The State of Telestroke Education in Vascular Neurology Fellowships: Current Practices and Future Directions
Nikita Chhabra1, David Liebeskind2, Amy Guzik3, Darin Zahuranec1, Brian Stamm1, Erika Weil1, Margaret McDermott1, Robert Miller1, Devin Brown1
1University of Michigan, 2Neurovascular Imaging Research Core at UCLA, 3Wake Forest University Baptist Medical Center
Objective:
To describe current telestroke education practices in vascular neurology fellowships to identify variability, barriers, and opportunities for developing standardized training guidelines.
Background:
Telestroke has become a vital aspect of acute stroke care, yet its incorporation into vascular neurology fellowship training remains unclear. As current ACGME program requirements do not standardize telestroke training for vascular neurology fellows, understanding current practices in telestroke education is critical to guiding the development of standardized educational curricula.
Design/Methods:
We surveyed ACGME-accredited vascular neurology fellowship program directors using an anonymous online survey. The survey evaluated institutional practices and educational structures related to telestroke, including supervision models, perceived adequacy of training, and barriers to fellow engagement. Descriptive statistics were used.
Results:
Sixty-seven/115 (58%) program directors responded. Nearly all (61/67) reported that their institution provided telestroke services, with 49.3% providing both video and telephone consults, 28.4% providing video consults only, and 13.4% providing telephone consults only. At most programs (62/67, 93%), fellows participated in at least 1 telestroke-related experience, including video (65.7%) and phone (50.7%) consultations, orientation training in telestroke skills (43.3%), didactics (22.4%), and simulation (10.4%). Supervision models included fellow shadowing (40.3%) and fellow-led encounters with (53.7%) and without (28.4%) direct observation by the attending physician. The majority of programs (64.2%) felt training adequately prepared fellows for independent telestroke practice, while 9.0% disagreed and 16.4% were unsure. Barriers to increased fellow participation in telestroke included direct supervision requirements (23.9%), credentialing challenges (20.9%), and need for program letters of agreement with spoke hospitals (17.9%). Programs reported additional funding (26.9%) and credentialing staff support (25.4%) as top resources that would help expand telestroke exposure for fellows.
Conclusions:
Telestroke exposure for vascular neurology fellows is widespread yet heterogeneous across programs. These findings support the need for standardization of telestroke curricula within vascular neurology fellowships.
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