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Hello and welcome to this lecture about how to become a neurosurgeon. This is basically your guide to applications to neurosurgical training in the UK My name is Doctor Chefs, um, a ham, the clinical education fellow at the Walton Center in Liverpool for neuroscience. Today, we're going to be discussing, um, basically a few steps about, uh, neurosurgical training in the UK. But to begin with that we have to understand what is neurosurgeon careers, like a lot of us go into medical school. And the common thing you hear is a lot of people will find the neuroscience or neuro anatomy and neurophysiology parts to be fascinating. And we get hooked very early into, um, choosing to do it as a career and understand Wi brain is the most fascinating organ of the whole body. And it's one we know not very much about still, with all the advancement and technology, so it's always exciting to learn more about it. Neurosurgeons divide into Big two divisions. There is a spinal neurosurgery, which is anything to do with the spinal cord and the better for college and everything around it. And there's cranium neurosurgeons. And they did with the brain and everything inside of it. And a lot of us go into your surgery thinking it would be a brain surgeon but doesn't sell. You mean that a lot of people find their passion towards spinal surgery a lot more fulfilling? And if we start talking about the spinal surgery just because of the less divisions than that, there are basically two big divisions. Obviously, there are things that common that everybody faces, and we all get trained to do, uh, during training. And it's kind of hold general conditions in neurosurgery. So everybody has trained to as a neurosurgeon can do them. For example, desk prolapses and any Hispanic cold compressions and simple things like this can be done by all spine neurosurgeons. However, there are more advanced or like subspecialties of the spinal surgery complex spine, which usually here to referred as, uh, for people who will have extensive spinal surgeries, things like fixations for kyphosis, Cleo's corrections and things like this. This is a domain that's shared between orthopedic surgery and neurosurgery, and they deal with more extensive, complex spinal cases rather than the straightforward compression ALS and then the other one, which is purely neurosurgical it's intramedullary operations or anything that is within the spinal cord tissue itself. So you get conditions, which are oncological nature Tumor's inter with other humors or schwannoma is meningioma is we must find record all of these things you can't be operated on. Also, there are some vascular malformations and, um, vascular, uh, spinal surgeries that are being done, although that is also being shared a lot now by a lot of the intervention, your audiologists. But that's one of the domains of the spinal surgery. In Crania surgery, there is five main domains, obviously being the biggest one oncology. Everybody thinks about brain tumours, and that's what oncology is. Is people who are operating on brain tumors basically, whether they are primary or secondary or metastases or whatever their vascular cranial surgery, which to be again. More obvious example of that is aneurysms and clipping of aneurysms. So they have to deal with everything that's vascular early, abnormal within the brain and the commonest being the aneurysm. But also you get AVMs are trivial venous malformations and, uh, any other vascular abnormalities within the brain. Then you have got skull base, which is everything to do with Ukrainian nerves level functions If you remember the the base of the skull that has all the existing foramina. And it has the bit witchery mainly. And, uh, these are the two commonest things. So the twittering surgery, which are approached by a skull base approach and all the cranial nerves So commonly speaking here about diseases like vestibular schwannoma affecting the eighth Korean nerve Or, uh, this is African, the seventh efficient of things like this. Okay, And then we have hydrocephalus, which is anything to do with the CSF circulation within the brain and how people who need chance since either childhood or uh in adulthood due to whatever hydrocodone, lick reasons, is our primary or secondary hydrocephalus to other diseases going on. So hydrocephalus being another big domain as well. And then we have got functional neurosurgery and this is not in the like. This is not like functional neurological disorders. This is functional neurosurgery in terms of dealing with brain function. When we refer to the biggest examples here in terms of epilepsy surgery, so things that have, uh, to control with basically either putting in, uh, invasive monitoring for epilepsy to find out an epileptic focus or putting into other advanced devices to deal with, um Epileptogenic Force I and things like deep brain stimulators and other things like that. Parkinson's disease? Obviously DBS is useful for that. And then also, spinal cord stimulators and other things related to that is functional neurosurgery. So in general, these are the obvious things. Obviously, there is also trauma. But that's again one of the general things that everybody is trying to do, like burr holes for securing hematomas and craniotomy knees and things like this, which again everybody is trying to do. So how What is the progression of the pathway of this career? How does someone transfer from or like, develop from becoming from being an F one F two into becoming a fully trained neurosurgeon? There are different pathways for this. Obviously, we're going to talk about the three commonest ones within the UK here, the Communist one is what we call a blue one. Over here, you can see is what we call a run through training program. So you finish medical school, you finish your foundation training one F two and then you apply for ST one run through program. Eight years of neurosurgical training all through. And then you get your ST one. You do s t one s t two six months of these, our neurosurgery and the other year and a half you're rotating on other surgical specialities just to gain more operative experience and have also some sort of rotational experience. So it's not just very, uh, tunnel vision to neurosurgery. And then you carry on from ST three onwards, becoming a neurosurgical registrar doing different all of the other admin on that kind of sub specialty of neurosurgery that we talked about which you call usually firms. Okay, so that goes on from ST three on the LSD eight, you finish your exams, the fellowship, obviously the, uh, membership of the college and the Fellowship of the Royal College in your surgery. And then you become, well, basically a post CCT and a fully qualified neurosurgery train. But usually that's not enough to give you a job as a consultant in the UK and the current, um, in the current market, if you may. So there is always a need for other things to be done. Most of the trainees now do a PhD which takes you add for three years. Most people don't know about ST for ST five time, and then after they finish their training, they do a fellowship in to CVS Specialty, one of the specialties they like. And they prefer to get a consultant posting and do for, like, longer term and therefore they after they become consultants. So that's the most straightforward pathway that you can actually face at the current, uh, like job market in the UK There's a different pathway to that that used to be a bit, well, more more, more, more or less available to people who don't get into, uh, run through training, which is rather than just doing neurosurgery or with with a number of securing the neurosurg neurosurgical registration from the start, you're basically doing a course surgical training before that. So again, it's the same thing you do medical school. You do a foundation training in front of two. And then, instead of just if you didn't get the ST one, that's why usually happen. People also apply for course surgical training, and they get 10. They do, uh, orthopedic trait themed on or neurosurgical theme. Don't they basically do few other rotations? Ent, maybe and the neurosurgery. Plastics, general surgery, things like this. And then they apply for ST to entry. Or do they even apply for ST one entry again? But there are also required, like limitations on that which we will mention our tap on during this, uh, session. So you you get into the ST to entry or the well. It used to be an S. T three is a registrar level entry after having done some course surgical training before. So you carry on from there, and again, it's the same thing. You have to finish your training, which is up to ST eight, and then you'll find yourself facing situation that everybody else is having a PhD. So you have to on fellowships, and you have to do one as well. And then, after you've done all that, you might be able to get consultant job as well. So it doesn't really matter, except for that part over here, between transition from cryosurgical to the neurosurgery, so you'll basically have to apply again the while after you finish your post surgical training into that, these are the two clinical bath ways that are common and standard. Now there's an academic pathway, which is like an academic clinical number. So basically, you do medical school foundation training and then plus or minus core training in surgery or medicine. Whatever. Meanwhile, you apply for an academic clinical number. So basically you have an academic clinical post, and these are more limited than the um Then the clinical just numbers basically and basically offered for people who don't academic foundation training rather than the normal foundation training. And they have huge interest in research or academia. And, uh, they usually are people who are working closely with prominent academics, neurosurgery, prominent researchers and professors. And through that, you can get an academic number if you got accepted into doing basically research theme neurosurgical training on to a specific thing. Once you do that, you'll do your research and your clinical. So your year is planning to nearly nine months of clinical three years, three months of academic research stuff, and then again, it's a similar pathway you got in. It's a it's a run through. Yes, you do from ST 12, s. T eight, and you still will have to do a PhD. But probably you'd argue it's easier for people who don't academic rated a PhD because they already are working on to a project and then do fellowship and become consultants. So that's the your three major pathways. I'd argue that these two are the straightforward clinical pathway. This is the straight word for the research pathway or economic pathway for people who are interested in academic training. Now is it easy to join neurosurgical training in the UK? Let's have a quick look at the competition ratios, and these are the recent numbers from the past three years. Uh, you would have correctly so have had and are aware that it is one of the most competitive trainings to get into with competition issues becoming something of ridiculousness and numbers or higher up on the market. Like, I think it only topped up by cardio vascular surgery. Cardiothoracic surgery. Sorry and yeah, maybe dermatology. These are the only two more competitive ones that I'm aware of anyway. So you can see also, if you look at the numbers throughout the years, the game worse and worse. So it was in 2020 it was 6.54. That was the competition ratio from applicant to victim appointed two vacancies, basically for ST one level. And then there were three S T three levels in the country. So 21 applied. You got basically a seven that was quite close from ST 12, s, t three. But then they changed that from 2021 over on words. There's ST three Entry, but they reduce the number. So it's only one position in the country. 22 people applied to the competition. She's 22 the ST one numbers have also stayed the same, but still much more like number. The number of applicants have been a lot higher. So 220 So we'll give you about 8.46% like conversion ratio from applied to appointed. Basically, uh, 2022 is quite shocked because they basically said they have over recruited people in 2021 then the, uh SPNS the Bridge Society of Neurosurgeons have basically come out with a statement saying that the current there's currently overflow or influx of trainees that we don't think we're gonna be able to appoint them as consultants in the by the time they finish their training. So they suggested that the national recruitment office reduces the number of applicants that they take and because they said they recruited over what they should have in 2021 I think their target was 21 people. But they recruited 26 that They said they're gonna lower down 2022 to 15. So the competition ratio again, You see, the application number is not that much increase. So 204 but the competition ratio obviously became 16.1 and the ST to Level, which they've introduced newly to assist them because they deleted this history entry point and they decided, Well, we are actually having, uh, well, lack of, uh, basically juniors uh s h O levels in your surgery. So they added ST to entry, which you have to do S H O role before you become, uh, an S t three. And your surgery and the four the competition rate have dropped have increased from, well, 22 29, 59 again, it's only one post. So, um, I'm not sure what the point is behind that recruitment post of having 59 applicants to go through and competing for only one post Um, yeah, it's a bit as you can see, the skin worse and worse. And there's more interest, obviously, in the neurosurgery. But, uh, the numbers are getting more limited. The the current vacancy of being 15 only last year is not expected to last. I think they meant to just correct the over equipment that happened 2021. And from 2023 onwards, it should go back to 21 around 2021 vacancies per year, which they plan to do. Um, yes. So, basically, it is competitive before you need to know exactly what you need to do to maximize your points and your position in the competition to get a number. So what can you do? First, you have to be aware of what your deadlines and timeline frame like. This is obviously, uh, one of the things that, uh, you keep in mind you basically working according to plan and has scheduled on timeline. So this was the one for last year that was 2022. Recruitment. Basically, people started in August 2022. Application opens around November 4th. So, Ellie November, you get released application and then you get a month to, well, basically fill your application and submit it. So it's by December 1st it was closed, and then they go through all the applications. Takes about three weeks, obviously, given Christmas like so it's until the seventh of January. Uh, the review, the applications. And it's not short listing, which we're going to talk about the short listing criteria after. Now they've introduced the MSRA Multi-specialty recruitment assessment test, which is, UH, G P exam, basically. But it's very similar to your final your exam in terms of broadly speaking about just general medical conditions and some professional dilemma questions. And that usually happens in early January. For the first two weeks of January, you have said, and that your score in this MSRA test counts towards your overall score in the short listing or the interview, and then you get an interview if you are so. Basically, this is another filtration phase, which is the MSRA test. So people who get the highest so basically, if they decided as you've seen there was 240 to apply applicants this year if they decided to interview 100 so they'll choose the highest score ing in the M S r A and the short lasting. So say sorry. So they will shortlist mail 150 then choose the highest score in 100 to interview. Then they interview them in March. As you see that the fourth was this year. And then you get scored based on your short listing. Score your application score basically, and your MSRA score and your interview score. So all of these are like different three kind of assessments exams through which you're being scored. Numbers and the highest calculation of numbers are the people who get highest ranking in the national selection. They get choice basically of applying to whatever they like. They get them offers and then you have a chance to look at the offers. Hold it well, until maybe you can upgrade. Somebody drops off. Somebody decided to change their mind. Whatever. And then you get the deadline to basically accept or refuse your offer on April. It was early April this year. Usually it's the end of March. But this year was early April. So and then you get two months. So basically brace yourself when you're surgical life. So what are these? Um, this is a short example of what is like how how hectic is for people applying from basically November onwards until April. It's about a good six months of your life focusing on this just interview process and application process. So, uh, as we said, the high scores, the people whose core highest are the ones who get free choice to basically, um, to get a to get a job or not. And basically, the the better score, the higher score, the better offers you get. This is the last year is like, Well, this year is 2022 short listing scores and this is your application, basically score on this. And this is where you need this from now on, these sort of things you can actually work on. And this is your holy career. This is your Bible. If you want to be a neurosurgeon, these are things you need to work towards from now until you graduate well until you finish your F one F two and actually apply to your surgery. So these are the things you can actually change things about, and the earlier you start, the better the chances are you have to scrutinize these criteria and know how much they score on each so you can focus your efforts if you if you're tight on time. So if somebody is listening to this lecture and they are F one or F two or F three and they decided to apply to your surgery. If you're time sensitive and you don't have that much time, then you choose the things you can actually work on, and that will give you biggest scores. So if you look here, for example, the first thing is undergraduate career research, audit quality improvement prices towards all of these things you get, you get basically in the the application you get questioned upon them, and then you have to provide evidence improve of it and each one of them get your number. If you've done a research or participate in research, you get a point. If you've done audit or quality improvement, you get a point. You had a bridal or nowhere to get another point, and that's your three points. Undergraduate electives and attachment. If you've done them one or two points based on how relevant they are and how well, basically, how how much they create them or how much they think they compared to the post. If you have a higher degree, if you have a master's or PhD, you get up to three points. Obviously, PhD three master's, too, and another degrees or one that excludes anything you've interc elated with interpellation itself. If you got P C or whatever you get, like one or two points on that, if you have done them and if you have any other degrees or diplomas. If you have done something that's not medical, say, for example, for Suffolk ER or humanitarian before you've applied to medicine or as a grad student or you have a different degree in something else, you can get another point of those. If you are, that's that's all until you graduate both graduate research if you've participated, or basically, if you're published in research now, it's because it's only one point. They don't care if you participated. They want your publication as a first author. Ideally, you get a point postgraduate. I got to make awards and prizes. If you've got a regional one, I think you get a point if you got a national and get two points close. Craddick Clinical courses. They give you up to two points of the courses that are relevant significant to your training. So basically, the stuff you have to do is I think a T l s and, uh, stuff like this. And then they give you either one or two points and then based on how well neurosurgery oriented are they if you have done a publication, it's up to three points based on where the publication is. Is a publication in a conference or like just a poster application, or is it just a publication in a non B reviewed journal or peer reviewed journal? Um, presentations, obviously again, re local, regional and national. You get up to three points on that. If you have done audit and quality improvement one for other quality improvement, too. For closed loop audit project, which are things you can do organization leadership skills. And they need evidence of something cemented here not just saying that you've led your own local football team. They need something that you have done within the NHS that actually shows leadership and, um, organization skills. Um, and then again, you get scored up to three points on their space on how regional national artist practical and psychomotor skills easily. That's the question that used to ask about if you've got any supports you're interested in or any skills you have. So a lot of people who do rolling or swimming or basketball and you get up to three points if you are competing locally regionally, or you've got a national or or above them that like award for actually doing this. If you've played kind of in a similar person way for a bigger team on the National, competing on national teaching, and that's become a big vague because they change it sometimes, based on, if you've done formal teaching, a lot of you would have done some informal teaching anyway. But that doesn't really score points anymore. You need to have done formal teaching, something recognized by the university or whatnot. So something like people who organize this course can be given, uh, regional points on that. There are people who are participating in national teaching, and then they give you scores based that if you've got any qualifications in teaching, if you got, uh, basically, uh, a certificate in teaching is in, like some sort of, uh, P g cert or something more recognized in teaching. You have a degree in it. So yeah, you get up to three points on that, and then your person statements are things that you get scored on based on how well can you sell it? So they're basically going to guide you on the application to tell you what exactly they're looking for. So they ask you to talk about yourself, Why you're applying in your surgery. What do you think are the criteria that in you that are good for a neurosurgeon and how you can basically see yourself as a consultant? So in gold kind of things and you get up to three points and this is very, very subjective. Based on how how will you express yourself? Align yourself with these points that they refer to in the application and how they perceive what you've written. So that's all to 42 points you've got. I don't know how long you've got before you have to apply. This is your Holy Grail. This is what you need to be as close as you can to 42 points, and it's all the tick box exercise, and it's all what you know, when these boxes that you need to tick is what we'll get you there. Uh, so, yeah, basically, I've not been aware of this, so I'm not I'm not former trainee. I was a former tree. I didn't train in the UK. I trained in Egypt and I got into neurosurgical training in Egypt. I was 61 there, and then I decided to move to the UK and the the offer. Obviously, I got at the start to start in the NHS. It was just the clinical fellow kind of thing is like a trust grade or trust employed doctor, obviously not training number. Actually, at the time, I wasn't allowed. So after 2021 you were not allowed to apply to training in your surgery at all. If you were not trained in the UK But then they changed it. And then now I can. And therefore, once I started digging into stuff, that's when I found out about this and I started working my way towards, uh, these points, but yeah, that was, like, kind of one of the things that pitfalls. If you may say about how training, uh, for me or applications were training for me that I could have improved if I knew about these early on. So it's a good point for you to start working on these from from early on. Then you get to the actual, um, basically limitations versus desirable criteria into, uh which what type of person are they looking for? What type of applicants they're looking for? They're not looking for somebody who is already a neurosurgeon. Remember that they are looking for somebody who they can train to become a neurosurgeon. Okay, so what does that mean? What? Where do you find these? These are they come with the job advert itself. They have that person specifications for what kind of person. They are looking forward to become a neurosurgical trainee. And when you look at, when you're done with, that file is very important because you'll find essential criteria for entry. And then these are the ones you will basically be allowed or not to apply to the training with. And some people will be dis dismissed from the start based on that. And I'll tell you how in a second and then the selection criteria are basically these are the things that are gonna get your short list as well into possibly exam. But anyway, the more you have of the STDs are supplementary to your, um basically, uh, national neurosurgical short placing score. So if you got as many of you can if you 42 points here, these are extra things that will distinction from other applicants as well, who are trying to get as many as they can from the 40 to. All right, so essential criteria are basically, for example, mmb, MBS, MBS are equivalent that you can apply with our medical degree. So if you want to understand and your evidence of that would be from the application, they will ask you to accept that evidence or GNC number or whatever eligibility. You must have full registration, whether hot license to practice. So if you have passed their fun, basically, that's fine. Have evidence of achievement of foundation competencies. So they want f one F two, and they've got either your If you got a foundation program. If you got foundation program a training foundation program recognized in the UK, you will have that automatically done for you. If you're not, you have to apply basically Here you go. These are the options. So, basically, current employment in UK Foundation Program Affiliated Foundation program or and foundation program accredited from a U. K. Within 3.5 years preceding the advertised start date. So basically, you would have finished it. But either you just finished it or like you're in it, you're an F two at the moment or you just finished it, but it cannot be more than 3.5 years. And then if you have trained like me outside the UK, you've got something that was called and you have to have 12 month experience in the UK and what they call the Crestor the certificate of redness to enter specialty training. Basically, it's a form that says, Signed Off by consultants saying that you are, um, well fed enough or you are safe enough to become a trainee. Fitness to practice obviously, is something they are aware of the safety and aware of the training needs and then language skills. You must have got English, uh, language efficiency, which again, if you study in the UK, these are not issues, but these are things for applicants from abroad. You have to, uh, MGs have to prove that they have enough English language knowledge. For that, uh, your health must need the G M C requirements, and you can see that and that would make a practice. Basically, if you have any health conditions, there are very few know those are limiting to training anyway. But basically, just see what the updated good natal practice on GM. See standards saying, and then you come to career progression. You must be able to give your full employment history progression consistent with your circumstances. So basically, while I explain this in a bit, basically, they are saying, um, that you should not be wasting time If you've graduated, you need to show progress here by year and have evidence of their prison level of achievement. So they want evidence of everything that you're doing at the moment. And then there comes the tricky bit. Is the time frame limitations on training that wasn't there before? But obviously with the increasing competition, they have added that 24 months and less of clinical experience to apply to ST one. So you can't have been a doctor. You can't have graduated more than 24 months with more than two years. So basically, you can't have done more than F one F two, of which no more than 12 months by any means into anything in Europe. So you can't spend your entire fun if to do in Europe, right, you can maximum do neurosurgeon. 12 months of neurosurgery, neurology, neurology, neuropathology and your intensive care combined. And that is, by the time and they you have actually started your training, which the training starts in August. So basically, that's by August 2023. Say, for example, if we're applying for, um well 2023 the next year to start. But that excludes your foundation module. So these are the extra jobs if you don't, which again is pretty much count of like that because they say 24 months or less of clinical experience, which basically, this is what they say. So here's the district, so it's two years post your foundation training. Does that make sense? So it's two years after you finish this, excluded the foundation change. So after F one F two, you can have done F three F four, and that's it. But of these ones, you can't just spend them doing your surgery or neurology on your I t. On your ideologies, you have to have done other things. And then if you're already in a training program, you have to, you know, tell your T V D. And then dismiss you as well from it and get approval to apply to different ones. And these are the essential things. If you have done more than you have done something like, for example, exceed the time frame or not done one of the essential criteria here, you're not going to even be allowed to process or progress with your application any further. So that is for the essential things now. Selection criteria. There are things that are essential, and there are things that are desirable. Desirable ones will increase your chance as well. Again. Qualifications. The essential one is your medical degree. Any extra ones will be desirable, but you already know that from your 42 points here and clinical skills. So that's a good one. So ability to apply sound clinical knowledge and judgment problems. Prior authorized clinical needs Maximize safety, minimize risk recognition of your own abilities. Recognizing ill patient's surgical patient's all of these things are your log book, and that's essential to show that you've done anything with acutely surgical or acutely annual patient's. However, it's desirable to show any kind of aptitude for surgical skills, something like hand eye coordination, May addicts 30 and spatial awareness. How would you prove these two things? Either the practical and psycho motor skills If you're doing anything that's coordinated, like rowing or something, like, um, basketball and the other one would be if you've taken any courses related to that, okay? And your referees can also be a point about this, your academic skills, you need to have some understanding for auditors and of research. So that's essential, right? But the desirable stuff will be evidence of you being participating in research and audits and quality improvement projects, something focusing on the patient's safety and clinical improvements. So they already given you guidance on what kind of audits you should be practicing or not the ones that focus on the trainees or the medical students and think on things like this. They ask you to focus on something related to patient's. They can't clinical improvement and then commitment to specialty, which is basically all of you attending this course is a commitment to specialty anything that's related to courses, pre pre grad courses in neurosurgery or even medical C level or courses that allow for Medical City in Georgia. Your doctor levels in neurosurgery that these are ones these ones are important. Teaching is part of the academia and then in taking any interest in teaching or evidence of feedback. If you've done teaching already, how do you prove it? You need feedback for that. If you got an instructor, status for a L S, A. T. L s or anything like this are are also a very good point. If you don't have an official recognized degree in teaching or a job in teaching, you can have the LS instructor or 80 less will be less. Any of these basically dissatisfied. But you can have any of these courses instructor roll, and that kind of carries similar points. And again, it will be based on your level personal skills, something you write to your communication skills. Obviously, your ability to communicate and demonstrate yourself will be obviously in your personal statement in the interview and then your interview as well itself and things like problem solving this room make, and they'll give you some cases in the interview. Empathy, sensitivity and capacity basically reflectiveness about how you have seen patient's and how that fits you and stuff like this. Respect for everybody being inclusive, being being kind of more aware of others around you. These are essential now anyway, ability to work in MDT format, multi professional teams and multidisciplinary formats because, well, any surgical job is a team job is you, anyway, ability to show leadership, make decisions, because you would be the leader as a surgeon on the team and then your capacity to work efficiently with the others. You can't be just like hating everybody you're going to work with. Then again, your capacity to manage prior authorize your time and your workload. You organize your ability to stop yourself from having any burnouts, and the training is hard, difficult. They already are aware of that. They just don't want you to to go into it without knowing that you can manage that vision. So capacity to monitor developed situations and anticipate issues that is basically you finding a problem. Intervene before it actually happens kind of risk assessment if you may coping with pressure here it has its own role. As I said, just your ability to work under pressure and your ability to actually show them how you've been already through some stressful situation gone through it and made you well, more, uh, more resilient and more hungry for the job values. They're basically align yourself with the core values of the NHS. That's all they ask. And the health education, then the the desirable stuff are kind of any evidence of management experience. If you've done any extracurricular activity, people leading, uh, the neurosurgical society and any of these things take evidence for all of that work because that would be helpful in the application, um, and understanding of the NHS. Management and resources basically understand what the key. There are some key papers that determine some governance issues in the NHS. Been talking about resources. They will always ask you and up to date issues with the NHS, um, and how you can fix them. And I think one of the common things about neurosurgery is like basically, how do you see the resources for, um, neurosurgery are in terms of developed, like how are we able to cope with the development of aging population. More and more, uh, neurosurgical neurological pathologies are, uh, more prevalent in the community. How they deal with that things like this effective entity approach. As we said, Well, I can leadership anything that's work based based assessment from different people showing that you're a team player. Basically, uh, I t skills. Well, your application is good enough for that. But any anything that showed that you can do if you actually can do, um, more advanced I thi things that would be better because a lot of a lot of the NHS uh, well, basically, start now are looking for more. Well, there are a lot of our work is related to technological solutions to some outstanding issues anyway. And yeah, it helps. It helps if somebody knows how to do, uh, say a program or design a website. These things are useful because you can use them for teaching for resources, for data gathering for things like this. I mean, I worked with somebody who's developed, um, their their own, like, kind of inpatient system. Um, it was a whole program, like on the computer that he used to was like uh, e p r like. And if the patient record, he developed it himself in house in the hospital, and that was in Cairo, and it was just He's one of the neurosurgical trainees, and I don't know how he found the time to do that, but yeah, it had all the identifiable. It's like it's as good as any other I've worked with, actually, if not better. Um, yeah. Also, uh, some other people, um um, I've worked with who are very well tuned into this and actually managed to create something as great as, um, for example, Orion for a fair on online interferon system. For all the neurosurgical. Well, a lot of the neurosurgical centers across the country. Um, so, yeah, this came from a neurosurgical restoring Cambridge. So yeah, Here you go. Uh, if you actually have some more advanced knowledge of I t. That can help your case and your trust. So be good. Um, other evidence of achievement of things outside medicine. They still want to know that you have a life, even though you've wasted it doing all of this pre recruitment stuff, but your face still need to be able to prove to them that you can actually do other things outside of work. You have kind of terry work behavior some good. Well, if you may, and then evidence of any organization skills other than understanding medicine, anything that shows that you can actually organize events, things, stuff like this. Okay, because you a lot of your work is managing people, and a lot of it has been organized being aware of what needs to be done in time. Okay, so these are things that are new personal skills and propriety. Obviously, this is essential to not have any issues with that And not have anything come up against you in terms of saying like this is unacceptable behavior from a doctor, a surgeon or whatever, and then your commitment to specialty this is usually an easy bit to go. So show how you're interesting to your neurosurgery, and that's an easy thing to show. Well, basically, you need evidence is on these things, but basically all the conferences you attend to all this kill, um, clinical skill sessions or the courses that you attend, all the things that are related to neuroscience. In general, neurosurgery can be added here and remember, it's not only specifically neurosurgery things, but you can always turn anything towards tailor it in a way to become more relevant to this. If it's, say, common surgical techniques or, um, just general neurological conditions or ideological things, any of this can be tailored to fit here. Makes sense. It's It takes a lot of skills and criteria to be able to do that. Okay, Right now, this is my favorite slide of this. Do you actually want to do this? I know. I know you're all here because you love neurosurgery. I know that. But you have an idea of what it is like and how your life is going to be like, but you don't actually know, especially with these criteria being added that you cannot have done more than 12 months of neuroscience. Uh, tool. Before you actually sign your life away for eight years or more for neurosurgery, you can't tell for sure. And most of the ST ones that I see nowadays have not done a job in neurosurgery at all. They just think it's nice because they shadowed as medical students and there's a fine of two's. But it's different. So there are quite a few important things, too. Think about here. Not in a bad way. I'm not saying that you can't do it. Anybody can do it. One of my favorite codes. Ever buy a neurosurgical Consultants, he said, that he can train a multi to become a neurosurgeon, but it's not about that. It's about whether you want to do it and whether it's good for you and whether that's where you see yourself best. So the biggest question being about work life balance because, yes, it is a very exhaustive career, and you will need to invest a lot, a lot more of your time than anybody else, maybe into doing this. So be a well aware of the sacrifices you would need to make to make it work and become a successful trainee and not drop out be and rightly so. In the selection criteria, they change it, and then you need to be able to manage your own stress because nobody has the time potentially to help you cope with the workload with the exam load, with the stresses of the job and some other things, um, there are things to do that to be aware of as well as life things like how this job is actually more than you think. And the outcomes are not, as always, happy as you would like them to peace. So how are you gonna be able to cope with such a kind of a very devastating disease? And how can you separate that emotionally from seeing your patient's going through your journey and then not get that into your head on affecting your enthusiasm to work in your ability to perform your job as well as, uh, as well as you should and apart on this all of the extra stuff you need to do outside of work as well to maintain your career progression in terms of like we said, PhD's research studies? Uh, audits, um, courses, exams extensive, less. That's not to say whatever you are gonna to be doing at work is alone. Not enough. You still have to go home and do more to be able to just finish training not to become a distinguished, like excellent train training or anything, just to be able to actually finish the training. Uh, but yeah, these are things to consider. But also to consider is that It's not your only option if you like neuroscience. Yes, um, it's not just in your surgery. Maybe you would like neurology, which has all the neurological conditions, all the neurological disease you see as well. However, you don't necessarily have to, um, deal with the same requirements that the surgical side has, and not the same time, pressure and training, pressure and competitiveness as well. But then again, maybe you like operating. But it doesn't have to be all surgical operating. Have you thought about interventional radiology? Interventional neuroradiology is an emerging kind of competitive training pathway for people who are interested in neuroscience and operative methods. But not necessarily. It's minimally invasive under ideological guidance. Yes, there are risks, but still it's taken over and over slowly, slowly, more and more of the neurosurgical patient's domain. So this is something you can do which could allow you to have maybe still yes, still has on call. Still, as time sensitive and still has all the same pressure that neurosurgery has not maybe a better life balance and things like this. So, yes, think about the other options, and if you're even sure about your surgery, still explore other options. When you're put in placement, do not dis it. Do not disregard it. Just go through it with an open mind. Don't set yourself up to something that you think you know how it's going to play out, But you don't actually have any Like, um, guarantee that you will enjoy it once you start doing it. So have more of an open approach to things. And, yeah, give yourself a chance to see what else you like. So what if you can't get into training? Is that the end of the world? No. Well, if you still are decided in your surgery, there are few things you can do. So the first and communist thing you're here is to see the pathway. Basically, it's a shadow training pathway. You do exactly the same thing as the trainees do without being in a formal training position. So you get a yearly contract type thing as an asset show, and then you upgrade yourself. After doing the exams, you get a registrar job, and once you finish these things, you're allowed to, uh, once you meet the criteria for the f. R. C s exam, you're allowed to sit your examples. You pass your exam, your have the opportunity to collect evidence of doing exactly everything that you need should have done within the eight years of training submitted to a committee of neurosurgeons and get it either accept reviewed to be hopefully accepted and added to the specialist pathway. So that's what we're going to see. Their pathway pros and cons of that pathway is that a you get your own flexible time to go through the training as many or as little years as you like. If you finish everything you know, one here and then you're ready to go, Uh, well, Superman into the next phase. That's great. And on the other hand, if you have other issues going on in your life, you want to take years slower, a year out or whatever. You can do that without risking dropping out of training or losing a number of license and, uh or you sorry, your number of training and then you will be less stressed about that, Uh, Collins are It's not really a guaranteed pathway. It's usually a lot harder to collect all the evidence because you don't have the, uh, like the yearly trick points the trainees usually get, and yeah, that's that's quite yeah, it's quite hard to sometimes manage. Uh, if you're not used to it. Um, well, you know, that is that's 11 thing to consider, though. And yeah, if you if you feel full or the criteria and popular exam there seriously should be nothing to submit from actually getting your, um, kind of specialist registration and becoming on the specialist register for the u G N C for neurosurgery. Uh, the alternative routes is too well, basically, As we said, the trust great jobs, which are the yearly contracts, are basically covering a service provision job without an official training number. And this is what I have done in the UK for, like more than three years. And it has its pros and cons. Um, yes, you can choose whatever like the center you work for. I basically could choose all the centers, and I worked for the two biggest ones in the country. And you're again. Yes, it's a service provision, but because they are always training units for neurosurgery, you end up having all the same well, not saying, but you have similar opportunities to the trainees to actually see all the training they go through. And because they have the facilities. If you are persistent and your key, they will teach you, um, the the These are the pros, and the cons are it's not guaranteed. It's not a training post. So you're not. You don't have a protected training time. You not have protected time to do your exams. You don't have time to do your list. You basically come. I want to say second, too, but it kinda is. You come second to trainees after they get their study leaves and, uh, their training needs first met, and then you can join after. However, there's usually more than enough to go around for everyone, to be honest, if your key, uh, other con for that that it's just as we've seen, it's now become more and more limiting to your, um, basically your ability to apply to ST one because they now limit the time you can do before you actually apply to training. The biggest pack of doing the job is that will actually confirm to you or the what the job is like, and you can decide for yourself have to haven't done it for a year, too. If you want to start persuade. If you wanna do persuade it to become a training number in your surgery or not, there's academic careers, which I N I chart. If you like neuroscience, you can do some sort of neurosurgical registrar research shops, which are funded by the N h i n I child. And they are basically research grants that you do the research at the main thing. And if you are well, su orange discharge depends on your level. You can do, um, some clinical work with them. You're added to the uncle wrote all most of the time, and it helps because you kind of see the on called acute stuff the bread and butter of neurosurgery and the surgical provision of the clinical stuff. But at the same time, you're advancing limits in research. If you're interested in academia and you couldn't get into academic training number, for example, um, there are international routes. There are some people who say, for example, if you're graduated from Europe, uh, they're basically if you passed the European board examination in your logical surgery, and if you have any other equivalent of the F R. C s. Basically, you can be resisted as a specialist on. Then you're basically on the G M C. Registry. Uh, so you can be a neurosurgeon in the eyes of the G M. C. Yes. No, you would get an actual, uh, consultant job here with that. I haven't done the efforts. Yes, I have no idea. I have not seen it myself before in this generation in older generation. Yes, but these are people who are actually were recognized or established in other European countries, and they come in, um, basically transferring their expertise into the practice here. But in this generation, have I seen it not to be honest, but still is an option. If you can clear your exams and you wanna be on the registry in a different way, that will set you up to do it. And that's what I meant by the GM CSF British register. Basically, there are so many ways to get on to the specialist register and become a recognized neurosurgeon in the eyes of the GM. See some of a C. C t. Completion of a certificate of completion of training, or see their pathway or European pathway. All of these things are alternative routes. Okay? Um, yeah. The neurosurgery I had in my experience, um, was basically different. I grew up in a different country. I trained in a different country. I knew a different pathway to become a neurosurgeon, and I did it. I I've actually managed to get into the training in the hospital I've always wanted, which is the top ranking. Um, basically, like in the what, tertiary center in the country? Um, yeah, funny enough. They were doing the and presidential candidate health checks in the hospital. So, you know, that's big deal when, uh when when you're there that day. But then I wasn't really Well, They practice in Egypt is quite different than the UK. It's mixed health care, private and public, and there's a lot of, well, challenges that come with that. But I didn't necessarily want to do a private pathway or have that concern for money in the back of my mind. So I decided to move the NHS, also recognizing that the NHS training is probably the most recognized around the world anyway, So it gives me opportunities to expand, uh, wherever my practice want to go next. Um, that was not an easy start. That g. M. C. Does not actually recognize any other, um, non. Well, non European, uh, places to become doctors. So either UK or Europe and otherwise you're not, doctor. Even if you're trained in America, you still have to take an exam to prove that you're actually trained and as a doctor. So I had to take an exam to prove that, um, a doctor is the dream. See, two exams, actually, and an English test to prove to them that I can speak English. Uh, funny enough, all my life, I've studied in English, but still, these are realities for the eye MGs, uh, that they'll have to come across. So yes, people who are coming in from other places Middle East, Pakistan, India, other countries, even Australia. I think they have to take these tests. And, uh, it really is a defeat. It really adds a lot more weight to the to the move to the transition into NHS. And that is a completely different system, by the way. I mean, like, even though it's well established and it's shadowed, um, in many places around the world, but I wish I knew how the intricate it's in the arts of system like there. There's no support for the i N. G s. Whatever to understand the system is which is good that you guys, as medical students, at least know the system know the ends and outs of it because, you know, junior doctors and other people tell you about it. But, uh, with things I wish I knew is like seeing things like I was telling you, uh, tell you about the 42 points score system for the short listing for neurosurgery. That what What do I need to do to become a more competitive applicant or how to, uh, uh, do a day ticks? Uh, these are things that you don't actually know what they are. And, uh, well, you just lost completely in the system for, like, two months until you find your own feet and slowly, slowly. I'm sure I'm seeing that some people are actually having some individual kind of attempts to improve the situation, but not really established thing that you can actually guarantee that anybody who comes to practicing the NHS who's trained abroad will actually find it easy or supportive, uh, to to find, to find, to find their way basically around the system. Um, it's a challenge that I enjoy to take because it's much like you guys. Well, joining the F one f two wrote after just finishing, um, your your medical school training and hats off, really, for the people who just cut their, uh, 50 years short to join F one during the pandemic. So that was definitely harder, I think, than just changing the practice after you have applied, like acquired the knowledge necessary. Anyway, uh, the limitations of coming from abroad is different is just until the leadership system. You don't really have that much of a support system inside work. You don't know the system very well to know in the nets of it. But also you don't have support system outside of work most of the time, even if you well didn't come here alone. If if you have family or friends here, Still, it's not like where you have been living or trained because it's not home for you. So that takes kind of a toll, uh, in a way, on your mental health as well as on your, uh, well, abilities to compete in the practice. And yes, you slowly, slowly. Um, well, actually, pretty quickly, in my case, realize that competitive kind of opportunities are going to be out of your league, and you will have to actually realize that. Okay, if you want to, um, if you want to be recognized, if you want the same opportunities as training and teaching, you will have to do 10 times as much work as everybody around you, and you have to make your peace with it, and that's a good way to go about it. And I respect that in a lot of the I m GS that I meet. And it was a good thing that I was told when I moved here, and I find it a very useful tip. There are also other limitations that comes with the fact that you didn't train here. Um, in terms of just generally how well, basically different places around the world have different guidelines. So you have to familiarize yourself with the guidelines everywhere first, which is really useful to have nice guidelines, um, for for that to work without the start. Um, so yeah, neurosurgery as a nine g is very, very challenging. I don't think, um, doing training, if you're not aware of these points, is going to be possible. But if you are aware and you've done them in your local country, you have to compete with everything else but everybody else applying from inside the UK And this is going to be a fierce competition for you so well, something to be very aware of that the not to get so disheartened by the well, the competition or the reality of how the system works. Because obviously people who are trained here will be more familiar with the system, knowing better what needs to be done to get in. I think that concludes my, uh, lecture today or my talk. Thank you so much for listening. I hope that was helpful and useful. You'll find all of these information resources based on the health education, England websites and R E. L or R E L, which is the national recruitment office, um, kind of portal that we use for national recruitment or applications. Um, they will very soon advertise the around for 2023 national applications, so keep an eye out for that if your key and and have a look at how different it becomes from me a two year, Uh, I hope this was useful. Um, please let me know if you have any questions and you can drop me an email to get in touch with anything. If, after the course, If you have any further questions about anything else here today, Thank you so much and all the best to all of you.