Meghana Srinivas, MD

AHA Scientific Sessions 2021
November 13–15, 2021

Session: “Updates in Stroke: Careers & Future Directions in Vascular Neurology”
Drs. Anjail Sharrief, Ashutosh Jadhav, Louise McCullough, Alicia Zhao

This session kickstarted by highlighting the timeline to consider a career path as a neurology trainee and why it is important to do a fellowship. In current times, there is rapid growth in the field of medicine, and with this, there is an increased demand to have specialists, and hence choosing a fellowship is important. The panelists discussed extensively a career in vascular neurology and why we need more vascular neurologists in practice. There was a shocking revelation showing the dearth of vascular neurologists as compared to our counterparts, cardiologists. The ratio of graduating stroke neurologists to that of cardiologists is ~1:10; however, the disease burden is not proportionate. Why is this? A part of this could be attributed to the amount of exposure we get in acute stroke management during our training as residents, making us comfortable to manage these patients and hence 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 poststroke care and management, which is also equally important. They discussed in detail patient care both in acute and in the post-discharge period, emphasizing that a fellowship is important, as it gives you an opportunity for continuity of care even at the community level.

As the panel was comprised of stroke neurologists with similar, yet different backgrounds in the field of vascular neurology, they went into various aspects of stroke care that we can chose from and apply into our practice. Some examples were health equity in stroke patients, stroke in the young, and stroke in women, to name a few. The newly evolving field of telemedicine/telestroke has become an important aspect of our day-to-day practice 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 are no stroke neurologists in the area and this can be made possible with the help of telemedicine to ensure secondary care. Drs. Sharrief 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 into training during your early career and even better if available during fellowship as this can give exposure into various nuances, especially to triage patients and appropriately direct their care.

Career paths after vascular neurology were discussed by Dr. Jadhav. 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 the formula for a successful match, was discussed. Having addressed this, the panelists emphasized the importance of picking a specialty that you are passionate about, as this will eventually make the journey worth it.

Research is introduced to us in one form or another as part of training. The attendees were interested in knowing how to make the most out of this and keep it consistent. Having a research foundation early on in training is important. With the expertise of their training and practice, each of the panelists highlighted what brings this foundation together. The right mentor and environment are of utmost importance when you are a novice. As trainees, we can start by familiarizing ourselves with clinical research methods and clinical trials, interpreting articles and carrying these lessons to further build on in fellowship programs. There are multiple online resources that can help us achieve this; one such example is through AHA, which offers courses on epidemiology.

The moderator asked the panelists about topics that are new and upcoming and that look promising in the field of stroke neurology. Dr. McCullough discussed mobile stroke units and how they are changing the phase of acute stroke management in the pre-hospital setting, with studies currently looking into their cost-effectiveness. They then moved on to discuss the “happening lytic,” TNK, and its future in acute stroke therapy.

The closing discussion was a question we have all asked at some point in our career: What are the ways to ensure a smooth transition after training? Some important takeaway points included looking into the right and adequate support system and resources to support your endeavors and help achieve your goals. At the end of the day, it comes down to understanding your worth, negotiating time and money, and protecting time for your academic interests. The first 3 to 5 years in any setting are very crucial in establishing yourself and knowing how you want to shape your career. Nobody is 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 out a niche for ourselves.