Education Research: Assessing the Current State of Telestroke Exposure in Vascular Neurology Fellowship

Abstract

Background and Objectives Telestroke is now a core component of acute stroke care, yet how fellows are trained to deliver care in this setting remains variable. With telestroke incorporated into Accreditation Council for Graduate Medical Education (ACGME) milestones, there is a need to better understand current training practices and gaps. The objective of this study was to evaluate telestroke training across vascular neurology (VN) fellowship programs in the United States and identify barriers to fellow participation. Methods We conducted a national survey of VN fellowship program directors identified through the Fellowship and Residency Electronic Interactive Database Access (FREIDA) database. The survey assessed program characteristics, fellow involvement in telestroke, educational modalities, and perceived barriers. Responses were analyzed using descriptive statistics. Results Of 115 program directors contacted, 67 (58.3%) responded. Most programs (92.5%) reported offering telestroke services, and the majority included fellows in clinical encounters, primarily through video (73.3%) and telephone (56.7%) consultations. However, structured educational components were less common, with 48.3% offering telestroke-specific skills training, 25.0% offering didactics, and 11.7% incorporating simulations. Although 71.7% of program directors felt fellows were adequately prepared for independent practice, 28.3% reported uncertainty or lack of readiness. Common barriers to telestroke fellow involvement included supervision requirements, credentialing challenges, and limited administrative support, with nearly two-thirds of programs identifying unmet resource needs. Discussion Telestroke training in VN fellowships is common but varies in structure, including the availability of formal didactics, simulation, skills-based training, supervision models, and barriers to fellow participation. Defining competency-based expectations, while allowing for flexible and scalable training models, may help address variability and better prepare fellows for independent telestroke practice.