The Overarching Goal of this proposed competing renewal of the Interdisciplinary Cerebrovascular Training program in South America (ICTuS) is to continue building a cadre of Peruvian physicians to reduce the morbidity and mortality of cerebrovascular disease in Peru through: a) identifying environmental, host and lifestyle factors associated with increased risk for cerebrovascular disease, b) implementing treatment and prevention programs to reduce these risks, c) enhancing post-stroke rehabilitation therapies for persons with stroke and their caregivers, and d) collaborating with academic institutions and hospitals to adapt policies to address population- level stroke care needs identified through this program. To achieve this goal, we propose the following specific aims: #1. Enhance investigation and management of cerebrovascular disease and post-stroke rehabilitation in Peru through workshops, didactic courses and Masters degree-level training in research methodology with clinical preceptorships for young Peruvian physicians; #2. Support mentored clinical research projects in Peru for all medium and long-term physician trainees to obtain data for thesis work, publications and future grant applications in the fields of cerebrovascular and post-stroke rehabilitation; and #3: Improve quality of stroke care and post-stroke rehabilitation in Peru through implementation science, quality assessment and quality improvement. Over this second five-year training period, we propose to emphasize implementation science and continuous quality improvement – which will be included as topics of workshops in Peru, didactic classes for medium and long-term trainees in Seattle, and as topics for mentored thesis projects. In addition, through the pending accreditation of the first stroke training fellowship in Peru – spearheaded by prior ICTuS trainee Dr. Carlos Abanto, we anticipate offering all of our proposed research training activities to new Peruvian stroke fellows – increasing the emphasis and integration of research into the stroke fellowship and increasing our candidate pool for training in Peru and Seattle. Our specific aims will be addressed through a combination of short, medium and long-term training, with an emphasis on master's degree training at the Universidad Peruana Cayetano Heredia (UPCH) and the University of Washington (UW) and three-month Comprehensive training in epidemiologic research methods at the UW with practical experience in stroke management and rehabilitation medicine. We also propose short training workshops in implementation science, cerebrovascular and chronic diseases epidemiology, manuscript and grant preparation, and responsible conduct of research; mentor training courses will be held concomitantly with workshops. The greatest strengths of this proposed training program are the development of the first stroke fellowship in Peru that is undergoing accreditation and will provide an increased stream of applicants for our propose...