Dr Harinath Chandrashekar, ST7
Brief ‘definition’ of specialty

Stroke medicine is a specialty which deals with the acute management of stroke, rehabilitation of stroke patients and stroke prevention. The primary purpose of a stroke physician is to contribute to the provision of skilled acute and rehabilitation care to patients with stroke as part of a multi-disciplinary stroke service.

Brief run-down training programme content and duration

Stroke medicine is a sub-specialty training programme open to all trainees holding a national training number in a relevant medical specialty, namely geriatric medicine, neurology, rehabilitation medicine, cardiology, clinical pharmacology and therapeutics, general internal medicine or acute internal medicine. Stroke medicine sub-specialty training may take place at any stage after appointment to the specialty training post. After satisfactory completion of sub-specialty training in stroke medicine, trainees would be eligible to have the sub-specialty of stroke medicine included in their entry in the General Medical Council’s (GMC) Specialist Register, after the award of a Certificate of Completion of Training (CCT) in their parent specialty.

Trainees will need two years of experience related to the stroke medicine curriculum to achieve competencies. One year will be spent in stroke-specific posts in the parent specialty and one year will be advanced stroke medicine training which will involve an attachment to a comprehensive stroke service including a hyperacute stroke unit, acute and longer term rehabilitation unit, and transient ischaemic attack (TIA) clinics. The two-year programme would have to be prospectively approved in a coordinated approach between training programme directors in the main specialty and stroke.

Exam requirements

There is currently no Specialty Certificate Exam in Stroke Medicine, but trainees will have to complete the Specialty Certificate Examination in their parent specialty.

Mandatory courses during training
  • Stroke thrombolysis course
  • National Institute of Health Stroke Scale certification
  • Modified Rankin Scale certification
  • Good Clinical Practice certification
Pros and Cons of working in this specialty

Pros

  • The work is flexible and could include acute stroke care, rehabilitation, prevention, or any combination of these
  • Provides the satisfaction of working in a multi-disciplinary team (MDT)
  • Provides plenty of opportunity for research
  • Vibrant specialty with new developments in treatment like thrombolysis and neuroradiological interventions
  • Stroke medicine Consultants can have sessions in other specialties like geriatrics, neurology or general medicine

Cons

  • Can be very busy at times
  • Can be emotionally draining
  • Lots of national targets to meet with continuous auditing
A day in the life of a stroke Registrar

08:30 am: Start with coffee and handover of new admissions overnight.

08:45 am: Quick meeting with MDT identifying patients for discharge/transfer and plan the day’s work.

09:00 am: Ward round in the Acute Stroke Unit.

10:30 am: Go to the Acute Medical Unit to review new stroke referrals.

11:00 am: Stroke thrombolysis bleep from Accident and Emergency (A&E). Patient reviewed in A&E and transferred to radiology for brain imaging. Thrombolysis initiated in Radiology Department as no contraindications. Patient transferred to Stroke Unit and complete thrombolysis.

12:00 pm: Lunch break.

12:30 pm: Rapid access neurovascular clinic seeing patients referred with a suspected TIA.

2:00 pm: Back to ward to review the thrombolysis patient and catch-up with work form the ward round. Check results and brain imaging of new patients.

3:00 pm: Speak to relatives of stroke patients.

4:00 pm: Call colleagues in the Stroke Rehabilitation Unit to handover patients being transferred from the Acute Stroke Unit.

4:30 pm: Back to the Acute Medical Unit to review stroke referrals from the day.

5:00 pm: Handover to evening Registrar and head home.

How this specialty differs from others and what made me choose it

Stroke medicine combines the diagnostic skills of neurology and the excitement of acute medicine with the satisfaction of working within a skilled MDT. Seeing a patient with significant limb weakness improve in front of your eyes after successful thrombolyisis is very fulfilling. Stroke medicine is a rapidly developing specialty and provides plenty of opportunity for research.

Tips for success in applying for this specialty

The most important thing to do is to get a specialty training number in one of the eligible specialties. You will then have a discussion with the training programme director of your parent specialty and express your interest in doing sub-specialty training in stroke medicine. Attending a stroke thrombolysis course and completing the National Institutes of Stroke Scale (NIHSS) certification gives you an advantage while applying for your advanced year in stroke medicine.

For more information

The Joint Royal College of Physicians Training Board - Stroke Medicine

British Medical Journal - careers advice article

British Association of Stroke Physicians