The Neurohospitalist Fellowship
The Neurohospitalist fellowship at UCSF is designed to help train the future leaders in academic neurohospitalist medicine. While the fellowship will obviously involve continued education regarding the complex neurologic cases that we see on the inpatient service, there are numerous other goals for our fellows, including: thinking critically about the transition to an academic faculty position; including team management and leadership skills; and trouble-shooting pitfalls; education of residents and medical students; and development of teaching style and formal lectures; and research endeavors, including critical assessment of hospital efficiency and protocols in the care of neurologic patients.
The year generally consists of the following rotations:
2 months as the fellow on our dedicated Neurovascular / Stroke service (including involvement in the acute care of patients with stroke and decisions regarding thrombolytics and endovascular therapies)
7 months rotating on our general neurology ward and neurology consult services at two hospitals, UCSF Moffitt hospital and Zuckerberg SF General Hospital, initially as the fellow working with a neurohospitalist attending and then later in the year as the attending physician (usually 4-5 months as the fellow, 2-3 months as the attending)
2 months of elective time (many options including working on research projects, taking classes in research design offered at UCSF, or additional clinical time learning about areas of interest such as EEG or inpatient EMG/NCS)
1 month of vacation
This is broken down into 2-4 week blocks. The curriculum and electives in particular are usually tailored to the fellow's specific interests, but the fellowship also includes weekly meetings with faculty to review challenging cases, discuss career options and mentorship, and collaborate on research projects.
The Neurohospitalist Fellowship Experience
Our first Neurohospitalist Fellow was Vanja Douglas, MD. Asked to describe his fellowship training experience, Dr. Douglas said, "The clinical training I received during my fellowship was invaluable. In addition to seeing a large number of patients with common inpatient conditions, I gained extensive experience in diagnosing and treating rare neurological diseases referred to UCSF from the rest of Northern California. I also gained an understanding of the issues specific to neurological inpatients, especially with regard to patient safety and quality health care delivery. Through the excellent mentorship of Dr. Josephson, I was also able to develop a clinical research program. This specialized training enabled me to take the next step in my career, joining the faculty at UCSF to dedicate my time to teaching students and residents about neurology and caring for inpatients with neurological disease."
One of his goals during the fellowship was to develop a screening tool to predict which patients are at highest risk for the development of delirium in the hospital so that clinicians can find ways to prevent it. The biggest risk factor for the development of delirium is pre-existing cognitive dysfunction, so he asked "How does one identify patients with cognitive dysfunction if they don't already carry a diagnosis of dementia or mild cognitive impairment?" Dr. Douglas and colleagues analyzed the responses to a large battery of questions asked of caregivers of every patient evaluated at the UCSF Memory and Aging Center. From this large group of questions, four turned out to be most relevant in identifying mild cognitive impairment or dementia, and these were combined into a simple screening tool. If a patient's caregiver endorses two or more of these questions, then the chance of the patient having cognitive dysfunction goes up. Dr. Douglas and his colleagues have used this tool in a follow-up study of patients admitted to the hospital to see if it can help predict those who develop delirium.
How to Apply
We will start accepting applications for the 2022-2023 academic year (that is, fellowship starting in July 2022 thru June 2023) starting from now through December 2020 and will then invite select applicants for interviews in the early part of 2021.
If you would like to apply, please send Dr. Maulik Shah: 1) your up-to-date CV; 2) a personal statement regarding your interest in neurohospitalist medicine and future career goals; and 3) 2-3 letters of recommendation from neurology faculty.
Looking forward to hearing more from you and about your interest in neurohospitalist medicine!
Please send curriculum vitae and a personal statement to Maulik Shah, MD., Director, Neurohospitalist Program, Department of Neurology, UCSF, Box 0114, San Francisco, CA, 94143-0114.