We assessed differing perceptions of stroke codes (SC) between SC initiators and responders and, among responders, explored the impact of SC on neurology resident education and well-being.

SC facilitate timely revascularization therapy, and numbers have increased. As neurologists face high burnout, the impact of SC on trainee education and well-being is not well understood.

We performed a real-time, cross-sectional analysis of initiators and responders to SC from 6/14/2025 – 7/18/2025. Participants answered Likert scale (1 = very unlikely/low, 5 = very likely/high) and free response questions about patient benefit, educational value, and contribution to burnout. We assessed correlations between perceived well-being, educational value, and busyness using Pearson's Correlation Coefficient and performed thematic analysis of free responses.

Fifty-four SC were called: only 9.3% (n=5) received revascularization (3 thrombectomy, 2 thrombolysis). Thirty-two initiators (59.3%) and fifty-four responders (100%) participated. Of responders, 90.7% were neurology residents.

Initiators perceived significantly higher patient benefit (4.0 ± 1.1 vs. 3.3 ± 1.2; p<0.03). Among initiators, perceived benefits included aligning resources, expediting care, and helping the patient/team. Among responders, perceived benefits included rapidly identifying/treating stroke and providing reassurance when not a stroke. Responder frustrations included limited clinical history and presentation outside the treatment window. Among responders, educational value was significantly greater for revascularization cases (3.6 ± 0.9, n=5 vs. 2.5 ± 1.2, n=37; p<0.03). Effect on well-being was correlated with educational value (r(52)=0.64, p < .01) but not with perceived busyness.

SC initiators and responders showed discordant perceptions of SC benefit. For neurology trainees, educational value was highest in rare revascularization cases and effect on well-being was correlated with educational value. Addressing the disconnect between initiators and responders, and maximizing trainee involvement in revascularization cases, may maximize education and minimize SC contributions to burnout.