Brief ‘definition’ of specialty
Using your logic and instinct to describe, define, localise and treat the problem.
Brief run-down of training programme content and duration
A five-year programme (ST3-ST7) with single accreditation. Training is based in teaching hospitals, with on-call usually from home. Clinical training in general inpatient and outpatient neurology, with sub-specialty exposure to fields such as stroke, movement disorders, multiple sclerosis, epilepsy, nerve and muscle disease, motor neurone disease etc. Many trainees will choose to undertake research or teaching degrees, some of which may ‘count’ towards time spent in clinical training.
Exam requirements
Knowledge-based assessment (KBA) to be taken between ST5 and ST7.
Other requirements
- Eportfolio (clinical evaluation exercise [CEX], case-based discussion [CBD], multi-source feedback [MSF]) and logbook to be kept throughout training
- Clinicians in management course to be completed before Certificate of Completion of Training (CCT)
Opportunities/expectations for out of programme/research
Neurology is traditionally thought of, and in reality still is, an academic specialty. As such, most trainees will undertake out of programme research (OOPR) (MD, PhD) or teaching degrees. Deaneries are generally supportive of this – but not always – so if it is your passion, make sure that the region you apply to has a good track record.
A day in the life of a Registrar/Consultant
08:30 am – 09:00 am: Arrive at work, get some coffee, check my emails, sign some letters.
09:00 am - 10:00 am: Meet on ward for rounds.
10:00 am – 12: 00 pm: See some ward referrals; sometimes complicated, sometimes straightforward, always thought-provoking.
12:00 pm – 12:30 pm: Grab a bit of lunch, more coffee.
12:30 pm – 1:15 pm: Academic meeting; an opportunity to present/hear about an interesting patient.
1:30 pm - 2:00 pm: Admin, discuss referrals with Consultants, review referrals again, check a few scans.
2:00 pm – 5:00 pm: Parkinson’s disease clinic – seeing a wide range of patients with Parkinson’s and other related movement disorders.
Pros and Cons of working in this specialty:
Pros
- Great if you like attention to detail and delving into the patient’s history for clues
- Gives you clinical skills that other doctors have never had the chance to hone – clinical neurological examination
- Fascinating trying to ‘work out’ the problem
- A wide range of teaching hospital sub-specialties that you can get involved in, but also suits those with an interest in district general hospital (DGH)-style general neurology
- On-call from home, and generally not too hectic, unless you do stroke thrombolysis
Cons
- A bad reputation for being stuffy and male-dominated – thankfully now no longer true
- A reputation for having limited treatment options – thankfully now no longer true
- Not so ‘hands on’ which puts some people off
How this specialty differs to others and what made me choose it
A bit more ‘thinking’ than in other more procedural specialties. More outpatient working and more chronic disease than most jobs. I chose it because I was interested in diseases of ageing (Parkinson’s, dementia), wanted to do a research degree and felt too stressed out when I was the Medical Registrar.
Tips for success in applying for this specialty
- Get into the clinics when you are an Internal Medicine Trainee (IMT) or Foundation Doctor
- Attend the regional academic meetings – this is where you learn the craft of neurological reasoning
- Ask around to see if there are interesting cases you can write up or audit projects that you can submit as a poster
- Don’t allow people to ‘put you off’ – I have never had cause to regret my change to Neurology
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