Neurocritical Care Fellowship

Overview

The Neurocritical Care Fellowship Program at Cleveland Clinic is one of the most comprehensive and long-running fellowships in the nation, with a 20-plus year history of training neurointensivists. We have trained fellows with diverse backgrounds ranging from neurology to internal medicine to neurosurgery. Many are now in leadership positions across the country.

Training & experience

Our rigorous training program is accredited by the United Council of Neurological Specialties (UCNS) and graduating fellows will meet all requirements for certification in Neurocritical Care. This fellowship provides a balance of clinical training in a busy 24-bed Neurology/Neurosurgery Intensive Care Unit on Cleveland Clinic’s main campus. Our fellows also train in medical, surgical, trauma and cardiothoracic intensive care units and operating rooms to gain comprehensive exposure to the full diversity of critical care practice and procedures. Fellows are also exposed to a broad spectrum of research opportunities encompassing basic, translational, neuroimaging and clinical approaches.

Our philosophy of training “true” intensivists with a focus in neurointensive care is also reflected by the fact that many of our graduates successfully function in a neuro as well as a medical and surgical intensive care unit setting.

Our team

Fellows work with a dedicated multidisciplinary team of specialists, including:

• All academic neurointensivists, as well as vascular neurologists, neurointerventionalists and vascular neurosurgeons in the Cerebrovascular Center.
• Advanced practice providers.
• Clinical pharmacy specialists.
• Residents from multiple subspecialties (neurology, neurosurgery and emergency medicine).
• Team of research coordinators.

Research

Fellows are paired up with a research mentor and expected to complete at least one primary academic project, presented at a major annual meeting (NCS, SCCM, AHA, etc.) and submitted for publication. Research training is overseen by staff physicians who act as a senior mentor for all fellows. Continuous EEG monitoring is a hallmark of our program and will soon be complemented by expanding options of multimodal monitoring.

Program Details

Curriculum

Our fellowship offers trainees:

• Comprehensive clinical training – Core clinical training is completed in neurocritical care in the Neuro Intensive Care Unit (NICU) and general critical care training in the Surgery ICU, Medical ICU, Cardiac Care Unit as well as Trauma.
• Formal procedural training – Provided in a one-on-one, hands-on environment, procedural training includes:
• Bedside ultrasound.
• Advanced airway management.
• Bronchoscopy.
• TCD ultrasound.
• Critical care echo.
• Critical care EEG.
• Central venous and arterial catheters.
• Thoracentesis.
• Swan Ganz catheter.
• Paracentesis.
• Rich research opportunities – With dedicated weekly research time and ample elective time, fellows complete clinical, epidemiologic, informatics or laboratory-based research.
• Extensive didactic schedule – Extensive experience in noninvasive and invasive monitoring techniques, provided through critical care rotations. Leadership in daily discussions of syllabi materials and weekly NICU school discussions. Bi-monthly journal clubs, neuroscience grand rounds and research seminars provide collegial venues for discussion and debate within the field of neurocritical care.

Rotations

Neurocritical care fellows rotate in two week blocks each month. Each fellow’s schedule is set up one week of day in the NICU and one weeknight float, with in-between elective/research/ICU rotation. Fellows are expected to work 6:30 a.m. – 6:30 p.m. on daytime in the NICU and 6:30 p.m. – 6:30 a.m. for night float rotation.

First Year Fellow

• 6 months in the NICU.
• 2 months in affiliated intensive care unit training – SICU, MICU, CCU, CTICU and Trauma ICU (the amount of time spent in each depends on the fellow’s background and prior exposure).
• 1 month on vascular neurology service.
• 1 month on neuroanesthesia and airway management service.
• 1 month in research.
• 1 month in elective.

Second Year Fellow

• 6 months in the NICU.
• 4 months in elective.
• 2 months in research.

Elective Rotations

• May be personalized for each fellow.
• Previous electives have included critical care EEG, echo lab (training alongside cardiology fellows), transcranial doppler ultrasound, neuro-infectious disease and nephrology.

Weekly Conferences

• Fellow Board Review – Thursday 12 p.m. – 1 p.m. , first and third Thursdays of each month (alternates between neurology and general critical care).
• Stroke Conference – Thursday 7 a.m. – 8 a.m. (case discussion among vascular neurology, neurosurgery, and neuroradiology).
• Neuro ICU Conference – Thursday 1 p.m. – 2 p.m.
• Neurology Grand Rounds – Monday 8 a.m. – 9 a.m.

Call

Fellows have a schedule of on-call responsibilities that is shared with a team of including an advanced practice provider and resident. The overnight on-call fellow is responsible for handling outside hospital phone calls and admissions as well as emergencies related to NICU patients. The fellow serves as first contact for the transfer center and directs patient placement along with proving to provide acute neuro critical care management. They coordinate with the neurosurgical and interventional neurology team on neurosurgical and endovascular intervention evaluations. 

Clinical Facilities

Cleveland Clinic Neurological Institute annually treats the largest combined volume of brain tumor, spinal cord injury, aneurysm, and arteriovenous malformation cases in Northeast Ohio. Patients are treated and fellows are trained in three neuro ICUs, including:

• Level I 10-bed unit on the 2^nd floor of the H building.
• Level I 14-bed unit on the 2^nd floor of the G building.
• Level II 10-bed Neuroscience ICU at Cleveland Clinic Akron General.

Cleveland Clinic Imaging Institute supports NICU patients with:

• 5 and 3.0 Tesla MRI units.
• Spiral CT.
• Portable CT scanner for the ICU.
• Linear accelerator.
• Latest generation Gamma Knife.

The Endovascular Neuroradiology Program operates out of a state-of-the-art neuroangiography suite and the intraoperative hybrid suite. The hybrid suite enables the endovascular neurosurgeons to diagnose and treat complex neurovascular disease in the operating room, endovascularly or surgically, without ever leaving the suite. Cleveland Clinic’s Cerebrovascular Center team serves multiple hospitals in the greater Cleveland area including state-of-the-art neurotrauma center at Cleveland Clinic Akron General with a Level I Trauma Center.

Fellows also receive extensive training in:

• Advanced intracranial monitoring including brain tissue oxygenation.
• Arterial pressure monitoring.
• Bronchoscopy.
• Central venous pressure monitoring, PA catheter.
• Comprehensive ultrasonography for volume status and cardiopulmonary assessment, and vascular access.
• Continuous and quantitative video EEG 24/7.
• Direct and video laryngoscopy and adjunctive airway management tools.
• EMG.
• Evoked potential assessment.
• Intracranial pressure monitoring.
• Noninvasive cardiac output monitoring-pulse contour analysis and pulmonary thermo dilution.
• Hypothermia devices-intravascular catheters and body surface cooling.
• Transcranial doppler ultrasound.
• Telemedicine.

Research

Research opportunities are available throughout our hospital and university network. Prospective applicants are encouraged to form mentored relationships with individual investigators with oversight by program leadership. Each fellow does at least one project per year, from development of a research question all the way through to manuscript production, and is guided through the research process by an identified mentor. The fellow’s progress is reported at monthly research meetings, a forum that provides dialogue and advice from attendees around specific questions that arise during the research process.

Clinical Fellows

Alumni of Cleveland Clinic’s Neurocritical Care Fellowship has experienced great success since graduating from the program, holding positions at prestigious hospitals across the country as:

• Director of Neurocritical Care.
• Director of Neurointensive Care Unit.
• Assistant Professor of Neurology.
• Staff Neurointensivist.
• Staff Neurosurgeon.

2021-2022 Clinical Fellows

Year 2

Adam Bates, MD
Medical School: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Residency: Cleveland Clinic (Metrohealth Medical Center)

Catherine Hassett, DO
Medical School: Lincoln Memorial University, Debusk College of Osteopathic Medicine
Residency: Cleveland Clinic

Year 1

Lawrence Nolan, DO
Medical School: Lake Erie College of Osteopathic Medicine
Residency: Albany Medical Center

Sydney Moseley, MD
Medical School: St. George’s University School of Medicine- Grenada
Residency: Westchester Medical Center

Applications

Cleveland Clinic’s Neurocritical Care Fellowship uses the SF Match Central Application Service (CAS) for document collection. Applicants should submit all materials via CAS (individual application documents no longer need to be sent to our program address) beginning in October, two years prior to anticipated start (July 1). We will consider applications from residents/fellows eligible for licensure in Ohio, including those with H-1 or J-1 visas. Interviews for those selected take place January through May of the year prior to fellowship, with the match occurring in June.

The following materials will be requested of you, by CAS:

• CAS Distribution List (Online Submission).
• Completed CAS application form (On-line Submission).
• USMLE Scores or equivalent score reports.
• ECFMG Certificate (applicable to International Graduates).
• Three (3) letters of reference.
• Curriculum Vitae (CV).

The SF Match CAS instruction manual, available through your SF Match online profile, will provide additional information regarding application requirements and the submission of application documents. Each fellowship's application instructions and requirements differ.

The application deadline is February 15 of each year.

Please contact our fellowship coordinator for specific information:

Natalie Douglass
Education Program Coordinator
9500 Euclid Ave.
Cleveland, Ohio, 44195
DOUGLAN3@ccf.org

Living in Cleveland

Cleveland, an ethnically diverse, mid-sized city located on Lake Erie, features a host of cultural attractions, recreational activities, major sporting events and an exploding culinary scene. Cleveland is home to the second largest theater district in the U.S., a park system featuring 23,700 acres in 18 reservations, and is the birthplace of rock ’n’ roll, home to the Rock ‘n’ Roll Hall of Fame and Museum. Cleveland Clinic is located near the University Circle area, which is the cultural epicenter of Cleveland. This area features Severance Hall and the world-renowned Cleveland Orchestra, the Cleveland Museum of Art, several other museums, and Case Western Reserve University. Downtown Cleveland, home to all major sports venues and an exploding culinary scene, is approximately two miles from Cleveland Clinic’s main campus.

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