Background: The Society of Hospital Medicine considers stroke care a core competency in hospital medicine. It also challenges hospitalists to lead, coordinate, and participate in multidisciplinary efforts to improve stroke care within their organizations. Hospitalist trainees will be better positioned to accomplish this if they have a broad exposure to the continuum of stroke care and an in-depth understanding of stroke systems.
Purpose: The “Stroke Systems of Care Curriculum” was designed to provide hospitalist trainees with a systems-based immersion experience, with an emphasis on interprofessional teamwork, transitions of care, and quality reporting and finance in the stroke system.
Description: Hospitalist Training Program residents at our institution traditionally complete two 4-week inpatient Consult/Neuro rotations, in which they become certified in the National Institutes of Health Stroke Scale, respond to stroke alerts alongside neurohospitalists, and provide medical consultation on stroke patients. The “Stroke Systems of Care Curriculum” introduces an ambulatory week into their third year, allowing residents to follow stroke patients through the entire “chain of survival,” beginning with the mobilization of emergency medical services (EMS) and through their rehabilitation and post-discharge follow-up. The residents attend a ride-along with the local fire and rescue department, shadow physical medicine and rehabilitation physicians and therapists on an acute rehabilitation unit, and participate in stroke clinics, which may include group clinic sessions or a combined Patent Foramen Ovale (PFO) Clinic run by neurology and cardiology. Residents also attend a Stroke Council meeting, where they learn about performance metrics, telestroke services, and community outreach activities for stroke. Ten residents participated in the curriculum during academic year 2014-2015. On a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), the residents reported improvement in their ability to “identify the quality metrics that hospitals report for stroke patients” (2.5 to 4.6), “understand the degree of interprofessional teamwork required at a Comprehensive Stroke Center” (3.2 to 4.6), “understand the role of EMS in pre-hospital stroke care” (2.4 to 4.0), and “understand the services that acute rehab facilities provide to post-stroke patients” (2.5 to 4.8). They currently rate the overall effectiveness of the curriculum at 4.6, agreeing that “the Stroke Systems of Care Curriculum is a valuable educational experience.”
Conclusions: This innovative curriculum offers hospitalist residents a comprehensive exposure to stroke systems which, in combination with their inpatient neurology training, will further prepare them to improve the quality of stroke care in the future.