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will be having a talk from Wesleyan before we break for lunch. Eh? So I'd like to introduce the next speaker. And so this is Catholic Hammon. He is a newer surgery trainee who is going to give a talk on You know why neurosurgery should be for you on the ends and out. So our hand over to him now. Thank you. Thanks very much. Money. I'll just share my screen. Nine. Yeah. So I I'm I'm Callahan, and I'm one of the neurosurgery trainees. And I actually got a job in the building MRI on Did ST One in ST to their on by Have stepped out defending for the last couple of years to do a PhD in the in the unit in Manchester or something I really enjoyed. And on something that, you know, there's a couple opportunities to do your surgery, and that's something I'll come to come to talk about later on. And I suppose just you know why we have an introduction as something that I could say that we sort of incontinent. My whole talk is that when I go into your survey, it doesn't seem like work to me and I really, really enjoy it. And I do it for, you know, you nearly said you would do it for free, and I enjoyed that much. And I know that a lot of my colleagues feel the same way as well. And it really is an amazing specialty. And hopefully I can them give you a bit more of an insight into it today. And so something that people are often not often. Ask me what is the structure of training. And you're a 30 which has been changed recently, actually. And so far as an S t three entry engineer, surgery no longer exists. And then they're really, for whatever reason, trying to push people Maurine to entry on ST one level. And so the vast majority of training posting your surgery and I are and are for people who are applying it s t one. There is the opportunity apply at ST, too. But there's very few jobs available for that. You know that it's a change. It's been in its infancy. But from what I can see, the only been maybe two or three jobs at ST to since they have them since they have introduced it and a Z previous speaker to fill. How did, uh, you know, in your surgery, there's, Ah, there's a maximum of 24 months post have to, um, a lot of which 1 to 12 months convenient either in your surgery or ah or on them or associative specialty. You know, I think what you will about that, but then it's just something that needs to be, you know, the that you need to bear in mind when you're thinking of applying for your surgery and right, they're wrongly I think that neurosurgery really is geared towards people who have decided to do near your surgery from when they were in medical school. Because a lot of the things that I'm going to talk about with which are foreign part of the entry criteria are things that I think would be a t. Some of them are difficult to pick up, and from Ah, um foundation level you're having said that I had a friend and I was university, an island with who, and didn't want to do your surgery. A tall until he got into F one on, he really went for and push himself started. He could took a took a year in Australia on day six months in a straight in six months. In your surgery job in London, I was able to get in in your survey. It ST one. So it is possible to be to disheartened. But I think it would be retested me not to say that there is, You know, there's a certain the way that the Israeli criteria are organized are such stop, and it really is to the advantage of people who decided junior surgery and in early on in early stage on a spoon. The thing to say about that is that if that is the case, if you're considering that, you might want to do your surgery than trying to get some early exposure to it, and medical school would be something that I would them something that I would recommend to see if it's safe. It's for you or not. And in the early stages of New York surgery, training him, are they try and influence on sort of broad based and training early. So sub stop you may of the first two years. You may only spend about a year of that doing your surgery with the rest of the rest of patients or to be decided at a local level. And so I did three months in accident emergency on three months of plastic surgery, and one was more useful with the other, and I'll let you guess which one that that was. But the the other things that people can do and I know that people have done are some time in your radiology Sometime in your intensive care. Predict if you haven't worked in intensive care before and then some people have even going done and your pathology for a while after their after that sort of phase one or early training, they talk about entry Point interferes to training, which is traditionally speaking of the register or years. And they usually ask that people have passed both parts of the MRCS Prior to that, um, that you know, you've come through, your ercp is okay and people are happy for you. Progress on to the registrar Rhoda, and that's really when you sort of engage in your general your surgery training. So you know you'll do some time in pediatrics sometime in neuro oncology, sometime in faster and your surgery and a lot of time in spinal near surgery, which is something I'll come on to the end. And then that is supposed to give you a broad based overview of the entirety of neurosurgery, the generality of neurosurgery. Such stop at the end of that training that you should be able to act up a day one consultant and usually at the end of that is to training. You'll and you'll set your four CS in your surgery, and I'm not sure if it's gets another surgical specialties. But in your surgery, you have to have passed your air. CP. It asked ST six and prior to being allowed to sit the exam. And then finally, there's in the phase three or final year. Finally, your training, which is when you really decide what yourself speciality interest is. And there's no not notice thing. Is the general neurosurgeon any more? And as is the case in almost every surgical special deny on and you have to, you have to really declare an interest on usually your your final year of training and then any fellowship training Years after that, our directed towards that on what forms the what forms the majority you know the the bulk of neurosurgery and I It's not them. It's not brain surgery anyway. That's definitely definitely sure. And I think that a lot of people myself included came into your shoulder. You think you would spend the whole time operating on people's brands, and I'm what you do spend a lot of time doing that the vast majority of the time and on the vast majority of clinical activity and your surgical units is for spinal surgery, and that's usually spinal degenerative disease. But there's also a metastatic spinal cord compression, also untrammeled form a very, very big part of the of the neurosurgery workload and more than half of them you can. Your surgeons and I are spinal surgeons and almost exclusively spinal surgeons, and that they might cover creating emergencies out of ours. But they certainly wouldn't have any elective cranial practice. So that's something just to bear in mind and to be aware of and other things that form a big part of New York City would be your oncology, so intrinsic brain tumors on increasingly night and metastatic disease to the brain. Given that there's so many more therapeutic options available now for people with systemic malignancy and people who, with them metastatic brain metastatic brain tumor shoot previously may have been and written off or not considered confidence for near surgery are are high. And I don't like being offered, um, surgical resection of their metastases and not, you know, that forms of a very big part of the you're on allergy workload. And, um, you know, the brain metastases. They're certainly much more common than them down transit, brain tumors and trauma, and depending on where you are in the country, forms a very big part of the workload. I'm certainly every weekend in Manchester we're inundated with head injuries and, you know, was not very difficult or complex to manage operatively. And these patients require, and often a lot of them input from our critical care colleagues in conjunction with us. And again, it forms a big part of the work boots and hydrocephalus. And although smaller than trauma again, that's, um, the management of people with CSF disorders and forms a very big part of New York's Are you particularly am on call in your surgery, whereby you will be very frequently referred patients with known diagnoses of hydrocephalus with deterioration in their symptoms and then a smaller. But I would say expanding specialties and functional neurosurgery. So we know that. And there are a novel, more patients with medically refractory epilepsy who would benefit from surgical surgical treatment of their epilepsy who haven't been offered it yet. And that's definitely a potential growth there in your surgery and as well as the really amazing things that neuro surgeons can do for people with movement disorders, with respect, deeper in stimulation and things like that, and then right down to the bottom, which forms a very, very small part of near surgery. Not, but perhaps what people think about and when they traditionally think of something that your surgeons do, use them out of em. Skull base and bastard, Your surgeries to stop the base near surgery is the practice of nursery focused on humor is growing right down at the base of the brand adjacent to, and you're very eloquent, your vascular structures and a lot of that work has been supplanted bye, and he used to start talking radio surgery, which is why that that has, um, certainly operative intervention for pathologies of the skull base of become last common on similarly and vaster in your surgery is definitely shrinking specially as a result of the increase in in endovascular work. So I supposed to take away from this is that them spine forms the vast majority of any in your surgical practice, and we'll definitely form a very large part of your training. And so, with respect to the to the pros and your surgery, you know, it's difficult to fit them on the one page, I suppose, but and what you could say is that you know, it's very highly complex technical surgery. Excuse me and what you know, not something about the specialty that I really, really enjoy. You know, a lot of our surgeries don't die in the microscope them or using loops. And the, you know, you're often operating millimeters away from very eloquent structures that if you were to damage them, the big issue would be left with a very profound neurological deficit. And, you know, it makes really demands of the surgeon in that regard. And I think that that's something that being a lot of my colleagues find and very exciting about, especially if it's something that we you know that's the sort of operations that we enjoy the most. And there's a very nice balance between elective an emergency work. So roughly 50 50 and you know, having been on PSD and art of program, I don't do any of the elective work. I just do emergency on calls. But I'm certainly not short of work to do on them, you know, in in big units like the Unit in Manchester, we're constantly operating at all hours of the day or night, and there's also a high volume of benign disease. So patients, as I mentioned with spinal degenerative conditions, patients with and movement disorders or patients with them either vascular skull bit, skull base pathology is whereby if you do a good operation than the patient should be and where there's a high chance anyway, that patient will be cured completely and then not something that's very, very satisfying when we're not something that you could be a part of. And they're not of the anatomy then that were involved in absolutely, absolutely beautiful and you know, you just a quick Caruso of any YouTube videos and your surgical operations will tell you that. And then it's also very, very buried. You know, you're operating right from the right from within the third ventricle down into the done into the lumber spine and you maybe this is either pro or con. But your surgery as a result of the result of the rarity of neurosurgical pathology, is concentrated into tertiary referral centers, which are based in the big cities in the UK and art. And and so I suppose that could be an either the pros or the cons. And so far as if you want to live in there Highlands of Scotland. It's perhaps not something that's, um, that's going to be suitable for you. And again, this could be a pro or con. Is them just tell you? Hi. Uh, probably we work with a neurologist on the piano physicians, but and in in all seriousness, dealing with the within your oldest protected with respect to the patients, you have movement disorders or, let's see, is really, really interesting part of the work. And there are definitely some columns from your surgery. There's no doubt about that. There's a very high volume of art of ours work, and we will frequently start operations up. Four or five in the morning, given the sort of critical nature of the pathology is that we do with. And it's not a specialty where you convey on call and then go home and go to sleep. And the entry engineer surgeries highly competitive. And it has become more competitive recently because of the third point did not box in. So far as the numbers of training numbers that have been supplied to neurosurgery have been decreased because there was a period of four or five years where trainees were very, very heavily over recruited. Well, a tip to the number of consultant books that are available in neurosurgery. And that problem has become so extreme that in 2027 28 that there's anticipated to be over 100 trainees who are post CCT and with no consultant job. And then perhaps that doesn't sound like very much. But when you consider that there's only 450 consultant, your surgeons in the UK and for there to be 100 training is without a consult. Jobs actually quite a substantial and a month, and that's something that where we're struggling to manage at the moment in your surgery on these, And yeah, As a result of that there, the ESPN, ask the society, British Neurological certain have reduced the number of training post available in your surgery. And as a result of that, then there's an often a requirement for relocation. You know, as you can tell from my accent, I'm not from this country. I had to fly over here and to work in the pill. Um, you know, that's something that I really enjoyed. But, you know, I came over when I was young. I wasn't married, I didn't have any Children. And then, for people who have those things that could be, that could be difficult. And and finally, you know, something that's really sort of homeland about near surgery is that, you know, there's unfortunately often a lot of morbidity and mortality and our patient group, and by the nature of the of the pathology that they they have and on got to be, You know, that's something certainly to be aware of and can be difficult at times. And, you know, I'm sure a lot of people are interested in the high to get into neurosurgery. So definitely early involvement with your surgical society up them medical school, including with him, including with Asset. I certainly and started off my involvement and in surgery, going to an asset courses. There are some acid course is directed towards near surgery, which will be running at the of the conference. The acid conference next year and on the involvement with just your local surgical society is a really good way of getting involved. And I certainly had arranged neurosurgical electives on student selected components in your surgery after my first placement in your surgery in my first clinical year of medical school. And that's definitely something that you want to try and get involved in. And as I mentioned, your surgeries of, um, highly competitive specialties are really doing well at medical school and on doing an interpretative degree or something that we looked upon favorably for sure. And these are two books that I always recommend everyone, and when I first started and never build, I remember that one of the consultants telling me that if you knew everything in the book on the right hand side in urology and your surgery Illustrated would need to be enough to get you through the entirety of your surgical training. I think that's probably right, to be honest, them, it's a really both of these books are excellent. And give a really, really good overview of everything that you need to. Everything that you need to know certainly get a certain at a junior level, and I can't recommend them highly enough. And when they're both very useful, particularly the you're sort of a basic surgical trainees book is very useful for interview preparation in your surgery. And I thought, really the best way of splitting this up by Hae Hard to get into your chart. It was maybe two. These air lifted from the neurosurgery application scoring criteria, and I felt the best way to split it up with just by career stages, Really so, and with respect to things that you can do in medical school, you condemn it, get involved in research and order it and then call the improvement projects. And these don't have to be relevant in your surgery at all. I had all that's in there. Geriatric department, where I worked and as a foundation doctor is part of my neurosurgery application, and as I mentioned any any undergraduate prizes or awards that you managed to get would definitely looked upon favorably. And I think that we we all have control over. Where are elective is going to be. It doesn't have to be anywhere for on our fancy. It can be in your local and your surgical department. You know, if you're there for 4 to 6 weeks, that we'll give you a really, really good exposure to and then your surgery on, perhaps, and give you the opportunity to get involved in any projects that they have going. And they mention here Ah, higher degree. So people who have a PhD or an MD prior to applying for near surgery to be almost, I think that represents the rarity, and I don't know if I know anyone who am I at the time of application actually had a PhD or MG. It's very common for people do within their training, and but certainly at the time of application, I didn't have a PhD or an MD, and I don't I don't think I need anyone who did, to be honest. And But what is more common is that a lot of people who are applying we'll have an interconnected degree, and I'm not something that you should them. That's something you should consider if it doesn't form them on automatic part of your medical school curriculum and with respect to the moving into foundation, feeling that all the things you can look at the other degrees or diploma is based. Getting dream RCs Part A and I'm not something I'm highly recommend. Getting down the night of the way is correct. It is possible, and postgraduate Clinical course is that there are lots, of course, is that are catered towards and your surgery. And there's one in particular run from not a game called the Ruina Course and which gives a really, really good introduction to basicranial in your surgical procedures on a model. It was designed by one of the consultants there, and on another course, which is running from Sheffield, spoke care of the critical neurosurgical patient on the scenarios that they go through that port really totally replicate sort of things that you will be asked in your in your surgical interview. And so getting a chance to do that is something I'd really recommend and, you know, clinical order and call improvement projects up here for a rewrite Them, you know, all all of the the selection criteria for surgical specialty. But I think the thing to bear in mind is that they don't have to be relevant to the surgical specialty per se on that they can be. And you know, they're Mawr there as a test to see if you're aware of the process and of the importance of these things rather than whether they're in the specialty itself, I would say, And with respect to research again, you know, the more the better, I suppose, is what I would say. I didn't have very many publications the time of my application to near surgery at all. And I don't maybe a couple of national presentations which happened as a result of again involvement with acid, which is very helpful for that. And so I suppose the thing I would say about the chest right here is is that you know, it's probably the more the most challenging criteria till fulfill and but try not to become too fixated on it. Um and you certainly you know, there isn't a minimum number that you need to have for Blanton. You're a Shorty are certainly not one that I'm aware of. And do you do your best to get involved in as many things as you can? But I wouldn't wouldn't become entirely fixated on with them. You know, there's a point to be made up, where for definite and with respect, teaching and management. Then, you know, there are so many things that can be, um, used as evidence of organizational on leadership skills, you know, involvement in clubs and societies and universities, positions of responsibility there, any charitable work that you do outside of university and and hold it in any community organizations. These are old things that I have included in my application and practical inside of cycle motor skills. There is always, you know, there's almost anything can be included legitimately in this, and certainly for maximum points, I think you know, you have to be an international laugh later, whatever. So I think there are very few people who will fulfill left, and I'm teaching is something that I really enjoy. And, you know, I think it's becoming more and more common for medical students themselves to be involved in the teaching of more junior medical students and being involved in community outreach programs. I know that my own on the matter Queens University about dust does a lot of that. And yes, I just get stuck in and try and get in and involved in not as much as possible and let us fill mentioned in the previous talk. Anything where you can provide evidence of formal feedback again will be, and we'll leave you more credibly, I think. And yeah, that's I've given overview of the specialty and on an overview of the application process, which is suspect people may be more interested in, and I'm more than happy to be to be contacted either on Twitter on or on any other new problem. It's all I'm happy to answer any questions. A great thanks catheter that was That was really good, because I think neurosurgery so distinct from sort of normal course surgical training, it's It's really good together inside, especially if they're thinking of applying for it. So I just think a couple of questions on the chat at the moment arm or just about I'm just, you know, putting the name say the newer surgery course is that you mentioned about you relevant links. If you're happy to do that either on the medals chatter or you can send them to me and I can post them jury. Uh, and it'll actually be a little foreign part of the assets. Pretty conference course is you know the collection. So So we don't have any links in a minute. But just I would say, Keep your eye on the on the acid website that'll be advertised on that, as it was last year. We ran it and we'll resume last year. And but clearly they am. The hope is that we did in person this year. It's much more fun. Yeah, nice and then, And for anyone, that's not always so pre conference courses. So when I was seeing the the conferences, another doing from the fourth to the Six of March, I think that pre conference is I'm assuming on the third of of March on, they'll tend to be, you know, specialty lead. So there'll be a whole pre conference a neurosurgery. We've got lots of others as well. And but newest everyone will be good. And is it Is it a practical element? Yeah, we'll do and were emitted to have them yet Basicranial and spinal Procedure Is this part of it? You know, I remember doing it myself when I was a medical student. I really, really enjoyed it. And and it's it's a good, good chance to have a child with, um your surgery training is is to, you know, in, um, or counted fashions Day exactly what they think of it and all those sorts thing. So and yeah, really recommend other than coming along Nice. And, um, just just to say, it's actually on the Fourth of Marginal, the third of Marshall of those, Like I said that wrong and someone so one will will do one question before we sort of hand over to Wesley. And so what to the advantage? Say shoe bomb asked. What are the advantages of doing a PhD in neuroscience is for neurosurgeon. Just this Gibson lever leverage and pre application? Yes, definitely. And as I mentioned your in the top, they're very few people. Who do you apply? And having already been a Jeep, having already had a PhD And but if you were able to do that, then yes, sir. That was something we haven't Agius and the fact that it's an irrelevant area would really give you. Um a very strong about is when you start training in your surgery and a lot of people within your surgery training during the time of their training, usually in the early years will step out and do pee. It stays and subjects that are relevant. So if you go on ahead and done it before 100 Yeah, it would be a big advantage. And And you can use your old skills. You are undoubtedly of the enduring a PSD and for the New York for the research that you we also take part in your in your training. So yeah, but starting about this is what I would say on a unique one. You know, they're very few people who would have that ever since. Nice. Nice. I think you know that. They're the main questions on the chest. But of course, as you said, you know, happy for people to contact? Um, yeah, no problem at all. You can email me your best to be on Twitter or whatever. No problem. Great. Lovely. Thank you so much for that. That was That was a really useful too. You're welcome. Thanks dot Thanks