peer-reviewed publication per year.

Year 2

In addition to year 1 responsibilities, the fellow will gain greater independence and responsibility for these functions with demonstrated, documented proficiency and experience during his/her fellowship. The fellow will review, interpret and integrate into patient management all pertinent diagnostic studies under the graduated supervision of the attending faculty and with interdisciplinary collaboration and consultation. The fellow will perform diagnostic and therapeutic advanced endovascular surgical neuroradiology procedures under the direct supervision of the attending with requisite post-procedure care that includes interdisciplinary collaboration. All procedures performed by the fellow will reflect demonstrated skills and competencies identified by participating attending. The case-based training structure of the ESN fellowship and recurring one-to-one attending supervision will guide competency-based assignment of fellow’s role and responsibilities during interventional procedures.

Daily Morning Report/Rounds: Designed to improve faculty-fellow-resident interaction and educational opportunities, facilitate the management and transfer of patient care information, and allow a forum for the discussion of patient care and management. An organized sign out process will utilize the presence of post-call neurosurgical team members, physician assistant, nurse practitioners, and a digital reviewer allowing access to previous radiographic studies obtained over the previous 24-hour period.

Weekly Neurosurgical Conference: Designed to enhance the educational opportunities to learn from different neurosurgical specialties from both academic and community settings regarding the management of neurovascular pathologies.

Weekly Reperfusion Conference: Designed to discuss IV tPA and mechanical thrombectomy cases for that week as well as any other stroke/ ICH/ SAH/ Carotid stenting/ CEA cases that require multidisciplinary input from vascular, NIR and neuroradiology.

Monthly Morbidity and Mortality Conference: Critically assess all complications and mortality on the Endovascular Surgical Service with input from specialties involved in the care of those patients.

Monthly Stroke Quality Meeting: By attending this meeting, the fellow learns administrative, quality and performance improvement tools necessary to lead a multidisciplinary Endovascular Stroke Surgical Service.

Monthly Joint Cerebrovascular Conference: Designed as a multidisciplinary conference where participating departments provide didactics and case discussions that cover all aspects of cerebrovascular topics and clinical practice guidelines.

Bi-Monthly Neuroendovascular Didactics: Rotating didactics and case review focusing on index topics in pathophysiology of cerebrovascular disease as well as the medical and surgical management. The fellow is expected to present a one-hour presentation twice a month with the supervision of the core neuroendovascular faculty

Quarterly Neurovascular Journal Club: Held commonly in a multidisciplinary forum with resident trainees from both Neurosurgery and Neurology with a focus on the critical review of current and classic publications in neurovascular surgery.