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In 1996 IV tissue-type plasminogen activator (tPA) was approved by the Food and Drug Administration for treatment of acute ischemic stroke. Although it is recommended by consensus statements and practice guidelines,1,2⇓ considerable data suggest that tPA is underused.3,4⇓ Lack of physician experience and training may limit its use.5 Indeed, most practicing neurologists completed their residency training before its approval and thus have had little formal education in its use. Neurology residents who completed their residency in June 2000 were the first physicians to have received their entire 4 years of training after the Food and Drug Administration approved the use of tPA.
Methods.
Using the American Medical Association Graduate Medical Education Database (© 1999; Chicago, IL), all adult neurology residents expected to complete their final year of training in the United States in June 2000 were identified. An anonymous 12-item questionnaire was mailed in March 2000. Experience with tPA and related issues was assessed using a five-point Likert scale. The presence of a dedicated stroke team at the residents’ …
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