Neurointervention rotations and comfort with clinical decision-making in stroke and neurocritical care: A nationwide survey of Indonesian neurology trainees

Abstract

Background & Objective: Cerebrovascular diseases are among the most frequently managed conditions in neurology residency. With advances in reperfusion and endovascular therapies, exposure to neurointervention has become increasingly relevant in residency training. However, neurointervention rotations are not uniformly implemented across Indonesian training centers. This study aimed to explore neurology trainees’ perspectives on neurointervention rotations and to evaluate whether participation in such rotations influences comfort with clinical decision-making in stroke and neurocritical care.

Methods: An electronic survey was distributed in early 2025 to 15 neurology residency training centers across Indonesia. Neurology trainees were randomly selected from each participating center to complete the questionnaire. The survey, adapted from previous studies, assessed demographics, exposure to neurointervention, and comfort with clinical decision-making using a five- point Likert scale. All responses were collected anonymously to ensure confidentiality.

Results: Of 120 invited residents, 116 (96.7%) completed the survey. Neurointervention rotations were offered at 11 centers, completed by 66 (56.9%) respondents. Most trainees (83.6%) believed such rotations should be mandatory. Residents who had completed a neurointervention rotation reported significantly greater comfort in identifying large vessel occlusion (p=0.003), interpreting cerebral angiograms (p<0.001), determining Thrombolysis in Cerebral Infarction score (p=0.018), and managing intracerebral and subarachnoid hemorrhage in stroke units (p=0.02).

Conclusion: Neurovascular and neurocritical care rotations provide a foundation for clinical decision- making in stroke. However, dedicated neurointervention rotations significantly improve trainees’ comfort in managing hyperacute stroke and neurointervention-related cases, and may also encourage pursuit of fellowship training. Standardizing such rotations across training centers could better prepare residents for the complex decision-making required in modern stroke and neurocritical care.