Could you tell us about your specialty?
Like all surgical specialties, neurosurgery is highly varied and challenging. Neurosurgeons manage diseases of the brain and spine. As such, the risks and benefits of operating vs. not operating are sometimes finely balanced and decision making can be as challenging as operating. As a young specialty, high-quality evidence – i.e. randomised controlled trials – to guide practice is often lacking. As such, neurosurgeons often need make decisions on the basis of fundamental principles of anatomy, physiology and pathology. This, along with rapid advances seen in technological adjuncts to surgery – from intraoperative monitoring of brain physiology to advanced image guidance require neurosurgeons to be open to new practices. Patients can be very unwell, in a coma, disabled, in extreme pain, suffering from cognitive difficulty and scared. In these challenging circumstances, making the best decisions with individual patients and their families requires neurosurgeons who listen carefully and have the ability to openly explain the limitations of treatments as well as their potential benefits. Operative neurosurgery employs hugely varied approaches: from short, highly dynamic procedures as in acute trauma and hydrocephalus, to extended elegant approaches to delicate structures around the brain stem and spine: there is something for everyone. What led you to choose the specialty? Neurosurgery sort of snuck up on me - I never really had a sudden moment of realisation. During my early years of medical school, I found our neurosciences modules fascinating: I had (have) a fascination in disorders of consciousness, where a person’s experience of life is profoundly altered in ways that are impossible to imagine. From this, I decided I probably wanted to become a neurologist, or sleep specialist... however I was also interested in general surgery and enjoyed the privilege of spending time in theatre tremendously. The operating theatre is a place where you see things that few people ever are able to. You can visualise and sometimes even hold the cause of illness. Having the opportunity to place a few sutures, or diathermy blood vessels was addictive. It took me an embarrassingly long time, and guidance of a few mentors, before I realised that at the intersection of neuroscience and surgery was a potential career. Describe a typical day in your life? Clinical days in surgery tend to start quite early. I get up around 6am, have breakfast and check my emails. I then cycle into work and arrive around 7:30. This gives time minutes to quickly check on patients who are post-op and to double check preparations for the day ahead. If you’re operating that day you will have to pop by theatres to “brief” with the whole theatre team, including anaesthetists, nursing staff and ODPs. This helps to make sure that everyone knows what is planned for each patient and that, all the necessary equipment is available, and that steps are taken to minimise potential complications. Around 8am the registrar who was on-call overnight presents cases to the day team and the registrar who will be on call during the day. Most days, next comes the ward round, where – between the neurosurgical registrars that are available – you visit every patient on the neurosurgical ward, or in outlying wards such as the intensive care unit. During this you need to follow-up on changes in the patient’s condition and take steps to push forward their management. From arranging investigations before an operation, to ensuring that patents are referred to allied health services and social work so that they can get home quickly and safely. These days, being “on-call” usually means staying in the hospital. Doctors in GP practices, other departments, or hospitals will call you to get advice on the management of patients with neurosurgical conditions, potential neurosurgical problems or to refer a patient to be taken over by neurosurgery as an emergency. Emergency operations tend to fall to you, and you may have to make decisions about patients who become unwell on the neurosurgical ward. Shifts typically last for 12h, but some places still practice 24h shifts. There are pros and cons of each work pattern. Because decisions made by on-call neurosurgical registrars can have highly consequential, there is often a higher degree of consultant or senior registrar supervision than for some other services. This is reassuring in the early stages of training and the degree of supervision is slowly relaxed as you progress to completion of registrar level training. When you’re not on call your day can be quite varied. You might be in theatre participating in an elective operating list with your consultant, reviewing patients who attend the ward for semi-urgent review, or in clinic. As an academic trainee, I may also spend time the lab, doing data-analysis, planning new research projects or disseminating findings by writing papers and giving presentations. Towards the end of the day, you will usually try to make time to pop by the ward and intensive care unit. This allows you to follow-up on patients who you saw on the ward round and to review the results of investigations requested. It also helps to flag up any problems that are brewing before handing over to the evening or night shift registrar. When not on call, the day tends to end around 6:30/7pm. Favourite things about your specialty? Spending time in theatre. Working with other specialties and healthcare disciplines. Trying to dispel the reputation of neurosurgeons as arrogant and unfriendly. Seeing patients’ symptoms improve. Being there for families when things are not going well is tough, but often rewarding in retrospect. Learning. Highlights of your career? Training for six months in Cape Town, South Africa. There I observed some incredible surgeons who opened my eyes to the wider scope of neurosurgery: from hybrid open-endovascular neurosurgeons, surgeons conducting cutting edge translational research into infectious disease alongside physicians and basic scientists, to those leading initiatives to expand surgical services and training across the globe and reduce inequalities access to neurosurgical care and training. What do you like to do outside work? I play squash, run and brew beer – all to a mediocre level. I love a ski when the opportunity arises. Any advice for medical students? Getting into neurosurgical training is competitive and if you can start developing an interest (medical electives, research/audit projects) at an early stage you will have an advantage. This puts some people off because they don’t want to over-commit to one specialty at an early stage in their career. However, I think that the focus of preparing for neurosurgical (or any other specialty) selection is beneficial to any CV. I was uncertain about whether I should rather do ICU and anaesthetics or neurosurgery – until the moment I accepted my neurosurgical post. However, having a CV that was geared towards neurosurgery wasn’t a major disadvantage for application to other specialties as my neurosurgical preparation could be related them and had allowed me to develop relevant skills. So, my advice is to throw yourself in, get the experience and if you find that something else takes your interest, don’t be afraid to change direction. You will have learned about what you don’t want to do and that will make your application for what you ultimately choose all the stronger. What attributes are best suited to your specialty? I don’t think there are any particular attributes that make a good neurosurgeon: drive, interest, and a degree of intelligence and conscientiousness are important for all careers, I think. Personality-wise we are a pretty diverse bunch, and this improves the specialty. There are few women consultants in neurosurgery at the moment and, as such, neurosurgery lacks the benefit of many talented doctors. Work is ongoing to address the issues which driven this situation and hopefully things will improve. So, if you are interested in neurosurgery, yet can’t see neurosurgeons who fit your mould please don’t be put-off: we need you.
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AuthorsArticles are written by Edinburgh-based students and doctors, for the benefit of those interested in surgery. Archives
March 2024
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