Career in Stroke

Stroke is the fourth commonest cause of death and commonest cause of adult neurological disability in the UK. It costs the UK an estimated £9 billion pounds per year due to combined costs of long-term care expenditure; rehabilitation needs as well as loss of employment ⁽¹⁾. Patients are from a variety of age groups and demographics with an estimated 25% of stroke patients now under the age of 65⁽²⁾.

Stroke medicine encompasses emergency presentation including investigation and treatment right through to long term rehabilitation and chronic disease management. Physicians therefore have the opportunity to supervise recovery, rehabilitation, disability management and transition back into the community.

Stroke medicine offers the opportunity to work closely with other multidisciplinary teams including emergency medicine, radiology (including diagnostic and interventional neuroradiology), vascular surgery, neurosurgery, cardiology, rehabilitation medicine and community services.

Visit our ‘Take-Up-Stroke’ page to view video testimonials from:

Prof. Al Shahi Salman – why chose a career in stroke

Anthony smith – why I love stroke medicine

Dr. Broadbent – joys of working as an MDT

NANSIG Conference on 23 February 2025 included a key note talk from Prof Werring, BIASP President, on Opportunities in Stroke.  To view the slide presentation CLICK HERE

Prof David Werring, BIASP President, presented slides at a recent NANSIG (Neurology and Neurosurgery Interest Group) event to encourage a career in stroke – CLICK HERE

NANSIG & BIASP Half Day Webinar – Stroke Careers: Shaping the Stroke Clinicians of the Future held on Saturday 12 October 2024

Physicians in stroke medicine come from a variety of different training pathways. The General Medical Council recognises physicians as having a sub-speciality interest if they have completed additional training in stroke medicine to meet the training criteria set out by the Joint Royal College of Physicians. Previously this was a 2 year stroke training placement, however with new Internal Medical Training (make more relevant to ROI trainees), additional training can vary from 6 months to 1 year.

In the Republic of Ireland the Irish Medical Council has embedded stroke curriculum and training objectives into multiple different higher medical training pathways. More information on this is under the relevant heading below.

If applying for a dedicated stroke fellowship, these are available throughout the UK and Ireland. 

The JRCPTB stroke curriculum was updated in 2022 and has broadened the scope for eligible trainees. Now, stroke fellowship applications are open to any trainee who has successfully completed the full three-year Internal Medical Training (stage one) training programme are now eligible to apply for additional stroke training.

Trainees from a group 2 parent specialty are still eligible to apply for stroke sub-speciality training however must first complete an equivalent of Internal Medical Training Year 3.

There is now officially an IMT stage 2 training programme in the UK, that allows for CCT in stroke and GIM after completion of a dedicated 3 year training programme. This includes two years of General Internal Medicine training and 12 months of placement in a regional stroke unit. More information on this is provided below.

The training pathway differs in duration depending on which parent specialty has been chosen. Below are worked examples of different parent specialties:

UK Trainees:

Acute Internal Medicine (AIM) as a parent specialty:

Higher specialist trainees from AIM will now complete a 4-year post IMT programme with joint accreditation with Internal Medicine. This includes basic stroke training circa 3 months over the course of training. However, to gain the skills to lead a service, additional training is required. The AIM curriculum recognises stroke medicine as a “specialist skill” It is envisaged trainees will  complete additional stroke training of 6 to 12 months duration.

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Geriatric Medicine as a parent specialty:

Higher specialist trainees from Geriatrics will now complete a 4-year post IMT programme with joint accreditation with Internal Medicine. Within this standard pathway there is approximately 3 months of stroke training embedded within.  The new Geriatric Medicine Speciality Curriculum (2022) permits for a dedicated “theme for service”, of which stroke medicine is one of possible options. To permit appropriate time to gain the skills to lead a service in stroke medicine, an indicative additional 6 months of stroke training is expected in addition to the 4-year programme. Trainees completing the indicative 4.5- year (54 month) programme would receive a sub-specialty CCT in Stroke Medicine.

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Neurology as parent speciality:

Neurology, Higher specialist trainees will now have the stroke curriculum embedded into a 5-year post IMT training pathway. This will be jointly accredited with Internal Medicine. Stroke training may be interspersed throughout the 5-year period, or a dedicated 6-month stroke placement may be offered. Trainees will gain experience of TIA clinics, in and out of hours exposure to cerebral reperfusion treatment and brain imaging interpretation.

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General Internal Medicine

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Other Group 1 specialties:

Similar to geriatrics and Acute Internal Medicine, Any other Group 1 speciality (Cardiology, Clinical Pharmacology & Therapeutics, Endocrinology & Diabetes Mellitus, Gastroenterology, Genitourinary Medicine, Infectious Diseases (except when dual with Medical Microbiology or Virology), Neurology, Palliative Medicine, Renal Medicine, Respiratory Medicine, Rheumatology and Tropical Medicine (except when dual with Medical Microbiology or Virology) is eligible to apply for Stroke sub-speciality training.

Trainees from these specialties should elect to complete an additional 12 month dedicated training in stroke.

Group 2 Specialties:

Remaining medical specialities now termed group 2 specialties, Allergy, Audiovestibular Medicine, Aviation & Space Medicine, Clinical Genetics, Clinical Neurophysiology, Dermatology, Haematology, Immunology, Infectious Diseases (when dual with Medical Microbiology or Virology), Medical Oncology, Medical Ophthalmology, Nuclear Medicine, Paediatric Cardiology, Pharmaceutical Medicine, Rehabilitation Medicine, Sport and Exercise Medicine, Tropical Medicine (when dual with Medical Microbiology or Virology). Trainees often elect to these specialties following completion of IMY2. Therefore, Trainees from these higher specialist backgrounds will be required to complete an additional IMY3 equivalent prior to completing an additional 12 months dedicated training in stroke.

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New Training Route for Stroke Consultants

There is now a new GIM-Stroke training pathway programme available which will take 3 years to CCT.

The stroke curriculum allows for training in GIM coupled to stroke. GIM acts as a specialty and successful applicants would CCT in GIM. Stroke is the sub-specialty. The training programme will last for three years with two years of GIM and one year of stroke. Unlike the usual stroke recruitment, applicants will not already have an NTN. They will be able to apply while completing IMT3. All applicants will have to have completed IM stage 1 or equivalent before they start. All applicants will have to have MRCP or equivalent by interview. On successful completion of training, trainees would have a CCT in GIM and a sub-specialty CCT in Stroke Medicine.

CLICK HERE for the physician higher specialty training recruitment website, this has a stroke section 

Watch Dr Anthony Pereira’s BIASP webinar on Training Pathways into Stroke

Republic of Ireland Trainees:

There is no dedicated stroke training pathway in Ireland. Stroke training is open to all trainees in General Internal Medicine. The training structure for Medicine in Ireland after Internship comprises of Basic and Higher Specialty training.

Once enrolled in Basic Specialist Training (BST) in General Internal Medicine, basic knowledge is gained in stroke medicine on the initial management of stroke via rotations in multiple internal medicine sub-specialties. This is a 2 year training programme.⁽³⁾ MRCPI completed during this time. Alternatively can apply with evidence of equivalency

The Higher Specialist Training Curriculum in General Intern Medicine outlines the requirement for trainees to be competent in the assessment and investigation of acute stroke. This training curriculum includes specific competency in the recognition and emergency management of stroke and TIA including thrombolysis delivery and assessment for thrombectomy referral. General Internal Medicine trainees are required to complete certification in the NIHSS Stroke Scale. All trainees in general internal medicine have basic skills in acute stroke care.

Stroke competency can be obtained through the following programmes:

• Geriatrics HST
• Neurology HST
• Clinical Pharmacology & Therapeutics HST

Remaining Medical HST programmes have some proficiency requirements for basic stroke management and if interested in a career in stroke post completion of HST, additional training can be obtained through a Post CSCST fellowship. See below.

More dedicated stroke training and curricular requirements are in place in the certain sub-specialties including Geriatric Medicine, Neurology and Clinical Pharmacology. These sub-specialty Curricula included dedicated competencies in post-acute stroke management, neuroimaging, post-stroke complications, secondary prevention, rehabilitation, delivering models of integrated care such as early supported discharge and legal and ethical issues. There is a requirement for “Delivering thrombolysis in Clinical Practice Course” in some of these sub-specialties. Curricula are currently being updated^(4)..

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A clinical fellowship in stroke can be undertaken during higher specialist training or following successful completion of higher specialist training (Post-CSCST fellowships) ⁽⁵⁾.

Physicians completing stroke specialist training go on to work in a wide range of rewarding career opportunities. These include:

1. Clinical acute stroke physician / hybrid type roles with parent specialty
2. Research opportunities
3. Academic careers – lecturing / education
4. Interventionists (coming from radiology background)
5. Subspecialism – Primary and secondary prevention (hypertension). Chronic disease management programmes
6. Rehabilitation
7. Leadership management and guidance. Shaping national and international guidelines. ESO/WSO.

Physicians completing stroke specialist training go on to work in a range of rewarding consultant posts. In specialist centres consultants may undertake majority of their work covering neurovascular medicine. In other roles they may have a more hybrid job plan which allows them to cover their parent specialty such as neurology or geriatric medicine.

Stroke is a very research driven specialty with many consultants actively engaged in clinical research. As a trainee there will be opportunities for research and quality improvement.

Stroke physicians are involved in all aspects of the patient journey, from the hyperacute presentation right through to post stroke rehabilitation and long term management.

Physicians gain experience in management of longer term complications of stroke such as chronic pain, post stroke spasticity and work collaboratively with MDT to manage these complications.

Specialty and specialist doctors ( SAS) form a big part of the medical workforce in the UK. Being an SAS doctor is a viable and recognised alternative career pathway for any medical specialty including stroke. You can be a local or international medical graduate and choose SAS as your career pathway to work at consultant level after obtaining the required competencies. 

If you have completed at least four years’ full-time postgraduate training (or its equivalent gained on a part-time or flexible basis) at least two of which will be in stroke ( a specialty training programme or equivalent experience and competencies), you are eligible for a specialty contract in stroke. You then have the opportunity for career progression within stroke to specialist grade contract and work at consultant level. 

For general information and guidance on SAS doctors career follow the link : 

https://www.nhsemployers.org/sas

For terms and conditions of service for specialty grade follow the link 

https://www.nhsemployers.org/publications/terms-and-conditions-service-specialty-doctors-england-2021

For terms and conditions of service for specialist grade follow the link 

https://www.nhsemployers.org/publications/terms-and-conditions-service-specialist-grade-england-2021

Further information and guidance on the above on the BMA website 

https://www.bma.org.uk/pay-and-contracts/contracts/sas-doctor-contract/sas-contracts

1. https://www.jrcptb.org.uk/sites/default/files/Stroke%20Medicine%202022%20Subspecialty%20curriculum%20FINAL%20July%202022.pdf
2. https://www.stroke.org.uk/what-is-stroke/stroke-statistics
3. https://www.rcpi.ie/Portals/0/Document%20Repository/Training/Basic%20Specialist%20Training/Curricula/Training_BST_IOM-GIM-Curriculum_2022.pdf?ver=szZChrHvVcHrUD6inMKMxQ%3d%3d
4. https://www.rcpi.ie/Learn-and-Develop/Training-Programmes/Higher-Specialist-Training/Internal-Medicine-Higher-Specialist-Training/Specialties-and-Mandatory-Courses
5. https://www.rcpi.ie/Portals/0/Document%20Repository/Post%20CSCST%20Fellowships/Institute%20of%20Medicine/Training_PCSCSTF_IOM_Stroke_Curriculum_2017.pdf