Neurocritical Care Fellowship - UCLA

Background

The UCLA Neurocritical Care Fellowship is a nationally recognized clinical training program in Neurocritical care. The program is a 2 year program. This is one of a few recognized training programs in the United States and has been in existence since 1999. The Neurocritical Care Society and the American Academy of Neurology Section of Emergency and Critical Care Neurology have recently recognized UCLA as a premier example training program which encompasses and exceeds all fellowship requirements in neurocritical care. We have trained many fellows who have gone on to academic and clinical careers since our inception. UCLA is one of the first UCNS Accredited Fellowship Programs in the US.

How UCLA is Unique:

The UCLA program is unique in several respects.

The program features an advanced ICU based research environment.

Critical Care education is integrated across disciplines and there is a large number of multidisciplinary faculty in critical care including medicine, anesthesia, surgery, pediatrics, and neuroscience who teach and mentor the fellows.

Team Complement:

The current program consists of four fellows, two ICU NPS, and 10 board certified attending physicians including: Dr. Paul Vespa, Dr. Manuel Buitrago Blanco, Dr. Yince Loh, Dr. Robert Shpiner, Dr. Joseph Meltzer, Dr. Rajan Saggar, Dr. Anahat Dhillon, Dr. Tisha Wang, Dr. David Boldt, Dr. Vadim Gudzenko. We also have a multidisciplinary team of dedicated Pharm Ds, Respiratory Technologists, and Nursing leaders. The fellow is the main ICU doctor for all of the patients in the Neuro-ICU and has primary responsibility for the treatment of these patients. Neurology and Neurosurgery residents rotate in the ICU on a monthly basis.

In addition to the clinical team, the research team consists of basic science research faculty members (PhDs - Dr. David Hovda, Dr. David McArthur, Dr. Thomas Glenn, Dr. Benjamin Ellingson, Dr. Matthew Wright, Dr. Martin Monti, Dr. Jack Van Horn), lab techs, a senior nurse research coordinator (Ms. Courtney Real) and two seniour lab assistants/researchers. The research team members are actively engaged in mentoring the fellows in experimental design, experimental methods, statistical training, and grantsmanship activities.

Fellowship Candidates:

The candidates must be ABMS board eligible or certified in Neurology, Neurosurgery, Internal Medicine, Anesthesiology or other critical care ABMS specialty, and are independently licensed or fible for licensure through the state of California. The fellowship consists of a 2 year period of time of dedicated clinical training and research.

UCLA is the NeuroICU of the Future:

The UCLA Neuro-ICU is a state of the art intensive care unit that is leading the world in patient care, technology, and research. We have moved into our new, dedicated 24 bed ICU in the new Ronald Reagan UCLA Medical Center. We have a total of 106 ICU beds at UCLA and a team of 40 intensivists house wide. We average 2000 admissions/year. UCLA NeuroICU fellows are exposed to a large volume of clinical material and experience. All neurological emergencies and critical care cases are admitted to the ICU with an equal balance of stroke, trauma, neuromuscular disease, status epilepticus, subarachnoid hemorrhage, intracerebral hemorrhage, brain tumors, myasathenia gravis, Guillain-Barre syndrome, cardiac arrest, and spinal cord injury/surgery admitted each year. We triage and treat every cardiac arrest patient in any ICU at UCLA.

UCLA Neurocritical Care is a leader in Research:

Basic and clinical science research are strongly supported through NIH funded research programs in brain trauma, intracerebral hemorrhage, and stroke. Fellows are expected to conduct a closely mentored research project, publish abstracts and full-length manuscripts and participate in ongoing research efforts. The ICU environment is strongly oriented towards innovation and cutting edge approaches and research. We are funded by several sources including an NIH Program Project Grant, NIH SPROTRIAS grant, NIH K08 grant, NOH RO1 grants, Department of Defense, The State of California Neurotrauma Initiative Grant and several industry sponsored trials. Each fellow participates in the 2 year NIH K 30 Clinical Translational Research Program that is offered at UCLA in conjunction with the NIH. UCLA features the Clinical and Translational Science Institute (https://ctsi.ucla.edu/) which facilitates interdisciplinary research across much of the distributed UCLA campus.

UCLA Neurocritical Care is internationally acclaimed:

The UCLA Neurocritical Care program is well regarded among neurointensivists. We have trained over a dozen graduates. These graduates of the program have matriculated to University Faculty Appointments in Neurocritical Care. Dr. Vespa is a Fellow of the American College of Critical Care Medicine, a founding member of the board of directors of the Neurocritical Care Society, and an Editorial Board Member of Critical Care Medicine, Neurocritical Care, Surgical Neurology, and The International Journal of Critical Care. Dr. Vespa is a member of the UCNS Board of Directors and was named Chair of the UCNS in August 2009. He is also a guest editor for several additional journals including Critical Care, Current Opinion in Critical Care, Journal of Cerebral Blood Flow and Metabolism, Neurology, Annals of Neurology. Dr. Vespa has served as a faculty educator for numerous national and international conferences.

Goals and Expectations for Fellows:

Fellows are very cherished in our program and one of the fundamental reasons for the existence of our program. The expectations for fellows are that each fellow matriculate into a premier position as a clinician-scientist and be positioned to make a significant contribution to the field. The job market continues to increase for neurointensivists and our candidates are encouraged to seek outstanding career opportunities. We expect fellows to pass the UCNS Neurocritical Care Board Examination within 1 year of completion of the fellowship training and be certified in Neurocritical Care. Fellows average 56 hours/week of work, well below the 80 hour work limit.

Benefits:

The pay scale and full benefits package are superior with starting salary at the PGY appropriate level (PGY 5 for year 1, PGY6 for year 2) according to the UCLA PGY pay scale and cost of living adjustment for Los Angeles. The salary is usually quite competitive and comfortable. In addition, there is an annual book allowance of $1000.00 and an annual travel allowance to one major national meeting. There is 2 weeks paid vacation.

Recommended 1 week visitor rotation at UCLA:

Since the selection of fellowship is a significant decision, we recommend that serious candidates spend a 1 week elective rotation with us at UCLA. This is an observer rotation that permits the fellow to familiarize one with our program.

Neurocritical Care Fellowship Curriculum and Core Schedule

5.

Call Schedule: The schedule consists of a one week on and one week off program. This typically will require fellows to be in house from 6AM until 8 AM the next morning during the long call weeks. A detailed on call schedule is available upon request.

Central Mission: The fellow will be trained as neurointensivists/critical care neurologists under a pathway that will enable them to matriculate as academic neurointensivists with specialized training and expertise in critical care.

The neurointensivist is the primary attending for on all ICU patients. The fellow serves as the main ICU physician for the patient and is responsible for treatment decisions as a "primary team" member. The nurse practitioners or neurology residents function as the unit resident. The fellowship is structured to not displace any resident from completing the ICU portion of their training, but to provide service for an unmet patient care need. The fellowship is balanced towards providing the fellow the opportunity to be hands-on and gain first-hand experience in treating critically ill patients, while providing time for education, reading and thoughtful contemplation. An integrated approach where the neurology and neurosurgery residents, fellows and attendings are on one team is our approach. Neurosurgery residents benefit from the interaction with the fellows in terms of learning classical neurology principles in the areas of stroke, seizures, coma etc. Fellows benefit from interaction with senior neurosurgery residents who provide surgical knowledge and expertise.

Academic Training:

Reading List:

Educational Curriculum for the UCLA ICU Fellow:

The fellowship program directors of the Neurocritical Care Society under the auspices of the UCNS have formulated a suggested curriculum for all programs in neurocritical care. Please see the UCNS website for complete details. We meet and exceed the suggested curriculum guidelines. The following serves to outline the core concepts.

Core Competencies of Fellows and Areas of Study/Training

Documentation Logs: Each fellow will keep a log of all patients admitted to the ICU with dates, diagnoses, complications. A procedure log will be kept and will include the patient's name, type of procedure, and complications. Logs will be surveyed every 3 months. Fellows will need to perform a defined number of procedures in order to complete the fellowship satisfactorily.

Yearly attendance at one of these meetings: NCS, SCCM, AHA International Stroke Conference or AAN annual meetings. The costs of travel and registration for the meeting will be paid for fellows who are presenting novel research in the form of a scientific abstract.