Dr Jacob Day (Neurology ST6) will talk through all things around applying to neurology, with an insight into academic careers as well.
Neurology: Applying for a Career
Summary
This online teaching session is relevant to medical professionals and offers an insight into neurology training, with a focus on day-to-day reality, changing trends, and the application process. It includes personal information from a neurology registrar on the days and tasks encountered during specialty training, which can range from post taking, ward referrals, and more, such as managing cases like headaches, strokes, seizures, infections, epilepsy and other neurological conditions. It's an essential overview for anyone considering or applying to neurology training in the UK.
Description
Learning objectives
Learning objectives:
- Identify common neurological conditions and appropriate treatments
- Recognize signs of stroke and take appropriate steps to treat
- Understand the application process to become a neurology registrar
- Discuss the changes to the new training scheme and how this affects future registrars
- Describe the clinical-academic training opportunities available in neurology
Similar communities
Similar events and on demand videos
Computer generated transcript
Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.
Talk about neurology specialty. Um what it's like day to day with a bit about applying. And I've also been asked to talk about sort of clinical academic side of training as well. Um So I'm gonna talk about my personal experience of neurology training so far. I haven't finished it yet, which will hopefully give you a favor for, you know, what the realities of being a neurology registrar are. I'm gonna touch on what's changing in urology. Um And again, we'll talk about this in a bit more detail, but um I am on an old training scheme, cos a new one has just come in as of two months ago. So anyone who is, you know, going into neurology training from now on is gonna be on that new scheme. So I'll try and talk a bit about that cos that's obviously gonna be relevant to, to people here. And I'm assuming that most of the people logged in here are gonna be, you know, predominantly junior doctors in the UK who are interested in applying for neurology. I will talk about the application process a bit, a lot of it's online. I won't go through all the details, but I'll try and give you the headlines and the sort of dates and things that I think you need to be aware of and just, just to have in mind at this stage. And like I said, I'm gonna talk about clinical academic training. Um I've done 22 posts of clinical academic training during my er training. Er and of course, this is, this is relevant to, to all medical specialties and not just neurology. So a few disclaimers just to keep in mind as we're going on, this is just my personal experience of urology if you spoke to a different registrar, even in the same hospital, but certainly a different registrar in a different hospital who maybe started a couple of years before me or a couple of years after me, they're likely to have quite a different experience. So just bear that in mind. And as I mentioned, I'm on the old curriculum. So some of the things that, that I'm gonna talk about or that are relevant to me may be a little bit different going forward and I've only ever worked in the South West England in the UK. Um So I've been, you know, quite geographically restricted in my experience. So again, just bear that in mind when you're sort of um drawing parallels to other parts of the UK. And again, I'm gonna talk for maybe 25 25 minutes or so. Um but hopefully you need lots of time for questions cos I imagine that some people might have questions that are specific to, to their personal situation or, or just about something that I haven't covered. So um please feel free to ask any questions at the end. So my experience in neurology, so a little bit of background just to try and orientate you about me. I try not to go about it too much. But so I was born down here in Devon. Um I went to Cambridge for three years, which is somewhere around here. Then I went to Oxford for three years and that was my medical school training. Um And then I came back to Devon. So I've done, you know, certainly nothing above Cambridge. So mostly South England and mostly it's been in Devon based. Um So I did my foundation years and my core training in Exeter, which is about here, the Royal de next to the hospital. Um And I've been doing my specialty training um in Dere Hospital, which is Plymouth, which is just 40 miles down the road around about here. I did get out for a bit and went to New Zealand uh between my F two and CT one years, which is really great and I could talk about that for a long time, but that's not really the focus of this webinar. Um So that's, that's geographically where I've worked. Um What have I done in terms of neurology? Um So I did do a couple of posts in neurology before my specialty training. Um so I managed to, to kind of ask for and, and was provided with a neurology attachment in my F two years. So I did four months equivalent of neurology in F two. Um I then did essentially the same job again in ct one, it was the same hospital, the same ward, which actually mean I've done eight months of neurology before specialty training, which I think is a, you know, a bit unusual, certainly not expected for people applying for, for neurology. And of course, I did it in the same hospital on the same ward. Um So you could argue that probably the sort of learning experience was, was not much more than doing it just once. So I was certainly not saying you have to do lots of neurology before especially, but, but just so, you know, where I'm coming from. Um I did also do a geriatrics placement during my, during my core training, which had quite a focus on Parkinson's because the hospital I was working in, er, the Parkinson's service was run by the geriatricians. So that actually gave me a pretty good handle on sort of inpatient Parkinson's management. And also I got to a clinic most weeks which was sort of quite unusual and really valuable in my core training stage. So that was something neurology related as well that I did pre specialty training. But of course, most of what you want to hear about is what specialty training itself is actually like. So I've been doing neurology, uh, specialty training since 2019. So I'm in my fourth year now. So I've done ST 345 and now I'm in ST six. I've done them all in the same hospital. Um, so far, well, I've just noted down a few things here. I'm gonna splurge at you about what I think about my day to day work. You know, the common things we see. Um Just to try and give you a bit of a flavor of it. But I'll try, I'll try and structure it a bit just around these sort of four areas. So what's a normal week for a neurology registrar? Well, if you take last week, uh I was on the ward. We have eight registrars in Plymouth. So we, we are on the ward one week and eight, which means we are not on the ward seven out of eight weeks, which is very different to working as a sort of foundation doctor or, or a core medical trainee. Uh So I was, I was on the ward last week. I was kind of paired up with a consultant. We do kind of Monday to Sunday. The same consultant is on call and the same registrar is on the ward and does the weekends you get really nice continuity. Um I was on the post take ward round every day with the consultants in the common conditions that come into hospital and watching, you know, a senior neurologist, post take, it was a really great learning experience. P is a very, um, it's quite a big hospital. Um, it's got about 1000 beds and it's got quite a big focus on acute neurology. Um, we also run the stroke service, er, and offer quite a lot of the Parkinson's service and also some of the sort of early onset dementia services as well. And those are all areas that aren't always covered by neurology, but they're pretty much all covered in Plymouth. So, so we have quite a large neurology service in Plymouth. Um the kind of things that we were post taking last week, there's lots of things like headaches, it's really common, thunderclap, headaches, headaches in people with conditions like idiopathic intracranial hypertension. You need to think if the pressure is going high and you need to do a lumbar puncture for that. Um people presenting with strokes again, really common tias. We had quite a lot of seizures last week. There were a couple of patients in particular, I'm thinking of one who is a kind of a new presentation of seizures and then a lot of that is working out or trying to work out why someone's developed new seizures in adulthood, you know, is it, is it just later on to epilepsy or have they got an unusual infection or, or something rarer, like an autoimmune encephalitis and all those things are treated in very different ways. So you have to be really quite careful about, about what, what might be causing seizures. And the other patient that sticks to our mind from last week was someone with, you know, with known epilepsy who had strokes sort of 10 years ago and had, had epilepsy as a result of that stroke was already on a couple of anti epileptics and I missed some anti epileptics because the pharmacy was closed and started having seizures, then got a chest infection and ended up being, you know, really quite problematic seizures where I had to give her lots of extra medicines and you know, really get on top of the infection in order to settle it all down. So that's quite a simple sort of reason for having seizures, just missed medicines and you've got an infection, but there's quite a lot of management issues to consider with that as well. So kind of ward rounds in the morning post taking. I do quite a lot of uh ward referrals in the afternoon. So not patients coming in kind of new to the hospital with, with neurological conditions, but patients who go to other wards who might then develop some problems. So maybe they develop stroke like symptoms on the ward or maybe they, they have, you know, like a seizure. Um despite coming in with a pneumonia to begin with or sometimes patients with sort of chronic neurological conditions who come in for an unrelated reason. So people with epilepsy who are in with infections, they might need a look at in terms of whether they're on the right medicines, if they're not swallowing properly, how are we going to correct that? Um, or, or other conditions, you know, myasthenia gravis is something, you know, that we need to, you know, make sure people stay stable because they can get very sick if their medications get, get disrupted and they can get very, they can get very unwell. So we try and pre empt that same with Parkinson's. Um, so there's a real kind of range of things as you can see from all referrals as well as the post take as well in terms of what we actually have kind of in on our ward. Well, our ward in Plymouth, every hospital will do it differently. It, it's kind of a shared stroke and urology ward, which means that actually the majority of inpatients on that ward are patients with strokes. So I think we only had about five patients with non stroke problems on the ward last week. But then we had a lot of patients in A&E in the medical assessment unit and often on other wards as well, um which is not ideal for patients, but that's how it is, unfortunately. Um, so I did that Monday to Friday kind of 830 till five and I was on call at the weekends, a kind of normal sort of long day, 9 a.m. till 10 p.m. And then, and then you do all the on calls, on call neurology and on call stroke. Um, and that's quite a big commitment, the the stroke side of things because obviously stroke is common and there's this real time pressure with stroke to assess people at the front door as they're coming in. Um, on the ambulance making a quick clinical diagnosis, doesn't look like a stroke then giving them a quick scan. So CT or CT angio deciding whether it's a stroke due to a bleed that needs BP management and reversal of anticoagulants or actually, is it a stroke due to ischemia? And should we be thrombosing the patient or, or taking them for thrombectomy? And Plymouth is a thrombectomy service, which is a, you know, exciting um service to be part of and is, you know, really great for, for people with big strokes who can get in and access that service. So that's what I did last week. Um But that's unusual because that's only one week and eight. You know, the rest of the weeks are quite a mash, a mash really. Um, you know, we try to get to as many clinics as we can. We have a nominal target of trying to get to 100 clinics a year. So that works out roughly 2.5 a week by the time you take annual leave and study, leave into account. Um, we're not making that unfortunately in Plymouth at the moment. And I think probably it's quite, quite rare for, for neurology regs elsewhere to make that as well. But, you know, ideally we get to, you know, when we're not on the ward or, or on annually things, maybe something like three clinics, um, which could be acute clinics like tia a clinics or admission avoidance clinics where you get access to same day scans, Doppler tests, blood tests, ecgs and you can kind of, they make a, a one stop shop where you diagnose the patient, you see them, you assess them, you do the test, you diagnose them and then you think about whether they need to come into the hospital, whether you give them the treatment and send them on their way. So that's, that can be quite satisfying. Um And then the other sort of more sort of normal sort of chronic disease management clinic. So you might be seeing new patients who have been referred in by the GP or you might be seeing people with long term neurological conditions under regular follow up things like epilepsy. Parkinson's multiple sclerosis, um headaches, I think they'd probably be the most common ones. So, again, very varied. So yeah, that's a mishmash. That's probably a, a kind of rough kind of idea of our normal week. We, we, we try and get one session of admin a week which again, is not something you get as a more junior doctor. Um, but you do need it because you generate quite a lot of admin through letters through clinics and seeing patients on call and discharging them. So that would be kind of one morning or one afternoon. And we also have a sort of academic meeting every Thursday morning, um, where cases get presented or audits and things and that's for the whole region actually. So kind of all for all. Um Devon and Cornwall. Ok. So common conditions, I cover some of this already. Again. Neurology has a reputation for dealing with rare conditions, but actually, particularly where I work, we see the common things because they are common and because as a neurology service, we do see them. So headaches, seizures are the new seizures or as part of people with known epilepsy, strokes and tias really common. And then patients with chronic neurological conditions who come in with complications. So things like Parkinson's or, or MS or MS is actually pretty well managed as an outpatient now, usually by a specialist MS service. Um so those are the kind of things you see, you know, we kind of work as a, as a diagnostic specialty quite a lot as well. So we get a lot of referrals for things that all this person collapsed, you know, could it have been due to a seizure or maybe a tia causing weakness and that's why they fell down and then it recovered. Um And sometimes then you just go and see the patients and you kind of take a history and you examine and you think about any tests and sometimes just like, oh, no, actually I don't think it really is in keeping with a seizure. So please carry on with your investigations for syncopic et fine. Um, so training, um I think as any registrar, not just urology and there's quite a lot more focus on, on your training. You know, you're going to become a consultant, you have to be trained properly so that you can be a consultant and manage these patients independently. So that's a really nice part of being a registrar, um neurology. We have this thing called Common Days, which I think are across the whole country. I think they're meant to be about one a month, but they probably work out as more like sort of 8 to 10 a year. Um And each hospital is sort of designated a topic within the curriculum to, to, to give teaching on and a lot of them done virtually now since COVID, but they're often really valuable and really great and obviously one poor person has to stay behind and do the on calls. But the rest of you get this lovely Thursday off and just get taught things. Um There's quite a lot of feedback from consultants as well. You know, working through your portfolio becomes a bit more of a sort of useful exercise rather than box sticking as it can sometimes be as a more junior doctor. Um, so, so I'd say the training opportunities, you know, the the specified training opportunities are really good. Sometimes we get a bit kind of lost in terms of having to do ward referrals, stroke on calls and things. That means we don't get to quite enough of the sort of training clinics where we get to kind of sit in and see the, the subspecialty side. Um, but I might come on stand a little bit later. I just noticed a little bit about practical procedures. So, um, neurology isn't really a practical specialty. So if that floats your boat, it might be best to think about something else. I mean, we do lumbar punctures. Um, you know, a lot of people do lumbar punctures, other specialties, more junior doctors. Um And then the only other things that we kind of are on the curriculum or for consideration are, are, are, are injections for headaches, Botox for migraines. Um And then also something called gon or greater occipital nerve injections which again use for migraines or sometimes other headache types. So those are the kind of practical procedures we tend to get involved with. There's no real competencies, you know, not you'd have for, you know, OG DS or in the cardiac Cath lab. Um So it is quite different from that respect, which is good for some people. But, but, but but, but not for everyone. So it just depends what, what folks or folks. OK. So that's a very sort of rush, sort of random explanation of what I think my specialty training has been like and what it is day to day and the kind of things we see. Um But again, if you've got any more questions, then please do ask at the end having assimilated all of this through the last three years or so. Um I come up with this list of good stuff for being a neurology registrar. It is really clinical. You hear people say this about neurology all the time and I was never really sure what it meant by this. I mean, you know, everything's clinical isn't it? But, but I think I do understand it more. You know, a lot of it is just sitting down and talking to the patient. Really going through the details of when did your arm weakness? Come on. How quickly did it come on? Did it spread? Which part of the arm did it affect? Did it involve the leg? Did it involve the face? Was there numbness? Was it just weakness? Was there neck pain all of that with a history really detailed, which is gonna tell you nine times out of 10, what the problem is and where the problem is. And then you go on and do your examination, which again, you do a lot of neurological examinations with which in general other people don't do just cos it takes quite a long time and it's maybe not so relevant to their specialty. So you become very expert at doing a neurological examination and interpreting it in the context of the history that you take and then coming up with a decision and often you can make a diagnosis just based on that without really any scans or, or anything, you know, a seizure is just a, a clinical diagnosis just based on the history of what happened according to the patient and the witness and a bit of an examination to see if there's tongue bites or anything that looks like it might be causing an ongoing deficit that's driving the seizure. So you don't really need any tests at all to diagnose a seizure, um which is really nice. Um Sometimes it's a bit frustrating because you think, well, all I'm going to do is come down and do a history and exam. So why can't the person who's referring do that as well? But obviously, you know, as a neurologist, you can see the certain conditions a lot more than them. So it is easier and then we can also instigate the outpatient follow up, et cetera, et cetera if it needs to be done. The other thing is that you do just see really interesting conditions. And I think this is the key thing. If you're interested in neurological conditions, then you're gonna enjoy neurology. There's a, there's a real range and they are really interesting. And also we've got new treatments now, you know, gone are the days where neurologists would just diagnose things and then discharged back to the GP. You know, there are obviously some conditions we can't cure, but in general, there are lots of treatments, thrombolysis, thrombectomy. Now for stroke is a real game changer, there's absolutely loads of MS disease model fine treatments that have really changed MS landscape. There's new antiepileptics coming out, there's new migraine treatments coming out. There's lots of Parkinson's medications as well which are not really prescribed in any other conditions so that there is lots of management to do as well. And they're really interesting conditions. You also need to work with lots of different specialties, particularly the other neuroscience specialties. I mean, like neurosurgery kind of neuroradiology, neuropsychology. So you, you form a bit of a sort of neuroscience network which is really nice as well. Teacher I mentioned about, uh, and then it is one of those specialties that's quite well set up for opportunities and research or teaching as well. So kind of going out of a program for that is kind of, you know, very accepted and probably more easily done than like that specialties at the moment. I'll put no nights, but I'll put it in brackets because that's probably gonna change and I'll come onto that in a bit. Um, of course, there's the less good stuff and I wouldn't be giving you a balance talk if I didn't highlight some of this and I would be lying if I said that every day I went in and had a great day because that's not true. Um And some things are very frustrating. Um But before I get bogged down with less good stuff, the headline is that neurology is a really great specialty and it's really interesting and overall it's good, but obviously you need to bear in mind some other things that, that might put you off. So there is a lot to cover. I mean, probably every specialty says this but, but I think it is definitely the case with neurology and there's lots of subspecialties, you know, I felt like I made the decision to do neurology. It's like, great, I've decided I'm going to be a neurologist and I was trained to be a neurologist and a few months in you start getting asked, well, what part of neurology do you want to do? What subspecialty do you want to do? Epilepsy, movement disorders? MS, it was like, well, wait a minute, I've only just decided what specialty, let alone what Subspecialty. And then you realize that some consultants are actually um you know, don't, don't really get involved with, with some of the areas of neurology. So in Plymouth, for example, the NS Service is almost an entirely separate service that's kind of run out of a different set of offices with a different specialist nurse and it doesn't really come under general neurology very much at all, which is not something I've really appreciated before I started neurology training and the same goes for other health specialties as well. Um, services often vary. So again, this is gonna vary according to where you want to work. You know, some places might have very good sort of, you know, genetic neuropathy services or hereditary ataxia, but a lot of places won't have any of those rare conditions. I'll put this in the less good stuff. Some people might like rare conditions. I find it quite challenging because it's hard to feel like you're being trained in a condition that you never see. And yet as a neurology trainee or a neurologist, you're kind of expected to know about them. So things like autoimmune encephalitis, which gets talked about a lot because it's kind of a treatable cause of seizures and sort of personality change of treatable movement disorders sometimes. But it's pretty rare. I've probably only seen two or three ever. And, you know, if someone has it diagnosed and somebody, you're kind of thrown them and say, well, you know, this is your bag, it's an autoimmune encephalitis, we need to know what to do with their steroids, etc, etc. Actually, I'm not sure because I've not seen it before. So that can be quite hard. But I think that's when, you know, you really have to get stuck into the teaching side of things. And you realize that kind of it's really value of being, being taught by neurologists and these structured teaching days to manage these conditions. And then try and take that into the rare occasions when you do see it. Neurology definitely for suffers from this problem, I think, and I think it comes with being a diagnostic specialty and sometimes things just are difficult to tell apart. And if someone comes in with a bad sort of migraine, sort of light sensitive, they've had a bit of visual aura and they get weak down the same side as their headache. I mean, it's probably a migraine, but if they've never had it before, you really can't tell that apart from a stroke that's triggered a sort of migrainous type headache from just a migraine that's causing sort of some motor weakness at the same time. So there's a lot of kind of scanning people who you think have probably just got a migraine and it's going to get better by itself, but you can't rule out a stroke. So you end up doing a lot of scans that are kind of normal, but you, you're kind of duty bound to do it. Um If you can't be absolutely sure, clinically that it's not something like a stroke that's very, you know, much more urgent and needs very different treatments. Um So, you know, that can be frustrating and a lot of the tests we send, you know, sometimes the lump puncture test or the autoimmune antibodies can sometimes take days, weeks, sometimes even longer to come back. And sometimes, you know, you can't really give a patient a definite result for many weeks and that can be quite frustrating as well. Um I am not getting to as many clinics as I would hoped as well. And again, I think that probably is mirrored across a lot of the country. Um but I can't speak for sure for other places. So I think this is tying into me not seeing some of the rarer conditions. Um and just making, you know, me perhaps not as confident somewhere as neurology, I thought I would be, but I haven't finished my training yet. So um we'll see where I am in a couple periods of time. Fine. And so that was kind of all I was gonna say about my experience in urology with a little bit of summary about the good stuff and the less good stuff. So I hope that was helpful. Um The rest of the stuff just gonna go through a little bit quicker. So this is one slide talking about what's changing in urology. Um And this is all a little bit up in the air because it's only just started. So exactly what form this takes um remains to be seen, but there's several sort of non negotiable parts of the curriculum and training that definitely are training that are changing, excuse me. So this is the new training procedure for neurology. So of course, you do your foundation years, you then go into internal medicine, which is a three year uh program as opposed to core medical training, which is a two year program. So everyone doing neurology are gonna have to do three of these core training years before they get specialty training. Unless you do A CCS, in which case you be four and that's gone from 3 to 4. So an extra year basically, and in your final year of that, most hospitals, as far as I'm aware, are having that I nt three trainees on the med reg rata often coupled up with a more senior registrar, but I think not 100% of the cases. So you're going to be doing some general medicine, um acute unselected, take registrar onco as part of I MT, which was not necessarily the case as part of CMT, which is what I did, you then apply for your specialty training. So I did CT one CT two ST 34567. That would be all of my training. Now, it's gonna be I MT 123 and then ST 45678. So some specialties are going are dropping especially down to four because I MT has gone up to three. So it's still seven years in total, but neurology is keeping five years and three. So it's actually gonna be one extra year in total from when you start um after foundation years until you complete neurology training. So that's one difference. The other big difference is that everyone in urology is gonna train. So they're gonna CCT which is completion a certificate of training, basically what you get your consultant accreditation in. So they're gonna get CCT in neurology and general internal medicine, which basically is, you know, general medicine means you can do the acute unset to take. And they're also automatically gonna get some specialty training in stroke. So actually people going into neurology now are gonna get neurology and GI M and stroke adit at the moment, we just get neurology. So I'm just gonna get a neurology CCT. If I wanted to get a stroke, then I would have to apply for a, a standalone stroke fellowship here as an extra year. So that's quite different. And it is obviously gonna have implications for the type of consultant who's trained and and what, you know, a consultant can offer to a hospital in the future. Although exactly how that's going to pan out is unclear because I was talking to Alex earlier just before the webinar started, you know, there's a shortage of neurologist, there's long waiting this neurologist to do their normal sort of neurology, outpatient clinics, if all the neurologists who are being trained coming up are going to be put on anu and doing acute take. That means they can't be doing the outpatient clinic. So we still need to fill those up. So whether those consultants are going to be doing the acute take or whether they're just going to be carrying on sort of more like a neurology consultant is at the moment is uncertain. So the headlines one extra year in total of training, you do general internal medicine and stroke, in addition to neurology and how it is gonna work out during your special training is you're gonna be five years, you have to do at least six months of stroke and then three months of that will count as general medicine, which means you've got nine more months to make up because everyone has to do 12 months of general medicine during a specialty training as part of this new curriculum. So it's gonna be six month stroke and nine months of general medicine and at least two weeks of general medicine on calls for the other years when you're not doing stroke or general medicine. So hopefully, that makes sense. I won't dwell on that too much longer. But the, but the take home message is that it's one extra year and it's gonna include more general medicine, some med med reading on call, which we don't do at the moment and, and stroke medicine automatically as well. Ok. Ok. Right. Briefly, uh the application process. So, um timelines is an auto application. It's done online through the system called oral. There's a load of sections which you score points in which are the same for whatever specialty you apply for. So you can have a look on that online. You can start targeting your kind of what you do with Q I projects and that kind of thing to try and maximize your points. OK? That is the same for every specialty. It's awesome application. So if you're applying this year, you need to do it fairly soon. I don't know the exact date, but it will be October November time. You will then get shortlisted simply based on your score. OK? And the top however many people who score on this um paper form or online form will then get invited to interview, which is generally held in March. It's about a 45 minute interview. There's four questions and one presentation. It's quite broad again. OK? The presentation will be something neurology focused. But as far as I'm aware and certainly when I did it and what I've heard about people who did it last year, the questions are very broad. It's just things like, you know, talk me through your portfolio. So tell me about your commitment to specialty. There will be something about your suitability of being an acute medical registrar. So probably some sort of acute scenario and there'll probably be something about um sort of disseminating findings or or doing a quality improvement projects, audit something like that. Um Government so quite broad. So there probably weren't actually be that many hard neurology questions as part of that. But that's much. Uh and again, that, that's the same for every specialty interview. Um But um but there will be some slight variations according to what specialty you're applying for. If you want more information, just go on this website. It's, it's quite good. It's got, you know, all the sort of time frame and the structures. OK. So I won't go into any more details about that, but it's online application in autumn and then an interview in March fairly general, but you can start targeting things in terms of um if you want to boost up your points from now. OK. Um Just to give you a little bit of an idea. So this was the um neurology applications from from 2020 which is the most recent one that they've um published online. This is just all the different deaneries down here. N TNS is national training number. So this is the numbers that they offer and this is how many were filled. So basically the take home message is that all 50 neurology numbers that were offered were filled. OK. So they were obviously more applicants than there were spaces in 2020. And there's also quite a lot of variation around the country. So particularly where I work, we have six numbers, which is a lot. Um whereas Bristol, the seven region just up the road had none whatsoever. So you need to give you a little bit of an idea on the numbers, particularly if you're someone who wants to work in a particular place. OK. So last bit, I'm just gonna talk about academic training. So remember this isn't specific to neurology. This is clinical academic training, which can be paired with, with any specialty. OK. This is the general structure. So medical school, um obviously some people do an intercalated research degree as part of that, some people will do an MD or a phd during their, their medical degree. That's pretty unusual and I won't talk about that anymore. But most people, you know, go to medical school qualify maybe have a an integrated degree as part of that join the foundation program. And at that stage, there is an option of doing this thing called an academic foundation program, which I'll go on to talk about a bit more in the next slide. Then after your foundation years, you go into your I NT or ST numbers which generally go from one all the way up to eight. So this is the kind of straightforward clinical training levels. Um but you can do alongside your early ST training levels, something called an academic clinical Fellowship. And then in your later ST levels, generally, you can do something called a, a clinical lectureship or an academic clinical lectureship. The difference between these is basically a phd. So an academic Clinical Fellowship is, is something you do before A phd to try and give you the best opportunity for, for getting funding and doing a successful phd and a clinical lectureship is something you do after a phd where you can build on the research skills and, and um sort of area that, that you've worked on during your phd typically. And there's a whole variety of sort of things you can do in two and once you're, you know, a consultant, so you can be sort of someone who's employed by the university directly. Um And then does uh just some, some clinical work. So they would typically do, you know, mostly academic kind of 80% something like that and maybe 10% clinical. Um or we do get some consultants who are employed by the NHS, but they have some sort of research time worked into their job plans. So that's the kind of variation you can get um in terms of being a consultant um and doing academic medicine. So a little bit more on that. Um So back in the day, people used to have to do academic medicine and phd is just kind of in their own time or certainly had to prepare sort of phd proposals and grant writing and that kind of stuff and work on projects in their own time. Now, we've got these structured schemes which makes it a lot easier and a lot more sort of realistic. And certainly I don't think I would have got anywhere if I'd had to do it all on my own time. I have been really, really tough. Um But you can still do that. So you don't have to go through one of these structure schemes, but certainly if you can get it, it makes it easier. Um So what are they, the academic foundation program? So this is generally something you do in your f 21 of your f two blocks will be academic, it doesn't have to be research, it will be education, leadership and management. I think quality improvement as well. Um So one of those blocks for a third of that year is something nonclinical but in these areas, but you still complete your F two in one year. OK, an academic clinical fellowship is similar but it is 25%. So it's a little bit less, it's generally a three year program. So I did this, I did an academic foundation program and I've also just finished an academic clinical fellowship. So I did this for my ST 34 and five. So I had 25% of my time was academic. So I generally took kind of one week and four. I worked on, on research work. Um And then the other three weeks I was doing my, my neurology specialty training. Um And as long as I kept up with my portfolio, even though I was only doing 75% of the clinical work that my colleagues were doing, actually, I still finished, you know, ST 34 and five at one year. So I did the whole thing in three years and now I'm ST six. The advantages of these are that you get dedicated time. That is the biggest advantage your pay is the same. Ok. Um, maybe a little bit less if you're not doing on calls during that. But, but generally your pay is the same. You get extra funding um to go on courses, you get access to the academic environment, you get supervisors, you know, in your institution, which is obviously essential. Um and, and they're really flexible as well. Um And finally, not something I've done, er, yet I might do in the future, the academic clinical lectureship is after your phd. Um it's 50% academic. Um so it's kind of, you know, a post do, er, position and, and then you do progress at half the rate. So if it's, if it's a four year, it can be a maximum of four years. Um and that will get you through two special years. So if you start it at the end of ST five, you do ST S six and seven without two for four years. Ok. An academic Clinical Fellowship is all about preparing the opportunity to, to, to apply for and to do a phd, an academic clinical L is about taking your phd work forward and trying to get to one of those more senior positions. An academic foundation program is really just kind of the sort of the initial introduction to, to academia and to try and give you a little bit springboard up to these other, other positions. Um And there are different schemes across the different countries in the UK. What I've spoken about is essentially the scheme for England. And that's all funded by the NIH R which is like the research arm of the, of the NHS. Um And there are similar but slightly comparable but slightly different schemes in Wales, Scotland and Northern Ireland. But I think you should remember that. Um you know, there's a lot of money, there's a lot of focus on trying to get doctors to become researchers because doctors kind of know the right sort of health research questions that need to be answered and they're kind of quite good at giving that research leadership. So there's a lot of opportunities um that can be taken to try and encourage people to do that. Uh So last thing, some good things about academic training. Well, you know, the, the some of it is that it is really good. I would, I would argue um you get protected time, it's really flexible. So, you know, actually, you know, there were times when I needed sort of three weeks, you know, in a row to get some work done. And as long as I gave my rotor coordinator enough time, this is during my academic clinical fellowship that could just happen. Um um you progress at the same rate generally for the foundation program in the ACF. So you don't have to worry about taking more time. You get the extra funding 1000 lbs a year as part of an ACF. Um I mean, you're also still eligible for your normal study budget um and your normal study leave. Um And as I said before, you access that academic community, there's also no obligation. So if you do an academic foundation program on an ACF and then you think actually, you know, research isn't for me, education isn't for me. You just go back to being a sort of straightforward clinical trainee and you've not lost out at all. So it's a kind of, it's a kind of a win win situation. I think that said there are, you know, some things that people find tricky and, you know, some things that make them harder that are important to bear in mind that you are essentially trying to do sort of two quite different jobs. I remember when I went into my academic foundation programs and all of F one just desperately trying to get, you know, get the hang of clinical medicine and suddenly you go back to something that's completely new again, you know, trying to, you know, write up a research paper or do some stats and suddenly there's all these sort of biochemists and nonclinical people that are mild better than you at doing it. And you're trying to catch up again. So that can be quite challenging. It can sometimes a bit challenging to fit your clinical work into less time as well. But generally people manage it. You know, I was always a bit worried about doing less clinical work and sort of being less sort of clinically proficient. And I think that is something you need to bear in mind. But again, if you're, if you're sort of conscious of that and you make sure you, you get the most out of your clinical work when you are there, then it can make up for it. I put flexible and less good things as well. I said it was a good thing, but sometimes it can be a bad thing because, uh, you know, sometimes you have to work weekends and evenings and not so clock on and clock off that your, your shift work is clinically. Um, so, so just bear that in mind as well. There can also be some sort of geographical and institutional limitations. And by that, I mean, you know, if you want to do researching, I don't know, you inherited neuropathy is you probably have to go to Queen Square and work with that specific professor because no one else is doing that work. Um, and if you're not flexible because you've got family or a house or whatever somewhere else, then actually, that can be quite challenging. So you sometimes have to make the sort of location of where you are work for you, um, or at least think about what's most important to you. Is it working in that particular sort of research, academic area? And therefore you need to move to the best place or is it staying where you live and making the sort of academic environment around you work the best for you given where you are? Ok. I have ended up speaking for quite a lot longer than I was expecting. Um Sorry about that. But um that's pretty much all I have to say. Um other than that, if you are interested in academic training, just talk to people. OK, academic trainees and leads are just really happy to be spoken to, email them, do a Zoom call, whatever and then you can find out what it's like in your area and often the academic training leads um can actually make positions if you think. Oh, you know, in two years I'd be quite keen to apply for an ACF they can sometimes have some wiggle room to create post. Um Even if one wasn't going to exist anyway, so talk to people if you're interested in, in academic training and that is everything I have to say. So, thank you very much. If there's any questions, I'll be very happy to take them. Oh, thanks so much, Jacob. That's uh yeah, it's going over the sort of a, a rice smile with some of the academic training stuff as well being in the A FP myself currently, er, it definitely hits home the, trying to feel like you're catching up with people that are very used to doing it themselves. Try to write research proposals while you're only 40% of your week is dedicated to that. It's quite a chart. So it's all part of a challenge but it's easier than having to do it without any of that time as 1020 years ago. Ok. Has there ever got any questions at all where you can take anything if you got any, like I said, academic, academic stuff or uh neurology related content or just general training in the UK? Ok. No, it doesn't look like anyone's gonna have got anything. Um So we'll give it 30 more seconds and then we will just leave it there one sec. All right. Ok. So no one's posting anything. So, um thanks so much for coming everyone. Um What we'll do is um we'll just leave it there if you don't have any questions, feel free to email Neurology at mind the bleak.com and I can get back to you or just pass the message on to Jacob. Um Please fill out the feedback. It's really helpful for our development of future sessions and check out the Mind. The Bleak Website as well for sort of our previous neurology content as well. Um And yeah, hopefully, see you soon. We are planning a new series of webinars, but uh until then