08 FYi • Career


GETTING AHEAD IN NEUROLOGY


The specialty promises a varied and challenging career


W


HETHER it’s playing a vital role in stroke care, treating infectious diseases such as meningitis or managing long-term conditions like epilepsy and multiple sclerosis, the specialty of neurology is varied and challenging. Neurologists diagnose, treat and manage disorders


that affect the brain and nervous system. They also treat peripheral nerve diseases that may result in weakness or sensory impairment. Diagnosis is commonly done by clinical assessment alone but there


are a range of advanced imaging and other tests available including genetic testing. One of the most challenging areas for hospital doctors is the


treatment of patients presenting with acute neurological conditions (these include stroke, meningitis, encephalitis and Guillain-Barré syndrome). These patients are then followed up either to clarify the diagnosis or to manage longer-term problems such as epilepsy, multiple sclerosis and Parkinson’s disease. Neurological conditions account for as many as 20 per cent of acute medical admissions but the Association of British Neurologists (ABN) identified a “significant variation of provision of service across the UK”. Figures from a recent ABN survey found that a fifth of acute hospitals have access to a neurologist on three days or fewer per week. Access to diagnostic investigations was similarly inconsistent. While 89 per cent of neuroscience centres have access to 24/7 MRI, 72 per cent of district general hospitals (DGHs) do not. The ABN is calling for national variations in care to be addressed urgently – so what better time to consider a career in this growing field?


Entry and training Upon successful completion of the foundation programme, it generally


takes seven to eight years of full-time training to become a neurologist. This comprises either two years core training or three years on the acute care common stem (ACCS) programme followed by five years’ specialty training (ST3-7). Sub-specialty training in stroke medicine adds a further 12 months. Trainees must acquire full membership of the Royal College of


Physicians UK (MRCP) before entry to ST3. During ST3-7 they must also pass the specialty certificate examination – developed by the Federation of Royal Colleges of the UK in association with the ABN – in order to achieve a certificate of completion of training (CCT). All trainees will undertake clinical placements of between three and


12 months in a minimum of two neurological training sites. At least one site must include the allied specialties of neurosurgery, neuroradiology, neurophysiology, neuropsychology and neuropathology. At least 12 months should be spent in a DGH-type setting. There is also the option for relevant out-of-programme experience (OOPE) which may include time spent in research or experience in other deaneries or overseas – this can be discussed with your educational supervisor and specialty training committee.


The job Most neurology services still work on a hub-and-spoke model, with consultants spending part of their time in a DGH and part in a teaching hospital with a tertiary neuroscience centre. Community-based neurology is rare but there are efforts to improve this in coming years. Multidisciplinary work plays a key role with neurologists working closely with other healthcare professionals including physiotherapists, occupational therapists and speech and language therapists. Many neurologists choose to sub-specialise in areas such as


movement disorders, dementia, stroke, MS and other neuroinflammatory disorders, epilepsy, headache, muscle disorders, peripheral nerve disorders, neuro-ophthalmology or neurorehabilitation. The ABN offers an overview of the kind of patients neurologists see. The most common problems encountered in new patients in clinic, it


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