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Stroke Medicine
Pros
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The work is flexible and could include acute stroke care, rehabilitation, prevention, or any combination of these
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Provides the satisfaction of working in a multi-disciplinary team (MDT)
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Working with other specialties such as Neurosurgery, Vascular, Obs and Gyn and Neuroradiology intervention team.
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Provides plenty of opportunity for research and clinical trials
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Vibrant specialty with new developments in treatment like thrombolysis and thrombectomy
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Stroke medicine Consultants can have sessions in other specialties like geriatrics, neurology, acute medicine or general medicine
Cons
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Can be very busy at times
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Can be emotionally draining
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Lots of national targets to meet with continuous auditing
Article Author
Dr Cosmas Anazodo is a Recently Appointed Consultants' Committee Member.
"Seeing a patient with significant limb weakness improve in front of your eyes after successful reperfusion intervention is very fulfilling."
How is Stroke Medicine different and why did I choose it?
Stroke medicine combines the diagnostic skills of neurology and the excitement of acute medicine with the satisfaction of working within a skilled diverse MDT. Seeing a patient with significant limb weakness improve in front of your eyes after successful reperfusion intervention is very fulfilling. Stroke medicine is a rapidly developing specialty and provides plenty of opportunities for research.
My top tips for applications in Stroke Medicine
The most important thing to do is to get a specialty training number in one of the eligible specialties. You will then have a discussion with the training programme director of your parent specialty early and express your interest in doing sub-specialty training in stroke medicine. Attending a stroke thrombolysis course and completing both the Modified Rankin Scale (MRS) and National Institutes of Health Stroke Scale (NIHSS) certifications gives you an advantage while applying for your advanced year in stroke medicine. Having current Good Clinical Practice (GCP) certificate shows your interest in research and will be an advantage.
Day in the Life of a Stroke Medicine Registrar
| 8.30am | 8.45am | Start with coffee and handover of new admissions overnight. |
| 8.45am | 9.00am | Quick meeting with MDT identifying patients for discharge/transfer and plan the day’s work. |
| 9.00am | 10.30am | Ward round in the HASU or Acute Stroke Unit depending on the team. |
| 10.30am | 11.00am | Go to the other wards to review new stroke referrals. |
| 11.00am | 12.00pm | Stroke thrombolysis baton bleep from Accident and Emergency (A&E). Patient reviewed in A&E and transferred to radiology for brain imaging. Thrombolysis initiated in Radiology Department as no contraindications. Patient transferred to Neurointerventional radiology suite as has large vessel occlusion in CT angiogram for thrombectomy. Transferred to theatre recovery then to HASU for close monitoring. |
| 12.00pm | 12.30pm | Lunch break. |
| 12.30pm | 15.00pm | Rapid access neurovascular clinic seeing patients referred with a suspected TIA with consultant support. |
| 15.00pm | 16.00pm | Back to ward to review the thrombolysis patient and catch-up with work form the ward round. Check results and brain imaging of new patients. |
| 16.00pm | 16.30pm | Update relatives of stroke patients and catch-up with other junior team members about any issues in the ward. |
| 16.30pm | 17.00pm | Call colleagues in the Stroke Rehabilitation Unit to handover patients being transferred from the Acute Stroke Unit. |
| 17.00pm | Handover to evening Registrar on patients to be aware and head home. |
Stroke Medicine Definition
Stroke medicine is a specialty which deals with the acute management of stroke, rehabilitation of stroke patients and stroke prevention. The primary purpose of a stroke physician is to contribute to the provision of skilled acute and rehabilitation care to patients with stroke as part of a multi-disciplinary stroke service.
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Stroke medicine is a sub-specialty training programme open to all trainees holding a national training number in a relevant medical specialty, namely geriatric medicine, neurology, rehabilitation medicine, cardiology, clinical pharmacology and therapeutics, general internal medicine or acute internal medicine. Stroke medicine sub-specialty training may take place at any stage after appointment to the specialty training post but it is advisable to go out of programme training (OOPT) in your senior registrar years (ST5 -6). After satisfactory completion of sub-specialty training in stroke medicine, trainees would be eligible to have the sub-specialty of stroke medicine included on their entry into the General Medical Council’s (GMC) Specialist Register, after the award of a Certificate of Completion of Training (CCT) in their parent specialty.
There has been a change in the training programme for the stroke sub-specialty following the new curriculum that came into effect from August 2022 with the aim of producing suitably trained sufficient doctors from the variety of backgrounds who will develop the full range of capabilities across all the stroke medicine and able to manage complex stroke patients on day one as a consultant.
Previously, trainees needed two years of experience related to the stroke medicine curriculum to achieve competencies but with the new curriculum, this has been reduced to a stand-alone dedicated year of training or can be flexibly adopted within the parent specialty curricula. Completing the three years of internal medicine (IMT) stage one training is now one of the entry criteria required to undertake stroke medicine sub-specialty training as trainees are expected to acquire the basic proficiencies required to undertake more dedicated stroke training.
Any trainee from Group 1 parent specialty (those with trainees that completed 3 years of IMT) will be eligible for stroke training but those from Group 2 parent specialty (Trainees not had 3 years of IMT) must complete the equivalent of the IMY – 3 years before being considered eligible for stroke training.
At the end of the stroke training year, the trainee should be able to:
- Manage the care of the acute stroke patients, including hyperacute care and cerebral reperfusion strategies.
- Manage the primary and secondary prevention of stroke and transient ischaemic Attack.
- Manage early and late stroke rehabilitation in hospital and community settings.
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Examples:
- Neurology: 2 Years of FY 3 years IMT(or ACCS – IMT) 5 years of Neurology with GIM and stroke medicine (6 month embedded in Neurology curriculum and 6 month block posting)
- Geriatric Medicine: 2 Years of FY 3 years IMT(or ACCS – IMT) 4.5 years Geriatric medicine with GIM and Stroke medicine (6 month embedded in Geriatrics curriculum and 6 month block posting)
- Acute Internal Medicine: 2 Years of FY 3 years IMT(or ACCS – IMT) 4.5 years Acute Internal Medicine and GIM with stroke ‘specialist skill’ (3 months core stroke in AIM curriculum and 9 months as a ‘specialist skill’)
- General Internal Medicine: 2 Years of FY 3 years IMT(or ACCS – IMT) 3 years Stroke Medicine and GIM training.
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There is currently no Specialty Certificate Examination in Stroke Medicine but trainees will complete the specialty certificate examination in their parent specialty except those on General Internal Medicine pathway.
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Trainees who want to sub-specialise in stroke medicine and be able to enter stroke medicine as sub-specialty in the GMC specialist register should discuss this early in their training with their educational supervisor, TPD, and get approval from the Postgraduate dean, They should have their stroke training done in a centre that is accredited by GMC for stroke training and have experience in all the Capabilities in practice(CiPs) required for higher training in stroke medicine. At the end of the training, the trainee should attend ARCP/Stroke Year Assessment (SYA) to be able to be recommended for addition of stroke sub-specialty into the GMC specialist register following successful completion of the parent specialty.
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There is no mandatory training specific to stroke but there are recommended training which will help the trainee in the course of the stroke training.
- Training in Acute Reperfusion Therapy
- Use of scales and other tools for stroke assessment – ASPECTS, BARTHEL, Modified Rankin Scale, NIHSS
- Good Clinical Practice Certification – for involvement in stroke clinical trials
- Training in Neurovascular brain imaging
- Spasticity and Botulinum toxin injection
