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Internal Medicine Perspective on Neurocritical Care Training By Firas Abdulmajeed, MB. ChB, Kim, Jennifer Ahjin,M.D., Ph.D., Bart R. Nathan, MD, FNCS 1) How did you learn about neurocritical care as a subspecialty? As a resident, I was always fascinated with critical care medicine but never knew about neurocritical care. I was lucky enough to know that neurocritical care fellowship exists because I interacted with neurointensivists at my first job out of residency. Also, two very close friends of mine started their neurocritical care fellowships and they introduced me to what neurointensivists do on daily basis. The whole idea of doing critical care fellowship and challenging myself with a relatively new range of pathophysiologic diseases was fascinating, so I decided to attend my first NCS meeting in 2015 and apply for the NCC fellowship. 2) Why did you decide to pursue neurocritical care fellowship as part of your training? “Everyone freaks out when patients crash unless you are an intensivist; we thrive on stress because I believe we are adrenaline junkies,” as stated by one of my friends who is a neurointensivist. I do agree with him. I believe we pursue education in critical care in general because we thrive on the mentally and physically challenging cases, and when I worked as a hospitalist I was so comfortable managing crashing patients but it was always a challenge when taking care of patients coming out of the neuro ICU. So, I decided that I wanted to conquer this field and enjoy the life-long educational journey. Moreover, knowing how relatively new the field is meant that it will always continue to grow and I will have the opportunity to grow with it. It also provided more research potential and a wider range of possible jobs that I could apply for when compared to general critical care medicine. 3) Given your non-neurology/neurosurgery background, did you find that there were particular challenges you faced during fellowship compared to your colleagues that trained in those fields for residency? Of course I faced some challenges ranging from learning a new system, neuro imaging, neurosurgical interventions, getting the appropriate training to lead stroke code teams when covering stroke codes, to gaining the trust of neurology and neurosurgery teams. I also had to adjust to the cuts in salary going from an attending position one to a fellow level salary, and finally, determining if I would be able to find a good academic job after graduating my fellowship. I was lucky enough that my fellowship program is familiar with training fellows from an internal medicine background, so my program director (Dr. Barnett Nathan) was very helpful in shaping my early rotations in a way that helped me overcome many of these challenges early on. 4) Do you think that you think that trainees in other specialties like internal medicine and emergency medicine have adequate exposure to neurocritical care? “I never knew that it’s a subspecialty that we can do.” — Emergency medicine resident “We never knew that we can do a rotation in the neuro ICU.” — Internal medicine resident Not really. Under my fellowship director’s guidance, I started looking into this issue two months into my fellowship. I discovered that not only is there a huge increase in the demand for neurointensivists as more institutes are heading toward becoming primary or even comprehensive stroke centers, but there is also a plateau in the number of fellows that join this fellowship every year. With the encouragement of my fellowship director, we decided to conduct a survey of internal medicine residents on their exposure to neurocritical care. We asked some simple questions to internal medicine (IM) residents across the U.S. (distributed through program directors and another set of questions to neurocritical care fellowship Firas Abdulmajeed, MB. ChB Kim, Jennifer Ahjin, M.D., Ph.D. Bart R. Nathan, MD, FNCS 28


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