Neurocritical Care Fellowship Curriculum

Clinical Rotations

Neurocritical Care

Core rotations in Neurocritical care:

The majority of the fellowship is spent in core rotations in the Massachusetts General and Brigham and Women’s Hospital NeuroICUs. Each NeuroICU features two teams led by an attending and neurocritical care fellow and consisting of residents from neurology and neurosurgery and advanced practice providers. The MGH NeuroICU is a 22-bed unit, and the BWH NeuroICU is a 20-bed unit.

The core Neurocritical care rotations provide comprehensive training in management of patients with a wide spectrum of severe brain, spine and peripheral nervous system injuries and diseases. These include traumatic brain injury, cerebrovascular diseases, status epilepticus, neuromuscular emergencies, brain tumors, and infectious and autoimmune diseases.

Acute Stroke Neurology (2 weeks/year)

During this rotation, the fellow works closely with the acute stroke attending physician and residents at MGH for acute stroke cases that need to be evaluated for acute intervention. Fellows also receive training in telestroke and telemedicine.

Selectives (4 weeks/year)

Fellows choose from rotations in other ICUs at the two primary hospitals, including medical, surgical cardiac, and cardiac surgical ICUs. Fellows may also opt for procedurally-oriented selectives, including interventional pulmonology, transcranial doppler ultrasound, and EEG reading. During the first year, all fellows use some selective time for hands-on airway training in the operating rooms at Newton-Wellesley Hospital, an academic community center affiliated with MGB.

Surgical Intensive Care Unit (4 weeks)

During the second year, all fellows rotate through the MGH surgical ICUs where they have exposure to both general surgical critical care, and the opportunity to participate in the hospital’s emergency airway team.

Independent Elective Time (10-12 weeks)

Elective time is completely flexible, and used by fellows for additional clinical electives such as those offered during selective blocks, as well as non-ICU clinical electives such as consult services for internal medicine specialties or interventional neuroradiology. Fellows also use this time to pursue academic projects and travel to conferences.

Weekly Conferences

The fellowship features multiple weekly conferences. ICU conferences at each hospital feature journal clubs, M&M presentations, clinical case reviews, and guideline reviews. Each Thursday is a formal fellow didactic conference with invited lecturers on topics ranging from management of common neurological and medical emergencies to strategies for the job search and transitioning to being an attending. The Neurovascular conference at BWH is a joint clinical case conference with vascular and endovascular neurosurgery.

• MGH Neuro ICU Conference (Mondays 3:00 pm)
• Fellow Didactic Conference (Thursdays 2:00 pm)
• BWH Neurovascular Conference (Thursdays at 7:00 am)
• BWH Stroke/ICU Conference (Fridays 1:30 pm)

Formal Procedural Training

During orientation, all fellows receive simulation training in vascular access and code leadership. Early in the first year, fellows have an airway management simulation with opportunity for hands on practice with video laryngoscopy and bronchoscopy. All fellows receive training in point-of-care ultrasound and Advanced Trauma Life Support.

Training in Multimodal Monitoring

• Advanced Intracranial Monitoring (brain tissue oxygenation, cerebral perfusion probe monitoring)
• Intracranial Pressure Monitoring
• Arterial and Central Venous Pressure Monitoring
• Continuous and Quantitative Video EEG
• Noninvasive Cardiac Output Monitoring
• Transcranial Doppler Ultrasound