Mr. Mark Hughes: Neurosurgery The Surgical Spotlight is a blog article in which Edinburgh-based surgeons shed light on their surgical specialty and daily life. Our aim is to educate students about each of the various specialties and the array of opportunities they bring. This time, we interviewed Mr Mark Hughes, a consultant neurosurgeon and honorary senior lecturer, who is also a member of both the Society of British Neurological Surgeons and the Faculty of Surgical Trainers of Edinburgh. Mr Hughes underwent neurosurgical training in London, Edinburgh, New York, and Leeds - and completed a Wellcome Trust-funded PhD en route. His subspecialist work focuses on pituitary tumours and anterior skull base neurosurgery.
His current research projects revolve around diagnosis, management, and outcome measures in pituitary and skull base surgery. His projects include developing of a smartphone based visual field assessment tool, exploring the use of artificial intelligence to analyse facial images for early detection of acromegaly, and the use of 3D printing to improve patient counselling and surgical planning for skull base operations. In the context of surgical simulation, he has been involved in the research and development of micro-neurosurgical and other minimally invasive surgery platforms. This work has been driven forward via the formation of a spinout company (www.eosurgical.com) from the University of Edinburgh and has had global impact, with simulators now in use on over 90 different countries and also incorporated into several regional training programs. The interview can be found below: What led you to choose the specialty? I knew I wanted to be a surgeon, based on a desire to incorporate dexterous manual work within my role as a doctor. My parallel interest in neuroscience and the nervous system, with its unparalleled complexity and beauty, meant that neurosurgery was an obvious choice for me. Could you describe a typical day in your life? A typical week involves a clinic, a full day operating, some emergency operating, ward rounds, meetings and MDTs, some teaching/supervision, a very little bit of science, and dealing with the relentless pile of paper-based and electronic admin. Last Tuesday, my elective list involved operating on a pituitary tumour causing acromegaly (endoscopic through the nose) then a second case working transorbital to remove a tumour of the orbit and skull base. For endoscopic skull base surgery I work within a team - including skull base ENT surgeons and an oculoplastic surgeon. I was also on call for 24hrs. Neurosurgeons cover large geographically areas which, for us, includes well over 1.5 million people in Scotland. As well as working closely with the registrar in providing telephone and electronic advice, we admitted several emergency cases. The following day involved urgent surgery on the spine for cauda equina syndrome and then a transcranial endoscopic procedure to treat hydrocephalus caused by a tumour. Amongst all this, there are wards rounds, communicating with patients and families and other specialties, and trying to keep the inbox under control. How intensive is your work schedule? My work schedule as a neurosurgical trainee was intense. Being a trainee is a time-limited window during which opportunities are many. Learning never stops as a consultant but one's remit is more defined. Working time rules (EWTD etc) are a double-edged sword and additional pressures on the NHS mean that trainees need to be ever more imaginative to maximise training opportunities. As a consultant, I now have a little more autonomy. Some skull base operations are long and our team of consultant neurosurgeons delivers a 24/7 on call service. Whilst I may not be in the hospital for quite as many hours now, I feel like I am perpetually connected! Favourite things about your specialty? It's a privilege and responsibility to take charge of someone's neurosurgical problem. When a patient does well, it is exceptionally rewarding. This demands an excellent team, of which I am but a part, and I enjoy the teamwork that is needed in neurosurgery. Highlights of your career? I'm too young to have a highlights reel! What challenges do you face? It is hard when patients do not do well. Bad outcomes in neurosurgery can be catastrophic. Learning how to balance introspection and resilience is a challenge that can't be taught on didactic curricula. It is probably a career-long challenge. It is also hard to try one's best to provide optimal care in a system that (at times) overtly prevents it. Having patients suffer because of political and system failings is demoralising. Thats said, at its core, the NHS remains a fundamentally excellent idea and I am hopeful that some of the current problems will be improved in future. Any advice for medical students? Indulge your interests and take your time. The road is long and there's no rush. It is almost inevitable that any meanders to your career path will bring benefits to you and or your patients. Try not to be too saddened by the state of the NHS! It has certainly got major problems just now - but these can still (just about!) be fixed. It is also important to remember that the grass isn't necessarily greener elsewhere. Do not be afraid of hard work. There is satisfaction in doing a good job and knowing it was only possible because of the investment you made in gaining skills and knowledge. What attributes are best suited to your specialty? Working as part of team, taking ownership of patients and decisions, communicating well (often remotely), being able to make decisions based on limited information - and being good at gleaning the important information, being empathetic (but not disabling so!), endurance... The list goes on but these attributes are good start. Who is your biggest inspiration? There are many people who have inspired me in different ways and at different times. An early primary school teacher encouraged an early interest in anatomy by allowing (encouraging) some early dissection of a dead hedgehog! A small number of my trainers have had a particularly big impact, though all have taught me something. ESSS would like to thank Mr Mark Hughes for his co-operation in the production of this article.
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