Faculty supervisors:
Dr. Randolph Marshall and rotating attendings
PGY-2 Rotation
Description:
The Stroke service is a busy teaching service that cares for patients with neurovascular conditions of all types, including ischemic stroke, hemorrhagic stroke, arteriovenous malformations, and others. Mastering the care of these patients on the floor, including an awareness of stroke related complications, will allow the PGY-2 resident to effectively perform consultations and act as a supervising resident in the PGY-3 year. The stroke service receives patients from the emergency room, the neuro-critical care unit, from outside referring institutions and from the faculty practice neurologists. Junior residents are carefully supervised by the attending faculty, stroke fellows (PGY-5 and PGY-6, and senior residents (PGY-3 and PGY-4), in all aspects of their work.
Evaluation:
Performance evaluations are completed by faculty supervisors from the Stroke Division using the MedHub system. Verbal feedback is given to residents at the mid-point and end of the faculty’s rotation by the respective faculty and fellow. Additional feedback is collected from medical students, nurse practitioners, and support staff.
Specific Objectives:
Patient Care
To develop competence in obtaining the neurological history and performing the neurological examination, including the national institutes of health stroke scale (NIHSS).
To perform a focused neurological examination on the patient with neurological deficits due to stroke.
To synthesize patient history, lesion localization, stroke subtype, and neuro-imaging information into a cohesive formulation and plan for clinical management.
To admit patients to the inpatient service and become the primary neurologist for the patients and families under their care.
To develop an awareness of the medical and neurosurgical approaches to stroke.
To manage acute stroke therapeutics in the floor and step down setting, including the use of anti-platelet agents, care after thrombolytic therapy, and management of blood pressure.
To evaluate, prevent, and manage the medical complications of cerebrovascular disease that arise in hospitalized patients, under the supervision of senior residents, fellows and attending neurologists, and with consultation from medical specialists.
To participate in the discharge planning for patients with stroke, with an understanding of patient centered factors that influence discharge location.
Medical Knowledge
To recognize the symptoms and signs of common stroke conditions.
To become familiar with the neurological complications of acute stroke and develop a diagnostic and management strategy for neurological deterioration in patients with stroke.
To recognize the indications and contra-indications for acute stroke therapy including thrombolytics and thrombectomy.
To become familiar with vascular neuroanatomy, and to use this knowledge as the basis for neuroanatomical localization of neurological deficits.
To acquire knowledge of the pathophysiology, vascular anatomy and epidemiology of stroke.
To learn the indications for carotid Doppler, transcranial Doppler and echocardiography, CT, CTA, magnetic resonance imaging,multi-modality brain imaging and catheter angiography for stroke diagnosis and management.
To develop skill in recognizing the radiographic appearance of acute ischemic and hemorrhagic stroke.
Interpersonal Skills and Communication
To interact and communicate effectively and compassionately with stroke patients and their family members in a professional, ethical and culturally-sensitive manner.
To develop skill in communicating with patients who have aphasia and other cognitive impairments related to stroke.
To develop and improve the interpersonal and communication skills, both written and oral, necessary to (i) transmit an accurate neurological history and exam to other members of the stroke service(including the NIHSS), (ii) present cases on rounds and in conferences, and (iii) to provide competent counseling to patients and families.
To maintain up-to-date electronic documentation of history, neurological examination, laboratory data and hospital course of patients with stroke and related conditions.
To communicate information and educate about stroke signs and symptoms, risk factors, recovery and post-stroke care to patients and their families.
Professionalism
To demonstrate the professional habits of punctuality, responsibility, honesty, integrity, compassion, and cultural sensitivity in responding to requests for neurological consultation.
To show appropriate respect for and cultural sensitivity to patients and their families
To demonstrate an appreciation for end-of-life care and issues regarding provision or withholding of care
To be compliant with ethical and legal standards, work hours guidelines and the requirements of patient confidentiality.
Systems-Based Practice
To demonstrate the ability to function well in a service that interacts with other consulting medical services.
To develop awareness of hospital protocols, practice guidelines and other resources that may enhance patient care.
To become familiar with discharge planning for patients with acute stroke, including recommendations for in-patient and out-patient rehabilitation, visiting nursing services, anticoagulation and stroke recurrence prevention.
Practice-Based Learning and Improvement
To begin to use the medical literature, including electronic databases and practice guidelines, in the diagnosis and management of stroke.
To become familiar with hospital information systems in the evaluation and treatment of patients with cerebrovascular disease.
To become familiar with the clinical trials and other evidence that has shaped the current standard of treatment for patients with stroke.
PGY-3 and PGY-4 Rotations
Description:
Senior PGY-3 or -4 residents rotate on the Neurovascular [“Stroke”] Service at Columbia University Medical Center and serve as team leaders under the supervision and with frequent consultation from the neurovascular fellows and stroke attending neurologists. This supervisory role becomes an important first step towards the transition to the independent practice of neurology.
Evaluation:
Performance evaluations are completed by faculty supervisors using the Medhub system. Verbal feedback is given to residents at the mid-point and end of the faculty’s rotation by the respective faculty and fellow, and additional feedback is collected from medical students, nurse practitioners, and support staff.
Performance written evaluations are provided by the stroke attending who receive the resident’s presentations using the electronic Medhub system. Verbal feedback is provided at the end of the rotation by supervising faculty.
Specific Objectives:
Patient Care
To supervise the anesthesia rotating residents, junior PGY-2 residents and medical students in the provision of basic, advanced, comprehensive, and multidisciplinary care to patients with cerebrovascular disease.
To perform complete, problem-oriented neurological histories and examinations in patients with stroke.
To participate fully in the discharge planning for patients with stroke, including attending daily rounds with the social workers, nurse practitioners, occupational and physical therapists and the Chief of Inpatient Services.
Medical Knowledge
To recognize the symptoms and signs common stroke conditions, including all the major stroke syndromes.
To be able to diagnose and manage for neurological deterioration in patients with stroke.
To expand and consolidate knowledge of vascular neuroanatomy and become adept at the neuroanatomical localization of neurological deficits.
To consolidate knowledge of the pathophysiology and vascular neuroanatomy of stroke.
To become knowledgeable regarding the epidemiology of stroke and the medical management for primary and secondary stroke prevention.
To become knowledgeable with the indications for diagnostic testing for stroke diagnosis, implementing evidence-based medicine guidelines and an improved understanding of health care economics.
To master the recognition the radiographic appearance of acute ischemic and hemorrhagic stroke.
Interpersonal Skills and Communication
To interact and communicate effectively and compassionately with stroke patients and their family members in a professional, ethical and culturally-sensitive manner.
To enhance communication abilities with patients who have aphasia and other cognitive impairments related to stroke.
To improve the interpersonal and communication skills, both written and oral, necessary to (i) transmit an accurate neurological history and exam to other members of the stroke service, as well as with faculty and staff on other medical services in providing and requesting consultations, (ii) present cases on rounds and in conferences, and (iii) to provide competent counseling to patients and families.
To educate patients and their families regarding stroke recovery, prognosis, quality of life, secondary stroke prevention and post-stroke care.
Professionalism
To demonstrate leadership in supervising, educating and mentoring junior neurological and anesthesia residents and medical students in the care of patients with stroke.
In caring for patients with stroke and interacting with members of the health care team, senior residents will demonstrate the many attributes of professionalism, including concern and respect for others, honesty and integrity, confidentiality, sensitivity to ethical issues, and awareness of safety.
To develop leadership skills needed for managing a team of health care providers, including time management, prioritization of tasks, allocation of personnel and hospital resources, and efficient communication.
To show appropriate respect for and cultural sensitivity to patients and their families
To become fully knowledgeable regarding end-of-life care, palliative and hospice care for patients with severe stroke.
To be compliant with ethical and legal standards, work hours guidelines and the requirements of patient confidentiality.
Systems-Based Practice
To demonstrate leadership and supervisory abilities in managing a team of junior residents and medical students that interacts with many other disciplines and services, both in-hospital and community-based resources, in the care of patients with stroke.
To direct discharge planning for patients with acute stroke, including recommendations for in-patient and out-patient rehabilitation, visiting nursing services, anticoagulation and stroke recurrence prevention.
Practice-Based Learning and Improvement
To demonstrate familiarity with the medical literature, including the rating scales for stroke and the seminal clinical trials of treatment for stroke.
To apply the neurological literature to the care of patients with stroke as it relates to disease prevention, diagnostic testing and therapeutic options.
To participate in Morbidity & Mortality conference by providing census data for the stroke service and leading a formal discussion of outcomes, complications, and protocols, using the medical literature and practice guidelines to improve care.
Updated 7/21/25