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Neurohospitalist Fellowship

The neurohospitalist program at UCSF plays a very active role in patient care, resident education, and clinical research in the department of neurology. With our fellowship, we seek to train future national leaders in the burgeoning field of neurohospitalist neurology. The fellowship provides the opportunity for additional specialized training in general inpatient neurology, including exposure to neurocritical care and cerebrovascular diseases, with the goal of helping trainees launch an academic career and become leaders in the field. Fellows will lead teams caring for critically ill patients with refractory status epilepticus, encephalitis, fulminant demyelinating disorders, stroke, and neuromuscular disease. As UCSF is the major tertiary referral center for neurological disease in Northern California and the neurohospitalist program receives numerous national referrals, fellows will diagnose and manage a wide range of both rare and common conditions. There will be ample opportunity to learn procedures. Fellows will be encouraged to engage in UCSF's vibrant clinical research enterprise and/or hone their teaching skills through medical education training. By year's end, our fellows will be highly qualified candidates for either academic or community-based neurohospitalist positions nationwide.

Candidates must be board-eligible and have a license to practice in the state of California by the start date of the fellowship. Please send curriculum vitae and a personal statement to S. Andrew Josephson, M.D., Director, Neurohospitalist Program, Department of Neurology, UCSF, Box 0114, San Francisco, CA, 94143-0114. Typically positions are filled 12-18 months prior to the July 1 start date.

The Neurohospitalist Fellowship Experience
Our first Neurohospitalist Fellow was Vanja Douglas, MD. Asked to describe his fellowship training experience, Dr. Douglas said, "The clinical training I received during my fellowship was invaluable. In addition to seeing a large number of patients with common inpatient conditions, I gained extensive experience in diagnosing and treating rare neurological diseases referred to UCSF from the rest of Northern California. I also gained an understanding of the issues specific to neurological inpatients, especially with regard to patient safety and quality health care delivery. Through the excellent mentorship of Dr. Josephson, I was also able to develop a clinical research program. This specialized training enabled me to take the next step in my career, joining the faculty at UCSF to dedicate my time to teaching students and residents about neurology and caring for inpatients with neurological disease."

One of his goals during the fellowship was to develop a screening tool to predict which patients are at highest risk for the development of delirium in the hospital so that clinicians can find ways to prevent it. The biggest risk factor for the development of delirium is pre-existing cognitive dysfunction, so he asked "How does one identify patients with cognitive dysfunction if they don't already carry a diagnosis of dementia or mild cognitive impairment?" Dr. Douglas and colleagues analyzed the responses to a large battery of questions asked of caregivers of every patient evaluated at the UCSF Memory and Aging Center. From this large group of questions, four turned out to be most relevant in identifying mild cognitive impairment or dementia, and these were combined into a simple screening tool. If a patient's caregiver endorses two or more of these questions, then the chance of the patient having cognitive dysfunction goes up. Dr. Douglas and his colleagues have used this tool in a follow-up study of patients admitted to the hospital to see if it can help predict those who develop delirium.