Research Training Goals
Completion of coursework in clinical research methodology including biostatistics, epidemiology, population genetics, ethics, clinical trial design, outcome analysis and grant writing. Additional course work will depend upon direction in clinical research (e.g., master’s in molecular genetics, master’s in epidemiology and biostatistics).
Hands-on experience in ongoing clinical research projects including medical record abstraction, stroke phenotyping, radiographic film review and classification, outcome analyses, handling and storage of biological materials including DNA, RNA and proteins, HIPAA compliance, writing of informed consents and protocols, participation in conference calls and meetings for large number of ongoing clinical trials and studies directed by our stroke center, data analysis and critique and preparation of manuscripts.
In addition, fellows will have the opportunity to collaborate with a number of very well-funded and active laboratories involving genomic and protein expression of stroke in animals and humans, genotypic analysis, models of intracerebral hemorrhage and ischemic stroke, models of arterial vasospasm, ultrasound treatment of arterial clot and magnetic resonance imaging.
- Active participation in weekly cerebrovascular research meetings.
- Participation in conference calls and meetings related to ongoing clinical trials and genetic studies.
- Submission of at least one first-author manuscripts by end of first year.
- Development of independent research idea by end of first year.
- Development of K-23 or National Fellowship Award specific aims by end of second year to be submitted during their first year of faculty at their new institution. Other grant submissions to foundations, AHA and the AAN are highly encouraged. Another option during the first two years is to become principal investigator of NINDS-funded study as the site PI.
Participation in Ongoing Research
In the first week of arrival, the fellows will meet with Dawn Kleindorfer, MD, for an overview of all ongoing research. This will include a discussion of all clinical trials, clinical research studies and basic science projects.
Within the first month, the fellows will meet for one hour with each training faculty to get a very in-depth review of ongoing research projects of each faculty trainer in the program.
In addition, the fellows will spend one hour with the lead study coordinator from every ongoing clinical research study. This will be to familiarize themselves with their colleagues as well as to understand the protocols. The fellows will receive a detailed protocol for all studies that will be placed into hand-held device (Palm or Windows-based system).
One of the main projects that the fellows will work on every week are the “Hemorrhagic and Ischemic Strokes among Blacks and Whites” and the “Genetic and Environmental Risk Factors for Hemorrhagic Stroke” studies. They will receive detailed training in reviewing these data forms that includes imaging reports and actual brain images in selected patients.
After this training, they will review and complete case report forms that contain a large amount of clinical information including testing as well the imaging reports and images. They will then phenotype potential cases that have been abstracted by the study nurses. This provides the fellows with an experience of a large number of stroke cases and helps them learn the key role of phenotyping in epidemiologic and genetic studies.
Stroke fellows will also participate in the large number of ongoing clinical stroke trials. This includes the evaluation and treatment of patients in our entire regional hospital system since at least some of the ongoing clinical trials and research studies are active at all area hospitals.
In addition, fellows are required to attend the weekly and monthly conferences regarding the studies that are coordinated by the University of Cincinnati.
This provides them with great practical experience of how such studies are managed as well as a large network of potential contacts for future projects and their career.
By the midpoint of the first year, fellows are encouraged to identify potential research areas of long term interest. By the end of the first year, the fellows are strongly encouraged to develop a grant proposal to develop this research area. This is often done in the context of a grant writing course.
By the end of the second year (if on the two-year track), the fellow is expected to have a national fellowship or K-23 proposal project chosen and specific aims written. Another option is be to be principal investigator at our site of a NINDS-funded study. Realistically, K-23 submissions often occur in the first half of the third year.
Clinical Training Goals
- The fellow's direct involvement with the evaluation and treatment of 35-50 ischemic stroke patients per year who receive intravenous tPA or who are treated as part of a research protocol within three hours of stroke onset; indirect involvement with 300 patients per year who are treated with recanalization therapy.
- Participation in the evaluation and treatment of an additional 100 stroke patients per year in the emergency departments who are not treated with tPA.
- Training in Transcranial Doppler techniques and interpretation.
- Active participation in weekly clinical cerebrovascular conference in which patients with the entire range of medical and surgical cerebrovascular problems are presented and discussed in a multidisciplinary setting. Participants include neurologists, neurosurgeons, neuro-interventionalists, emergency physicians, neuro-intensivists,neuro-ophthamologists, research nurses, residents and medical students.
- Management and diagnosis of stroke patients on the UC Medical Center inpatient service, including ordering and interpreting appropriate diagnostic tests, prevention of medical complications and participation in the patient’s rehabilitation plan.
- Evaluation and treatment of stroke patients in the various outpatient settings, including the UC Medical Center practice, and Daniel Drake Center for Post-Acute Care, among others, in conjunction with stroke attendings. This will include management of anti-thrombotic medications based on the latest scientific literature, diagnostic testing and enrolling patients in prevention clinical trials.
Graduate-Level Coursework in Clinical Research
All formal coursework will be taken through the UC Department of Environmental Health's Division of Epidemiology and Biostatistics. In addition, a number of excellent clinical research seminars are also given at Cincinnati Children’s Hospital Medical Center.
Vascular neurology fellowship training includes, at a minimum, the following coursework:
- Introduction to Biostatistics (fall quarter)
- Introduction to Epidemiology (winter quarter)
- Either Clinical Trial Design or Management of Field Studies in Epidemiology (spring quarter) in a two-year cycle
- Ethics in Research
- Grant-Writing Course in Winter Quarter
Fellows who stay a second year are encouraged to take advanced level courses in epidemiology and biostatistics, clinical trial design, human genetics and outcomes-analysis depending upon their research focus. The second year schedule is more flexible depending on the focus of the fellow.
Stroke Fellow Daily Schedule (does not include Stroke Call)