As an undergraduate student, Cherylee Chang, MD, wanted to be a cardiothoracic surgeon. Fortunately for our Department, a third-year rotation in neurology convinced her of the field’s potential with challenges to engage deductive reasoning. Now, as our new Chief of our Division of Neurocritical Care, she’s working to bring our team of clinicians, nurses, advanced practice providers, pharmacists, and others to our new neurocritical care unit in Duke Central Tower. In this week’s “Spotlight” interview, Chang talks to us about this work and her previous roles at The Queen’s Medical Center and as president of the Neurocritical Care Society. She also discusses finding work-life balance by connecting with her children, sailing, and reading.
Welcome to the Duke, and to the Duke Neurology Department! What were your previous roles at the Queen's Medical Center, and how do they compare to your new position at Duke?
When I was first recruited to the Queen’s Medical Center (QMC) in 1997, t-PA for stroke and neurocritical were both new to the practice of neurology. I was brought on as the Associate Medical Director of the Neuroscience ICU and to set up a stroke center. In 1999, I became the Medical Director of the Neuroscience Institute and the Medical Director of the Neuroscience Intensive Care Unit and the Stroke Center. In 2004, QMC became a TJC-certified Primary Stroke Center, and a TJC Comprehensive Stroke Center in 2016. Thereafter, I handed off the stroke directorship to concentrate my efforts on our ICU and further building our Neuroscience programs.
As the Neuroscience Medical Director, my role was to establish both inpatient and outpatient services that also support the University of Hawaii School of Medicine’s neurological education. This work has included the stroke, epilepsy monitoring unit and NAEC-verified epilepsy center, the neurohospitalist service, and a telemedicine movement disorder clinic to the University of Virginia, and teleneurology throughout the Islands. More recently, QMC has begun an outpatient presence that includes general neurologists, neuromuscular, memory disorder, and on-site movement disorder.
The differences in my role here at Duke now, as the Division Chief of Neurocritical Care, is my ability to concentrate on my work specifically in the area of neuroscience critical care. During my time at QMC, I helped design our new neuroscience floor and the Neuroscience ICU expanded to 14 beds, with the capability to increase further. Here at Duke, we are moving into the new Duke Central Tower and I look forward to working with our neurocritical care team, Neurology Department leaders, other departments and the hospital leadership to set up the unit and its workflow and processes for success to provide the best, most advanced neurocritical care possible.
I have always found joy in the collaborative teamwork that is found in the ICU. Similar to my work at QMC, I hope to establish connections, camaraderie and collaborative efforts with other departments as well as our clinical bedside partners, including our neurosurgeons, the RNs, APPs, respiratory therapists, pharmacists, unit secretary, and all the ancillary/supporting staff including our biomedical, imaging and information technology support. Close communication is also essential with the transfer center, bed control, and the other intensive care units here at Duke and beyond.
Of note, at QMC, we established the Neuroscience ICU APP role in 2007, however, Duke under Cecil Borel, MD, helped to establish an APP program in the 1990s! I look forward to having a similar partnership and teamwork as we not only provide cutting-edge clinical care, but also participate in research and the education our fellows, residents, medical students, and trainees in all areas.
What do you see as the biggest current challenges and opportunities in the field of neurocritical care? What are your top priorities for our Department over the next year?
The biggest challenge facing neurocritical care is also an opportunity. Since we have established the subspecialty area of neurocritical care, it has always been a challenge and opportunity to embrace the multiple primary specialties that have an interest in this subset of patients. We initially accredited fellowship programs and certified individuals through the United Council of Neurological Subspecialties (UCNS). Through the UCNS, we were able to widen the field beyond neurologists to include neurosurgeons, anesthesiologists, internists/pulmonologists, surgeons, emergency medicine physicians, and even pediatricians.
As we moved certification to be recognized as an American Board of Medical Specialty-recognized subspecialty, we have had the challenge to work with all relevant member Boards and now to move toward harmonizing the curriculum to the Accreditation Council for Graduate Medical Education (ACGME) and integrate the requirements into our current training programs such that our NCC fellowships will be inclusive of the requirements of the Residency Review Committees (RRC) for each of these specialties. International certification for Neurocritical Care remains both and challenge and opportunity.
The NCS has taken on the Curing Coma Campaign and it will be an all-hands-on-deck effort both from the science, research, data-base mining, professional, governmental, institutional and public standpoint. In addition to all the other neurocritical care disease processes such as TBI, stroke ICH, status epilepticus with unknown pathophysiology and treatment, this is yet another challenge.
My top priorities at Duke will be to get to know the people here and establish a transparent and open working relationship. In this way, I hope to establish the trust and confidence in me to help achieve our shared goals for patient safety and quality care through education and research with our hospital, department and Duke community. These immediate priorities will be to establish our new unit, create a workflow for the providers, and enhance patient flow. This will help create the platform for Duke to lead the way in cutting-edge clinical practice and to promote the education of trainees through inclusiveness of the multi-professional team, research, and open-minded perspectives on change and innovation.
How and when did you first get interested in neurology? What do you enjoy most about working in neurocritical care?
I always thought I was going to be a cardiothoracic surgeon. My early research forays were with the American Heart Association working with CT surgeons. However, during my third year of medical school, I had the juxtaposition of a surgery and then a neurology rotation. My neurology attending was one that had started his career as an emergency room physician. I saw the value of neurology in the context of another field of medicine; additionally, the incisiveness of being able to figure out the location of neurological injury by a bedside exam was fascinating. The mysteries and untapped potential of the field (in 1982, the only stroke treatment was aspirin) hooked me into neurology.
During my neurology residency, however, I was frustrated by the inability to provide many/any solutions to a majority of the neurological entities we diagnosed. It was during that time that I saw the need for a neurologist who also knew critical illness and could help bridge the gap between intensivists and neurology. As mentioned earlier, I enjoy most the collaboration of the teamwork in the ICU, but I also enjoy the ability to understand the nuances of the interactions between neurology and the other systems of the body.
You served as the president of the Neurocritical Care Society from 2007 to 2009. What do you see as your biggest accomplishments during your tenure?
The NCS had just been established in 2003. During that time, we were still defining the structure and the organization of the Society. First, as Vice-President, my responsibility was to chair the annual meeting. It was an amazing experience to pull together expertise to help make such a meeting happen. As President, my biggest accomplishments included involving other professionals such as nursing and pharmacy to help expand it from what was essentially an all-male physician group. It was both challenging and exciting to establish it as a multi-professional group that embraces nurses, advanced practice providers and pharmacists and others who provide care to our neurologically critically ill patient.
As a new non-profit society, we, of course, had bylaws but there was no document codifying the decisions we made as a young board of directors. One of my biggest roles included creating a policies and procedures manual that documented the rules and decisions we made both on the Executive Committee and the board. One of my contributions was to create a liaison committee to be inclusive of the input and communication of other national and international societies.
Of note, since 2003, I co-chaired the certification committee for NCS and became to chair of the Neurocritical Care certification committee for the United Council of Neurological Subspecialists. During my presidency, the efforts of the writing committee came to fruition with the first NCC certification examination was held in the fall of 2007.
What advice or thoughts do you have for residents or medical students interested in the field of neurocritical care?
It’s a great field of collaboration and ongoing challenges to learn more, explore more, and work as a team. As I mentioned earlier, the NCS is starting work on a Curing Coma Campaign. This is yet another exciting area in our field to tackle. In NCC, be prepared to always ask questions and be willing to change your ideas and practice as we are constantly learning more and finding that what we did previously might not be right.
It is a field that can be exhausting due our on-call clinical responsibilities; and also, for many of us, teaching, research, and administrative responsibilities. Yet, life is always about balancing work with our personal life and responsibilities. This life-work balance is an extremely important skillset that you must master. Even to this day, I am still learning this. Learn to say “yes” to the challenges and the excitement and education that brings. Learn to say “no” to the things that do not bring you joy and/or fulfill your short- or long-term goals.
What other passions or hobbies do you have outside of the Department?
My daughter and son are both grown and still in training (global public health and the other in medicine), and I still love learning from them. Their passion is to make fun of their mother when she is trying to keep up with the phone and other technology.
I love to travel. Yet my outlet and love has always been running. I love to explore the outdoors this way. I love to sail, golf and cook. Sailing is a great past-time of being in the moment. One’s mind is focused of wind, water and boat/sails with enough concentration to be both challenging and relaxing at the same time! I used to love reading novels, but find less time in this endeavor as medical journals have become more the media du jour. As I said, I’m still finding that work-life balance….
In the photos above and below, Chang enjoys fishing and a visit to a Husky homestead during a trip to Alaska last year.
