One hundred and fifteen aspiring neurosurgeons flocked to the Royal College of Surgeons in London for the fifth annual Society of British Neurological Surgeons (SBNS) / Neurology and Neurosurgery Interest Group (NANSIG) Neurosurgery Careers Day, held on January 16. The careers day aimed to give students and junior doctors an insight into life as a neurosurgeon in the UK and a road map for how to get there.
What is it like to be a neurosurgeon in the UK?
The typical path to consultant neurosurgeon is five to six years at medical school, two years in the Foundation Programme (FY1 and FY2), followed by eight years of specialist neurosurgical training (ST1-ST8). A surgeon is classed as a ‘registrar’ once he or she has reached ST3 level of training. Surgeons who have completed specialist training and fulfilled other requirements set out by the General Medical Council and Joint Committee on Intercollegiate Examinations may apply for consultant posts.
Akbar Hussain, Neurosurgical Registrar, said in his careers day talk that the best part of his job is how each day presents a new challenge or experience. In the same week, a registrar could perform, for example, a spinal reconstruction, carpal tunnel surgery, and shunt surgery for a baby with increasing intracranial pressure. He says because every day presents a new challenge and there is always more to learn, the work never gets boring. Consultant neurosurgeons can specialise in a wide range of areas, including neuro-oncology, paediatric neurosurgery, complex spinal surgery, and functional neurosurgery.
Getting on the ladder
During her talk, Amy Bowes, FY1 doctor, presented her ‘golden rules’ for getting on the ladder in neurosurgery, which included good time management and early research experience. It can be hard to get your foot on the research ladder as a medical student, but Amy said that studying for an intercalated BSc or MSc degree is a great opportunity for early experience and publication. During his talk on CV building, Chris Cowie, Consultant Neurosurgeon, said that a doctorate is beneficial for an academic career in neurosurgery, but noted that this career path might not be of interest to everyone.
The latest research in neurosurgery is presented at SBNS meetings and published in specialised journals such as the British Journal of Neurosurgery (BJN) and larger journals such as PLOS ONE, among others. We were fortunate to have Prof Paul Eldridge, Editor-in-chief of the BJN, and three members of the SBNS committee with us at the careers day: Richard Kerr, President; Paul May, President Elect; and Alistair Jenkins, Treasurer.
Paul May came across as someone with immense enthusiasm for his specialty and great belief in the next generation of surgeons. He said he felt inspired by the presence of so many students at the careers day, addressing us as “the bright future of British neurosurgery”. Already contributing to that bright future were the students and junior doctors presenting their work on the day.
Innovation in neurosurgery
A highlight of the day was hearing the three keynote lectures, delivered by Professor Sir Graham Teasdale, Co-inventor of the Glasgow Coma Scale; Mark Wilson, Consultant Neurosurgeon at Imperial College Hospitals Trust and Pre-Hospital Care Specialist; and Richard Ashpole, Consultant Neurosurgeon at the Queen’s Medical Centre in Nottingham. The overarching theme of these lectures was the need for innovation in neurosurgery.
One neurosurgical innovation that has stood the test of time since it was invented 40 years ago is the Glasgow Coma Scale, a neurological scale for recording the conscious state of a patient. There were many different systems to measure consciousness before the advent of the GCS, but consciousness measuring strategies was chaotic with no international consensus. Prof Teasdale and his colleague Professor Bryan Jennett came up with a way to measure three separate components of consciousness: eye opening, verbal response, and motor response. In his keynote lecture, Prof Teasdale said that the beauty of the GCS was that it wasn’t some complicated system that required specialist training; it could be used by anyone in the medical profession with the same success. Prof Teasdale and Prof Jennet’s original paper in a 1974 issue of Lancet has become the most frequently cited paper in clinical neurosurgery. And a recent review in Lancet Neurology of the scale’s position 40 years on showed that the GCS is now used in more than 80 different countries, 74% of which have translated it into their native language.
During his keynote lecture, Mark Wilson highlighted the need for better management of patients with brain injury. Mark has a saying, “if you’re not dead when we get to you, you shouldn’t die,” meaning the medical profession should be able to prevent death from secondary brain injury. He also emphasised the importance of learning from different countries and cultures. For example, he said that if you are in Berlin and you have a stroke, the ambulance sent to you has an on-board scanner: you can be scanned on your doorstep and treated, if appropriate, on the way to the hospital. Mark’s talk showed that embracing innovation is judiciously adopting protocols that have been shown to be successful in other settings.
In the final keynote lecture, Richard Ashpole introduced us to ROWENA (Realistic Operative Workstation for Educating Neurosurgical Apprentices), which housed what he described as “a squidgy reasonably anatomically correct brain with ventricular system!” Richard said that simulation in surgery has been successful in a number of fields, and for things like endoscopy where margin for error is small it is better to practice on something plastic first. He would like to further improve the model by adding more intricate anatomical landmarks to the squidgy brain, including more sulci, a falx, and the circle of Willis.
Choosing a specialty
At the end of his talk, Tim Jones, Consultant Neurosurgeon, reassured us that we ought to take time when deciding on a specialty, noting that he dabbled in many different specialities before eventually deciding on neurosurgery. He said his decision was based on liking the people in the team, the interesting pathology, but also an illuminating moment in surgery when everything clicked for him. This moment was performing burr holes for the first time: a simple procedure, but one he still remembers for the impact it had on him.
As I reflect on my own career aspirations, I don’t plan to rush into neurosurgery, but my Tim Jones-style moment was assisting in a brain tumour resection during my first year at medical school – and that will be hard to top.
Editor’s note: this post has been amended from “a PhD is essential for an academic career” to “a doctorate is beneficial for an academic career”