The Neurocritical Care Fellowship Program at Johns Hopkins pioneered the training of fellows in the 1980s and continues to be the leading program in this sub-specialty, aiming to develop Neurocritical Care Clinician Scientists. We have trained more than 50 physicians from a variety of fields who went on to work at leading institutions as directors of neurocritical care programs, chairs of departments, established research investigators, institute directors, and hold key positions in professional societies related to neurocritical care.

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Director | Clinical Training | Electives | Education Program | Research | Faculty | Current Fellows | Alumni | Letter from the Director

Fellowship at a Glance

• Accreditation: the program is ACGME-accredited since July 2022 and maintains UCNS accreditation
• Duration: two years (52 weeks of clinical work, and the rest academic work)
• Eligibility: current residents and board-eligible recent graduates from an Accreditation Council for Graduate Medical Education (ACGME)-accredited residency program in neurology, neurosurgery, internal medicine, surgery, emergency medicine or anesthesiology/critical care medicine.
• How to apply: applications are received and screened via SF Match.

Program Features

The strength of this program is in collaboration between faculty from departments of neurosurgery, neurology and anesthesiology and critical care medicine.

Upon successful program completion, fellows are certified in advanced cardiac life support and advanced trauma life support. They are board-eligible for the United Council of Neurologic Subspecialties Neurocritical Care examination, and have accumulated a research and publication foundation for their academic career.

Clinical Training

Expectations and Responsibilities

• Fellows spend their first year developing patient care skills, teaching ICU medical students and supervising house staff and nurses in the bedside care of patients.
• The second year adds responsibilities of:
  • Team management as a leader of the NCCU team (with the attending physician’s support)
  • Formal teaching of the concepts of neurophysiology and treatment for various neuropathologic processes and general critical care issues to residents and fellows.
  • Developing research activities in the critical care environment.

Electives

Fellows can rotate through several different selective (mandatory electives) and elective rotations during the course of their fellowship which include:

1. Airway Selective: Fellows receive hands-on training in endotracheal intubations, bag-mask ventilation, LMA placement and moderate sedation techniques in a longitudinal series of rotations through the operating rooms, outpatient surgical center and endoscopy suites. 
2. Medical Intensive Care Unit Selective
3. Surgical and Trauma Intensive Care Unit Elective
4. Coronary Intensive Care Unit Elective
5. Cardiovascular Surgical Intensive Care Unit Elective: Fellows get exposed to management of ECMO circuits, participate in neurological prognostication and collaborate on research projects in neurological effects of ECMO through our HERALD collaboration network created by NCCU faculty member Dr. Sung-Min Cho.
6. Critical Care EEG Elective: Fellows practice interpretation of critical care EEG monitoring, utilizing the Persyst software and interpretation of quantitative EEG monitoring trends through rotations in the EEG department with our neurophysiology experts. We also conduct biweekly NCCU and EEG joint rounds, where neurophysiology faculty and fellows meet with NCCU fellows to review critical care EEG records. 
7. Interventional Pulmonology: for training in bronchoscopies, thoracentesis, chest tube and pigtail catheter placements.
8. Neuropharmacology Elective: In this intense 2-week training elective designed by our senior neurocritical care pharmacist, senior fellows learn advanced pharmacological principles in antiepileptics, sedatives, antiplatelet and anticoagulant agents as well as antibiotics, working through complex neuropharmacological cases.

Educational Program

Our fellowship offers an abundance of didactic training to the fellows, which include:

• Summer Bootcamp Lecture Series: These lectures are provided to incoming fellows in July and August by NCCU and external faculty members, offering a refresher on important general and neurocritical care topics, such as shock, sepsis, vasopressors, antibiotics and management of intracranial hypertension. 
• Weekly Lecture Series: Faculty deliver weekly lectures to fellows and residents on advanced neurocritical care, general critical care and neuropalliative care topics. Additionally, we have weekly divisional seminars, where international and national speakers are invited to give talks on novel aspects of neurocritical care and general critical care. Fellows also present journal clubs and performance improvement conferences twice per year throughout their training to the entire division.
• Board Review Series: These are fellow-driven didactic sessions under supervision of the fellowship director and NCCU faculty. Fellows present a short overview of board review topics and work through board questions as a group. This lecture series is designed using the ABPN/ABA/ABIM/ABEM Neurocritical Care Board Examination guidelines to help fellows prepare for neurocritical care boards and promote self-directed learning.
• Procedural Training in the Simulation Center: Training for procedural competency begins immediately in July of the first year with a Simulation Center series focused on common critical care interventions. Before their clinical duties require performing these procedures for patients, fellows practice in the simulation environment:
  • Invasive and noninvasive mechanical ventilation simulation workshops 
  • Direct laryngoscopy and endotracheal intubation
  • Insertion of central and peripheral venous and arterial catheters
  • Lumbar puncture and insertion of lumbar drains
  • Formal neuropalliative simulation using standardized patients to train in delivery of Neuroprognostication information and lead goals of care conversations. 

The Simulation Center also allows for structured exposure to emergency neurological life support (ENLS) events. Finally, fellows certify for advanced cardiovascular life support (ACLS) in the simulation environment using complex, realistic scenarios that provide more problem-solving opportunities than the "megacodes" used in conventional ACLS certification testing.

Research

The Johns Hopkins NCCU faculty have a vast experience running clinical trials, basic science and translational research, providing an excellent resource for research mentorship opportunities. Fellows also have unique opportunities to collaborate with faculty from different departments and divisions within the departments of neurology, neurosurgery and anaesthesiology and critical care medicine that comprise our neurocritical care division.

Fellows have access to a variety or research datasets and other resources at Johns Hopkins:

• Large trial datasets with longitudinal outcome information can be accessed via the Division of Brain Injury Outcomes (BiOS).
• The neurocritical care division has established the Precision Medicine Center of Excellence providing a data repository for high-frequency continuous signals obtained from patients’ bedside hemodynamic, respiratory, ICP and multimodality monitoring. This dataset provides an excellent resource for clinical, translational and precision medicine projects.
• Johns Hopkins Armstrong Institute has resources for quality improvement research projects.

Given the long-standing commitment to research, the Johns Hopkins Neurocritical Care Fellowship Program has a mandatory research expectation from fellows.

• Fellows undertake 12 months of clinical, translational or laboratory-based research. Each fellow has the combined resources of major contributing departments at their disposal.
• Once an area of interest is identified, a formal mentorship is established with a faculty member.
• In January of their first year, fellows present research ideas to the division faculty for review. Based on this presentation and the input provided during discussion, fellows submit an application to the Human Investigational Review Board or the Animal Use Committee.
• In July and again in December of their second year, fellows present progress reports of their research.
• Most program faculty author reviews and book chapters and provide editorial review for journals. Trainees may collaborate on such projects. The program gives all fellows the chance to present projects at national conferences and publish a journal article by the end of their training.