2 year fellow pathway (neurology background)

• 8 months neurocritical care and stroke service
• 5 months general medical ICU service
• 5 months call-free elective/research time
• 2 months neurotrauma service 
• 2 months anesthesia service

1 year fellow pathway (neurosurgery background)

• 3 months neurocritical care and stroke service
• 4 months general medical ICU service
• 1 month anesthesia
• 1 month surgical ICU service
• 1 month neurointerventional service
• 1 month neurotrauma service

1 year fellow pathway (critical care medicine background)

• 7 months neurocritical care and stroke service
• 2 months neurotrauma service
• 1 month neuroradiology and neurointerventional
• 1 month clinical neurophysiology

Two-year fellows spend eight months total on the neurocritical care and stroke service. The rotations are concentrated at the CPMC Davies campus where the neurocritical care unit and neurointerventional suite is located. As it is a combined service, fellows have the opportunity to manage neurocritically ill patients in the ICU and follow those patients in the step-down transitional unit as well as manage subacute stroke patients on the ward.

While the neurocritical care and stroke service is the primary service managing the patients, rounds are multidisciplinary and also include the pulmonary critical care attending, medicine hospitalist, rotating Dartmouth students or CPMC residents, ICU pharmacist, bedside nurse as well as neurointerventional radiology and neurosurgery.

Due to our extensive telestroke network including both Sutter-affiliated and non-Sutter hospitals, many patients are transferred to CPMC for higher level of care and emergent endovascular or surgical intervention.

At the Davies campus, fellows will be exposed to a variety of primary neurocritical care conditions including intracranial hemorrhage, subarachnoid hemorrhage, ischemic stroke, status epilepticus, meningo-encephalitis, and acute neuromuscular disorders. Procedural skills include interpretation of continuous EEG, transcranial doppler, interpretation of MR, CT and perfusion imaging, management of external ventricular drains and ICP monitoring, and administration of intravenous and intraventricular thrombolysis.

While at the our Van Ness/Geary campus (newly opened in March 2019),  fellows will have the opportunity to manage patients with fulminant liver failure and cerebral edema, neurologic complications from cardiothoracic surgery, anoxic brain injury from cardiac arrest, hypertensive encephalopathy, and other neurologic conditions related to systemic disease.

Two-year fellows typically spend a total of 5 months on the general critical care medicine service at the CPMC Van Ness/Geary campus. The Van Ness/Geary campus is a newly opened 274 bed flagship, LEED certified hospital. It has a 36 bed ICU with specialty care in transplant, advanced cardiac, cardiothoracic, vascular, and pulmonary disease. The ICU rounding team consists of the pulmonary critical care attending, medicine hospitalist, CPMC medicine residents, Dartmouth medical students, ICU pharmacist and beside nurse.

The critical care medicine rotation exposes fellows to a variety of medical conditions including sepsis, acute lung injury, renal failure, cardiac arrest, immunocompromised conditions, GI bleeding, trauma and post-surgical complications. 

Fellows will become proficient in airway and ventilator management and learn critical care procedures such as arterial and central line placement, intubation, bronchoscopy, chest tube placement, lumbar puncture, bedside ultrasound, ECMO management, and pulmonary artery catheterization.    

Two-year fellows spend two months total on anesthesia and learn the basics of airway and ventilator management and become proficient with intubations and line placement. They participate in a variety of surgical cases including neurosurgery, cardiothoracic, transplant as well as more elective surgeries.

Fellows spend 1-2 months at Eden Medical Center in Castro Valley for their neurosurgery and neurotrauma experience.  Eden is a level II trauma center with its own helipad and a hybrid 24 bed intensive care unit comprising of trauma, neurosurgery, and neurocritical care patients.  Dr. Lawrence Dickinson (neurosurgery) is the site director and Dr. David Bonovich (neurocritical care and neurointerventional) is the medical director for the neurointensive care service.

Electives include bedside critical care ultrasound and cardiac echo, transcranial doppler, transplant, surgical and cardiothoracic critical care services, neurointerventional radiology, neurosurgery, clinical neurophysiology, and research. In addition, fellows are encouraged to participate in the CPMC/UCSF clinical research design course. The goal of this two month course is to help fellows design a clinical research study and protocol for IRB submission. There is also opportunity to participate on the Sutter Mills-Peninsula Mobile Stroke Unit, the first of its kind in Northern California. The ambulance is equipped with an onboard CT scanner, point of care labs, CT tech, stroke nurse and vascular neurologist, with the ability to provide IV tPA within minutes in the field and help triage to the appropriate primary or comprehensive stroke center.

1. Monthly neurocritical care/stroke didactics
2. Monthly neurocritical care/stroke journal club
3. Monthly neurovascular/neurointerventional radiology case conference
4. Monthly neuroradiology case conference
5. Monthly neuroscience grand rounds
6. Medical ICU lectures weekly during critical care medicine rotation