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SURGICAL SPECIALTY SERIES: NEUROURGERY

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Summary

Join us for an engaging session with Mr Singh, a neurosurgical registrar at Adam Brookes Hospital in Cambridge. Tuning in to his experiences and insights, this session will delve deep into the world of neurosurgery. Mr Singh will tackle the roots of his interest in neurosurgery, covering his love for neurosciences and neuroanatomy, as well as his satisfaction in solving problems using his physical skills. Hear about the responsibilities of a surgical trainee, the nature of on-call duties, the types of procedures he's capable of performing independently, and memorable cases. This session will give medical professionals a fantastic opportunity to explore neurosurgery and understand the rewards and challenges this specialty presents. Note that a certificate of attendance will be provided after you complete the feedback form.
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Description

Our next event is in collaboration with Cambridge University Society of Neurosurgery. We look forward to talking to Mr Prabhjot Singh Malhotra, a neurosurgical specialist registrar at Addenbrooke’s Hospital, Cambridge. Mr Malhotra graduated from the University of York in 2020 and completed a master’s degree in Clinical neuroscience at King’s College London with distinction. He has a keen interest in research, education and medical technology. Join this interactive session if you are interested in pursuing neurosurgery and want to know more about the application process and what life as a junior neurosurgeon looks like.

Learning objectives

1. To understand the career path and daily duties of a neurosurgical registrar. 2. To understand the unique challenges and rewards present in a neurosurgery specialty. 3. To learn about the process of diagnosing and treating neurological complications and emergencies. 4. To gain insights into the decision-making process when faced with high-pressure situations in a neurosurgical setting. 5. To learn the importance of having both theoretical knowledge and hands-on skills in the field of neurosurgery.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hey, can you hear me? Uh, yeah, I can hear you. Are you able to hear me? Ok. Yeah. Yeah. Sorry. Yeah, I was not, uh, I was supposed to finish by 530 but I got hung up with a kiss, so I've just finished. That's ok. You don't have to apologize at all. Um, so I think we already have quite a few people in, um, you've joined. So, are you ok for us to start the session? Yeah. Yeah. How's the, uh, camera set up and, uh, Mike and things? Yeah. No, that's fine. You're vertical because I think you're on your phone, but that's completely fine. Ok. Yeah, I don't think I'll be able to make that horizontal. That's fine. That's ok. Um, ok. Well, hi, everyone. Thank you for joining us and for joining our, um, surgical specialty series. Um, as always, if you have any questions, please put them in the chat and we can, um, try and get them all answered and a certificate of attendance will be given after you complete the feedback form. Um, so today we're quite lucky to have, um, Mr Singh who's a neurosurgical registrar at Adam Brookes hospital in Cambridge. Um Thank you so much for joining us, Mr Mota. How are you? I'm good. Please call me proud. Sure. Um So the, the point of these sessions is just to kind of get a feel for um neurosurgery, what your life looks like. Um And so I'll just be asking you a few questions. Um So just to start us off, um why did you pick neurosurgery? So, I think um with regards to whatever you wanna choose to do in life, like, obviously, you guys are probably still at the stages where you're making up your mind. I think it's important to choose things based on your level of interest. So personally speaking, I was always very interested in like Neurosciences and neuroanatomy. And just even as a first year, you know, I found the functioning of the brain and uh you know, however our mind words influencing who we are as a person and so on just very captivating and that sort of drew me towards uh the Neurosciences in general. And then as a personality trait I'd like to get in there and try and solve problems with like physical skills and, you know, try and make a difference by actually going ahead and doing something with my hands. So putting those two things together like neurosurgery seemed like the um natural sort of field or specialty that I would be interested in. But then from then on, you know, what the advice I would give, um, people who are still making up their mind is that if something draws you towards it and it's interesting or, you know, it, it's something that, uh sparks your curiosity, it's well and good to go and explore it. But then you should try and start to look at like what the specialty actually entails. Um And if that fits into your interest, then you should go ahead and try and see a future in it, you know. Uh So for me personally, once I realized I was interested in Neurosciences and neuroanatomy, et cetera, I realized that in your surgery, you have to be extremely uh calm in high pressure situations and be able to manage multiple things at once and make sensible decisions. And I felt within me that that's something that, you know, II I'm capable of doing. So I went ahead and, um, decided to proceed neurosurgery. Ok. Um Thank you. And I think you're an ST two. Is that correct? Yeah. So I, um, so the way neurosurgery works I can give, uh, I, I'm presuming all of you are medical students, but, you know, I apologize if I'm going over things you already know. Um, but the way it works is that once you finish, um, your medical degree, you have to do foundation, you one and two, which is, uh, which applies to every graduate. And then from there on, you can apply for broadly speaking, either medicines, surgery you know, things like a and anesthetics or uh GP training or psychiatry. And for those who want to do surgery, uh for most of the specialties, you go through course surgical training. So after F one F two, you have to apply to CST which, which is two years in itself and then you go into T three where you have to reapply for the specific specialty that you want to do. So be that orthopedics, vascular plastics, et cetera, neurosurgery is one of the few I think like cardiothoracic and ophthalmology, which is a run through surgical specialty only. So they're very, it's almost close to impossible for you to get in after you do CST into ST three. you'll have to reapply for ST one. So, yeah, to answer your question, fortunately, I'm gonna run through programs on ST two and next year, I'll be ST three, which is when you typically start on the registrar ro down. Ok. Um And I'm going to ask you about the application process um in a bit, but just as a reg how, what does your day to day life look like? So currently I'm still on the ROTA, I'll be going on to the RA ROTA in August, but because I'm close to stepping up now, I sort of have to familiarize myself and, you know, get comfortable in that role as well, so I can answer that question for you. Uh I think for any surgical trainee like, if you wanna do surgery, you're going to face more or less the same challenges. Some specialties will be a bit more chill than others. Uh Like, you know, but at the end of the day, it's the same thing where you're doing your regular clinical duties, which would involve being ready for water drawn in the morning before your consultant gets there, you know, getting through the ward rounds quickly and then going and consenting your patients making sure the list is intact. Uh And all the patients who are listed for whatever operating list you are scheduled on is is ready. Uh And an example with that would be, you know, making sure all the bloods are done. All the consent forms are in place, all the patients were starved overnight. And then yeah, you go on and do your uh theater lists, which in the initial stages will be with the consultant who is teaching you and you know, you're assisting and learning. Um And there'll be a range of procedures. So some procedures will be where just be the consultant doing most of it and you're literally just watching them and learning uh to you being able to assist and be actively involved. And then there'll be the ones which are more relatively simpler and you'd be doing most of them. Um So that will be a typical, you know AAA non on call day where you're either in theater running through these lists or you're in clinic, uh speaking to patients who again, uh are meant to be seen by the consultant, but you're working with the consultant in these clinic lists and then the on calls are pretty crazy. Like, um, you know, for neurosurgery, we get about 60 referrals from all of east of England. And these can range from, you know, minor stuff to very, very serious stuff where patients are like where you're making life and death decisions in the middle of the night by yourself. Uh, so the on calls can be pretty stressful because you're managing those referrals. But then you're also operating in the middle of the night, fairly complex cases. Ok. And you touched on um, some procedures that you're able to do yourself. And I think you talked about this in the previous conference where you met. So, what kind of procedures do you feel that you can do quite independently? Yeah. So a actually I've been fortunate over my F one F two. So I got it straight off F two. So I have, um, I've done about, you know, this is my fourth year as a doctor and I've rotated across orthopedics, plastic surgery, um, general surgery, vascular surgery, and neurosurgery. So I've got a good scope of like what procedures people who are, you know, in that sho bracket can do independently. And in neurosurgery that would be, um, doing a hole evacuation for a chronic subdural or doing a mini craniotomy for a chronic subdural putting in an EVD, putting in an ICP bolt or pressure monitor, putting in a lumbar drain. I know a lot of these words won't mean much for you guys, but I can equate that with like plastic surgery where you can do tendon repairs and wound washouts and abscess drainages. Um, and in general surgery, I know a lot of my colleagues have done uh, appendices uh in, you know, f two even and in orthopedics it's um uh I think it's like hip replacement or DHS. Uh Yeah, II might be wrong with that but um there's definitely procedures that you could get involved in all surgical specialties. Um Are there any particular cases or like one particular case that I stood out to you in terms of being like, quite memorable or enjoyable? Um Yeah, I think so. It, you know, the thing with neurosurgery is that it has a connotation that is very, it's a very morbid specialty where you have very bad outcomes and people are very, uh you know, most of our patients die or whatever and while that can be true in some circumstances for some pathologies, there are also cases where you could do an operation for someone who's in a comatose state and very likely going to die imminently and then they actually end up making a recovery and they, you know, they, they do uh pretty well. So, uh I think I spoke to you, I spoke about this in one of the previous um uh dogs that I've given. But when I first started on, I had uh done a um a decompressive craniectomy for a patient. Which uh so essentially what that involves is you take off part of the skull to allow room for the brain to expand in cases of high pressure. And the reason she had high pressure was she had a venous stroke uh after which she suffered a bleed. So she was a 24 year old uh international student who was studying uh her master's in the University of Cambridge. And she had woken up and essentially been, you know, drowsy and things and her housemates went to check up on her and then she stayed in a coma and they couldn't get her to wake up. So they brought her to Ed and when she got here, one of her pupils at Blown, which as you guys know, is a very bad sign prognostically speaking. So we had to rush to the theater do this procedure. Her family was all abroad in, in India. And so before we spoke to uh before the case, we spoke to them and they were literally getting on like they were booking their flights as we were operating. Uh So they were flying over whilst we were operating. It was me and my registrar who was taking me through the case. Uh so that like I could really, you know, I felt very involved in that because it was such a you we all have friends who are like international students or families abroad, you know, living with their housemates. So it's such a realistic and like a situation you can relate to. Um And then, yeah, so she was very bad before the operation and after the operation, obviously, it took her a long time to recover and things. But at the end of it, she was essentially somebody who's had a, you know, a stroke. So she had weakness on one side. But from what I've heard with ongoing rehab and with time, these sort of patients can, especially when they're young, they can pick up and live, you know, quite independent lives and go on to pursue their careers, et cetera. So that was quite rewarding. That also sounds really intense. Um That's one of the things I would say, like you could be very interested in the specialty, but you have to see how that fits out. Like I was saying earlier, how the life and the specialty fits into your personality because there are some people who just will not like to, you know, juggle five things at one time or be in very stressful situations where, you know, ed consultants and any anesthetic consultants are looking at you as a registrar who might be on the ST three to make a plan for the patient in a very stressful situation. So if that doesn't appeal to you, you know, then this specialty isn't for you, but it's good to explore these interests at an early stage so that you can make your mind up. Ok. And I guess, you know, because you've talked about, um, the stressful environments and having to make such big decisions quite quickly. Um, do you think those are the things that you find most challenging about neurosurgery or is there something else? So, yeah, I think, um right now I'm on the cusp of going from, to being a registrar where I'll be in the center of that, you know, in um, a ABS hospital is the only neurosurgical unit for all of east of England, which goes a region of about 6 million people. So it's quite daunting when you think that when you're on a night shift, it's just you who's the main gateway for all of these referrals coming through? And um, yeah, the, the risk of some things that you might overlook could then mean, you know, that a patient has devastating complications. Like I've heard of stories where um a patient was referred and, you know, something was not acted on and then in the next half an hour they just crashed and they were again in a comma state being intubated or if you're asked to clear the spine or, you know, look at a spinal X ray or a fracture on the CT scan and you miss something that's important that may look relatively minor. But then they, you know, in the morning were drawn, uh, the it consultant messages saying that this patient does not have any sensation below this level of a sedation. Hold. So those kind of things are very scary because they might, may seem like, you know, decisions that you're fairly confident about. But then you don't know what you don't know. So if you make a bad decision, it can go on to have some pretty drastic consequences. Ok. So, um, so something, I don't know, sorry if this is obvious to other people, but something I didn't know, cos you mentioned that you're still in the sho er stage, but I thought because of a run through program it'd be a bit different. So for the first two years for neurosurgery, do you still, um, get to rotate through different specialties or is it just about the responsibility that differs between ST two and ST three? No. So I think almost all surgical specialties make you rotate in your sit years even if you're like, run through or whatever. And personally, I think that's a very good thing, like for neurosurgery specifically, I did in my two years as an sit. So an ST one C two, I've, I've done 12 months in neurosurgery, but also I've done six months in NCCU, which is the neurocritical care unit, essentially a neuro ICU. And, um, I've done six months in plastic surgery, which is really good because uh firstly, if your, so your surgery is very, you have to be very medically competent even though it's a surgical specialty. So going on to NCC only enhances that and you learn a lot of key critical care principles, which are important because you know, a lot of times when we are going to med school, we either think of things like medically or surgically and you want to know like what surgical procedures could be done versus what the medical treatments are. But in reality, you know, with the uh complex pathologies, but also every patient nowadays having multiple morbidities, there is a mix of both things, you know, so the decision making lies in the spectrum. So you could be really good at surgery and know the procedures and how to do them. But if you don't know the other side of the coin, then you can't make those well rounded decisions. So it was good to go to NCC and pick up those skills. Uh and then from plastic surgery, you know, um they are very, very meticulous in how they operate, how they hold their instruments, how they do, even the simplest of things like applied dressings and uh suture, they like to make everything look very pretty and aesthetic. Uh So it's good to like pick up those skills from a, from an allied specialty like by six. OK. That's good. I didn't know that. But thank you. Um So because you, you said that you managed to get uh you manage to join ST one immediately after a foundation training, which is, I think insane because I know how competitive neurosurgery is. Um from previous talks, we've, we've heard about, you know, doing research projects and audits. Is there something specific to neurosurgery that can help our applications going forward? Yeah. So I think this is something that maybe throws more people off than it should because I know most people view uh publications as sort of like the X factor where you should have publications and you know, that will help you get uh get somewhere or get in a program that you want to. But I think if you, if you plan ahead, even if it's like three years ahead or four years ahead, uh you know, that's including F one, F two. So if you, if you're in your final year or if you're in your fourth year, um you know, as in like 50 or whatever, if it's a six year program, if you start planning ahead, you can look at the scoring matrix that each of these specialties has. Uh So if you want to go into co surgical training, if you open up the scoring matrix, you'll realize that publications do carry points, but there are a lot of other things as well. So if you are able to get a few points for publications, so you don't need to have like 20,000 publications. If you have enough to get a few points in that section. Uh But then you also go on to score relatively highly in the other sections. You stand yourself in a good chance to at least give yourself a chance that you do well in an interview, you know, um, and if you do really well in the interview and as well as the exams that they've introduced, which is the M SRA if you do well, in all of these three components, you stand a good chance to at least get in a position where you might get an offer, you know, maybe that's only the place you want to go to, but at least it keeps the possibility of working in a specific specialty alive. Ok. And anything, so, I guess that kind of applies to all surgical specialties but anything kind of specific to neurosurgery that you think could help. No, it's, it's, it's a generic, uh, it would be, you know, doing research. So if you can publish something well and good. But then also if you're unable to publish a project, if you apply for several conferences, and again, it's just a matter of trying and applying to as many things as you can, it doesn't matter if it turns out into a rejection. So you could have like a project that you think doesn't sound that fancy. But if you Google, you know, the relevant specialty, find a conference, any conference that's advertised on the internet is at least a national conference because otherwise it's not being advertised, right? So if you just scavenge the internet and find some conferences, no matter how small it is, you apply for it, you get selected with the abstract you wrote, you can then go and present over there. Uh that counts as a national conference. So, you know, you have, you gotten either a poster or a uh um an oral presentation out of that and then doing audits is something you just have to do in F one F two. But if you're smart about it, you can make your audits more than just a compulsory project, you know, so again, do the audit but do it in a topic that you think applies on a wider scale and not just to your department. Uh and then try and present that audit at a national meeting. And again, that's one more thing you've got ticked off your uh your list. Um And, and be so I learned this after I've got into this program because I wasn't as true as some of the people who have met, who are in neurosurgery. So, you know, you, you hear of these people who've got like 50 60 70 publications and you think like, wow, they're incredible and they are, but then they're also smart in the sense that a lot of it is a collaborative effort. So if you're able to, you know, early on in med school find a research group or even create a research group with some of your peers were like equally motivated. You can combine your efforts and that way their projects become your projects, your projects become their projects. So you're collectively publishing a lot more papers and what you individually would have. Um So it's, it's a lot about trying to work with others as well and you know, going to these conferences and trying to network and find uh people who are equally motivated as you are. And then, yeah, so that would be audits, publications presentations and then try and do teaching and do some leadership stuff. But that, I think that comes naturally, like if you're, you know, if you're running a program such as this, it, it counts as leadership. So, and, and again, it doesn't have to be something that is attracting, you know, 100 or 200 people, even if it's 10 people in your hospital, that's a program that you've set up and it's um it counts as leadership. So in my year in F one, I had set up a teaching uh a virtual teaching group for medical students at KS. And I essentially got all the F ones together. I made a whatsapp group. I asked them what specialties they'd be interested in teaching. And uh we set up like two seminars every month where, you know, pairs of them alternated between themselves and taught uh medical students that came from 3rd, 4th and 5th year online and it was a good effort of like, 2025 people and it got all of us certificates. So, it's about working with other people, you know? Ok, that's good. And actually that's quite, um, useful and interesting because normally everyone thinks s surgery is so cut throat and it's like every, every, like, every mind for themselves, but actually being collaborative could probably get you a lot further. Yeah. Yeah. Yeah. I think it's, it's kind of sad now with the state of the NHS because it, you, it's attracting a lot of international graduates who are, who may have more clinical experience and more qualifications than the uh you know, homegrown uh trainees. Um And then on top of that, if you add this preconceived notion that oh yeah, it's just not worth applying. It's a waste of time. It's too competitive. It just acts as a, you know, an extra demotivating factor and then we end up losing, you know, surgeons who may have been amazing talents. So I think it's a numbers game but you shouldn't be put off by that. You should maybe try and plan ahead so that you favor way for yourself. Um But then at the end of the day, you know, you have to work hard but you could not be rewarded for it like nothing is a guarantee. No. Um We have a question on the chart. Um It says is the run through the run through self assessment criteria, different from the CSF matrix. CSF I Fluid Matrix. What's that? I think you said like there was a criteria, the things that you had to kind of take. Yeah. Um um And then where could you find the specific neurosurgery? You just Google it, you should be able to find it. So if you literally Google anything and do national selection scoring criteria for the year that you're looking at it should come up. It might not be like easy, like that, easy to find, but it should not be more than a couple of clicks away. So if you Google CST, uh you know, national scoring criteria for 2023 you'll find it. And if you do neurosurgery, ST one national scoring criteria, you'll find it. So you can apply that to anything IMT orthopedics, ST three, whatever and you should be able to come across it. OK? Um I hope that answers your question. Um So because uh neurosurgery is a run through program, I guess you get less time to explore neurosurgery. Um So, you know, with co surgical training, you can kind of rotate through, but because of that, what advice or would you give students right now to kind of maximize their exposure in neurosurgery? Um So I think, yeah, you're right that it gives you less time to expose other specialties, but the whole point of run through training is that you're in the specialty you want to specialize in. Right. So, even when you apply to CST, that will be a theme that you're picking if you get a decent enough score. So you'll get what's called a theme job, which means that for at least 12 months you'll be in that specialty. Which makes sense, right? Like you wouldn't wanna do become an orthopedic registrar. But your first two years as a CST one and do have no orthopedics, you wanna get at least 12 months of orthopedics, so you can prepare yourself if you, you're an ST three orthopedic surgeon, right? So, um, in that sense, I think most, whether you're doing CST or, or run through training, you will have the bulk of it will be the core specialty that you wanna go into. Uh, but having said that as medical students, I think, you know, I do make it sound possible, but it does require a lot of work to build your portfolio and get selected. So, starting early is always a good thing if you're in med school now and you're interested, the first thing would be to actually make sure that you wanna do it because otherwise you're just wasting time. So I would like go to theater, watch the procedures, speak to a bunch of people within the field. Um, and the best time to do that is not on conferences because like everyone is well dressed well rested on a conference and they'll probably try to sell the specialty to you. But at the end of the day after you've been in the operating room and you, you know, you've spent the day with the registrars, just go and sit down with them whilst they're writing the op note or whatever and then speak to them. And then a lot of the reality will come out, you know, about how they feel at the end of the day. So get that inside um experience of like what the specialty actually holds. And then once that's done and you're like, you know what? I still love it. This is still what I wanna do. Then you start with speaking to someone who's doing a bit of research saying you're interested in a project, you know, do some data collection for that project, get your name on a paper or two. And then go on from there, do some audits, do some teaching and then all the stuff we spoke about before. So start gearing up your portfolio for a blind 23 years down the line. OK. Um So if any, are you still, are you still happy to carry this on? Because I know you said you had to review page. Yeah. Uh The only thing that happened, I can actually tell you guys. So um because I'm going on to the uh reg rota soon, I need to be uh like manic was saying I need to be independent in doing certain cases. Uh which I've mentioned, you know, so like taking out blood clot from around the brain, putting a drain inside the ventricles when there are like large ventricles, uh putting a pressure probe inside the brain when there's head injury, et cetera. So before I go on to the regime, I need to be competent enough to do these independently with nobody else in the hospital. So I already feel like I'm at that level, but just to improve my confidence whenever such a case comes up, I should try and go and do it. Uh So once a game came up at uh 4:30 p.m. So when I was starting, I was like, you know, this is definitely gonna finish before seven. So I should be fine, but then you'll realize that the is very inefficient and nobody has incentive to try and work faster. Um So everything happens really slowly. So by the time the patient gets to the theater gets on the table, the case starts, it's at least like 45 minutes have passed. So I finished at like 650 I was, I was running a bit late for that reason, but you have me for an hour. So don't worry, thanks. Um So if anyone has any questions, please, uh you know, put them on the chat. Um I had a question. It might be a bit tricky but um like are, are you, you might be aware of like the stereotype with neurosurgical consultants. Um And, you know, there's a lot of talk about how the culture is quite tough. Um So what has been your experience with, you know, your colleagues and your seniors? Um Yeah, so, so it does everybody in this uh whoever is attending, are they all interested in neurosurgery or are they interested in like surgery in general? That's a great question. I think, I think a mix of both. I think a mix of both. I would have thought it because neurosurgery is quite niche that most people in the crowd just want to do uh surgery. So I can answer your question broadly. Initially, I think with regards to medical consultants and GP consultants or whatever and surgery, you're more likely to find surgeons to be a bit more particular, have a bit, you know, higher expectations from the people who are working in their team. Maybe they might be a bit more expressive as well when they're unhappy. So basically, I'm trying to say it in a nice way, but you're more likely to meet people who can make you cry in the surgical specialties that in medicine, right? And after that certain surgical specialties will have a higher intensity of workload and a higher degree of stress. So naturally, there will be circumstances where, you know, you will be at an emotional limit and then someone will come in who's unhappy with you and will express that unhappiness that can push you over the edge. Um, so a, I would say that if you wanna do surgery, you just have to be prepared for that because, you know, if you're giving a medication to somebody as a, as a medical doctor and that medication has a side effect or, you know, you are a bit late in ordering a scan or you make a misdiagnosis, et cetera. It's like your, the, the damage that's done is because you, you didn't do something theoretical that should have been done. Whereas in surgery you'll see that a lot of times the mistakes that happen are things that you have done. You know, so you may have done a surgery which goes bad or there's an infection or there's a bleed after your surgery. So a lot of it is like you feel a lot of personal responsibility that sh you should, I did this. Um, and that's just a natural thing you have to deal with as you become a surgeon and then to add to that. Yeah, you're right. There'll be certain consultants who can make you feel bad about that and there'll be certain registrars, maybe your, your colleagues, you know, people, you consider your friends who are talking about that or making you feel bad about it. Um, so as a surgeon, you just need to have like a hard sort of, um, mindset before you go in and to add on to, on to that, you know, certain specialties, like I said will be a bit more intense. So if you want to do that, you have to wait it out. This is what I want for the rest of my life. Am I somebody who can manage that kind of external pressure? Ok. So generally do people considering surgery just have to be a bit more resilient, thick skinned, I think. Yeah, you have to be a bit more resilient. I would, I would like to think that it's changing. But like I can say, from my personal experience, I'm somebody who gets on, I'm quite easy going. I get on with most people very easily. And, you know, I'm pretty relaxed and calm. But even me like, and this is completely got nothing to do with the people around me. But even me, when some things in theater go wrong and one of your patients has a complication like that does make you feel pretty bad. Um So I can imagine that if on top of that, you know, you're somebody who can easily panic or gets anxious when there is conflict. Um And you don't have, it's easy, it's OK to feel those things, but you need to have um coping mechanisms, you know. Uh So it's, it's good to reflect now and see that if you're the type of person who can manage that kind of stress and have coping mechanisms in place to deal with difficult people and difficult situations and then enter the field because at the end of the day, like you wanna be happy, right? You don't want to just enter a field because it looks great and you feel like you could do it, but then you're miserable inside it. Ok? Thank you for the very honest answer. Um Sorry, I'm just gonna jump about a bit um because I forgot to ask this question. So when you were talking about projects and research, I was gonna ask you, you know, what kind of projects or audits are you involved in at the moment? And there's only scope for medical students here to, you know, contact you or get involved with that. So um currently I'm doing do audits but they don't have much to do with uh like, I'm not sure how a medical student could get involved with. But the pro the research project that I'm working on right now involves um mixed reality technology. So like, I'm sure you guys know of the Microsoft Ho Lens or the Apple Vision Pro where you put it on and you can see, you know, augmented reality. So a 3d depiction of uh of whatever um over overlaying, you know, your, your field of view, so that similar technology is being introduced in theater as well where you can essentially overlay a patient's scan onto the patient's surface anatomy or, or the patient's body. So, an easier way to explain it is, you know, if you can visualize a uh an X ray of the humerus just overlying the patient's arm. So you're looking at the patient's scan as you're operating on it, but it, it makes you feel like you can see you have extra vision and you can see below and uh you can, you know, a appropriately plan your surgical target as well as where you're gonna make your incision and so on. So we're doing a similar thing with the brain where you can see the ct scan of the brain before you start operating on the patient's head. And that way you can, you know, accordingly, plan out where you're gonna make your incision and then use that also whilst you're doing the procedure. So that's something I'm working on currently. And um you know, that this actually feeds back to another thing. Like if you wanna do research, you should try and plan and go to a unit that does research. But then again, I'm not one of those people who is super fussy or particular about like you have to go to X unit to like succeed or do excel in research or whatever. I feel like you can make the most out of wherever you're at, you know. So uh if you have an interest in research, you could literally ask a simple clinical question about, you know, anything that you see in your clinical practice and make that into a research question and write a paper and collect some data and you know, publish it or present it and so on. So there are a lot of research opportunities to be involved in, in surgery. And um yeah, fortunately in Cambridge, there's always like money to run projects and take things up from that. But like I said, like you shouldn't be so bothered about that. You know, I feel like when I was applying, there was always this, um I had this does this sort of um glamour to certain people and certain places where you feel like, well, you know, it's just those special people who can get in and they have access to like some special contacts, some special network that allows them to get published in like, you know, crazy good journals and things, but try not to think of it that way and just be like, I can do that if I work hard and if I, if I put an honest effort and thanks. Um So your projects sound really cool. Um And II think that comes under health tech. Is that right? Ok. Yeah. So I'm, I'm pretty interested in medical technology because I feel like that's going to be the future. Hopefully, at least in the, you know, in the, in the foreseeable future, there are things like robotic surgery and, and, and stuff and like a I obviously is a big thing for all research projects nowadays. But um I just think like, I personally don't have a coding background or a computer science. Background. So as a clinician, you can offer input towards A I projects. But I feel as if there are clinicians who are far more senior than me that would be able to make better contributions uh when they work with computer scientists. Um So a I didn't really fit into my, you know, uh set of interests and then robotic surgery, I think again, is too far down the line, at least in the UK to be introduced in a wide scale. Um, you know, I may be completely wrong on this, but that's how I see the future. Uh Whereas this specific thing with medical technology and simulation training, et cetera, I feel it's more tangible in the near future for before, you know, for my, uh the next few years in my training. So I just wanted to get involved in it and luckily being in Cambridge, there are a lot of opportunities to like, explore any interest that you may have. Uh So yeah, that's essentially how I got into it. Ok, thank you. Um So I guess while, you know, while we wait for people to put their neurosurgical questions in the chat, um I want to talk about something a bit more different if that's OK. Um And that's about um, foundation and training because I know you did that, you know, just two years ago. Um So I wanted to ask about that because I think at the moment especially, you know, in in my medical school, there's a lot of kind of anxiety and uncertainty about um joining the NHS and being a foundation year doctor. Um, I mean, I think quite a lot of negative attitudes and I don't know if it's specific to my medical school or if it translates to, you know, other universities as well. But I just kind of wanted to know your experience of foundation, your training, what went well, what you think could have been better, you know, just general advice on that front. So it's actually interesting, you know, because I completely get what you're saying. I can't imagine what it's like to be in med school right now and having to go into F one because I feel it now where there is this general sense of, um you know, just this lack of clear reason as to why most doctors do what they do just with, with the entire issues regarding being overwhelmed, underpaid and just constantly feeling like you're not doing enough and you're providing subpar care, but it's completely due to no fault of your own. It's just the system that you're working in and that in itself makes you feel, you know, reduce satisfaction with your, with your own personal performance. But also just generally in life, it doesn't make you feel good about yourself when patients are complaining that they haven't been clean for six hours in the ward, you know. Um So nobody, I think it's very hard for most people in healthcare currently and, and doctors, nurses as well, you know, uh to stay motivated and on top of things. So as a new, the next cohort coming through, you know, people like yourself, I can only imagine that it's even, you know, there are more questions going on in your heads, whether it's worth it or not. Uh And like I'm not gonna lie. It's obviously it is what it is. You know, I'm not gonna sugarcoat it. It's a decision you have to make for yourself. Uh There, I have very close friends who left medicine and are doing um either consultancy or working in Big Pharma and they're making a lot more money and they have a lot more free time. So, yeah, it is a difficult decision but having said that um yeah, it's ii don't know where to go with that. Honestly, it's, uh it's all my friends, all our colleagues, we all talk about how, uh you know, how challenging it is. But what, what exactly were you asking me? Remind me again? Uh Yeah. So your views on that and what your, how your foundation is? Wow. Yeah. So if you put that aside in my f one year, I was pretty motivated to like do neurosurgery and to be honest with you, there was not a lot I saw myself doing other than your surgery. So I did ask myself like, if I didn't get in, would I be one of those people who takes a year out and a second year out to reapply or would I maybe try and switch careers, you know? Um, so I did go through those thoughts as well when I was, when I graduated from med school. But putting them aside, I decided that, you know, you have to double down and focus on trying to get something if you truly want it. And I did that in my F one F two. So in terms of advice, what I could say is that, you know, F one F two is challenging because you're a doctor and everything is new and you know, so on and so forth. But if you want to rise above the crop, you have to try and be good at the basic things, you know, so being a good doctor is very important and it's the first step, but you should be able to get that down to at quicker than others so that you can then focus on building your portfolio and getting everything in, in uh in line for applications because a lot of people do not get in after F two. So what that means is they're doing an F three and even an F four at times. So they are now competing with people like you guys who will be applying for F two if you do. So if you want to get in straight to F two, you have to think that you're competing with people in F three and F four or even maybe international medical graduates. So, yeah, if you're one of those people who can manage your time properly and, you know, fulfill your responsibilities as af one doctor, then it would be good to do that tick that box and then start looking at how you can gear up for applications in the next year. But remember, yeah, it's not a race. I don't want to stress you guys out like take it easy. If you can do an F three or an F four, please go ahead and do it like I'm from Dubai, I don't have a UK passport. So I had to get into training to stay here uh on a work visa. But I if you, if I had the option like yeah, doing F three is great cause you can make a lot of money and stuff. So don't be stressed out. Thanks. Um We talked about, you know, using those years to build your port portfolio. Um So, you know, apart from that, how can we make the most of our foundation here training? So I think becoming a good doctor goes a long way in your, you know, there, there are people who take shortcuts who will not be as good of a doctor, you know, and when I say that, I mean, not do as thorough of a job and be as meticulous and doing ward rounds and assessing patients, you can take shortcuts and finish your clinical duties pretty quickly in the day. Uh But a that's not good because I'm sure in some way shape or form patients carers being compensated. So a compromise, sorry. So that would be totally something I would not advise against. But even looking at your personal growth and development, you could cut those corners and make some extra time to, you know, do your portfolio stuff or do your academic stuff. But at some point in the long run, it will catch up to you. So I think in terms of the what advice I would give is that firstly, in F one, make sure you've got your clinical skills down to a deep, you know, the basic stuff, like taking a good history, making a list of differentials, recognizing what's urgent, what, what needs to be prioritized, what needs to be escalated and recognizing what you can independently do within the limits of your competence. Um And once you've done all of that and you're, you know, you're satisfied within yourself and you also receive good feedback from your seniors and your colleagues, then you could start to branch out and be like, you know what, now I can start to build and develop myself a bit further take on audit projects, take on this and that and the other and courses as well as a big thing. So like try and book courses ahead of time because a lot of times, um these courses get booked like, you know, up to a year or like six months in advance. So surgical courses, especially if you can start to try to book them early on in F one. By the time you do them, you'll be like finishing F one, you know, so that's another good thing you can think in advance about any specific courses that you have in mind. Yeah. So, uh you know, basic surgical skills is a very good one to do early because you'll get your head around basic surgical skills. And then you can apply that to uh whenever you get the opportunity to maybe suture a wound on the ward or uh do a simple incision and drainage or something. And um uh there is the ATL S score that again, it is very difficult to book, but the sooner you try to book it, it will be good. Then there are, there is the care of the critically ill surgical patient which I think is only applicable after F two. But there are a bunch of them that you can get through to. Um if you, if you like check on the oncologist surgeon's website. Uh And also the other thing I was gonna say is that there's the MRC S exam that you guys will have to do at some. Now, a lot of people don't do it in F one F two because it's like, you know, you're still getting to grips with being a medical student and being a doctor. But again, if you're able to manage your time and get past that initial hurdle and you're quite settled in your work life, you can think of doing your exam towards the end of F one or the start of F two because the sooner you get it out the way, the easier it is and just like mapping out applications and it frees up a lot of time down the line, you know. Um So that's another thing that you could try and plan into your Yeah, schedule. Thank you for that are really helpful. So a lot of things to think about quite early on. Um We have a good question in the from a So how many, how much opportunity is there to get there to time during F one? Um There's, you hear a lot of different things from different people to get uh what time and a one time, dinner time. So I have a bit of an unorthodox opinion on this because um you need to have, I think about 40 cases for CSD uh before you apply and neurosurgery doesn't have a minimum theater time, but getting 40 cases, for example, is not hard to do, you know, and it's not even that you have to go and do something in them. You could literally go scrub up and hold the sucker for like 15 minutes and that counts as the case, right. So doing that is not difficult. So if you want theater time to do that, it's, you don't need it. You could literally go at 2 p.m. and be out by 2:30 p.m. and go back to doing your ward jobs to getting back out of the experience is easy to do an F one F two. The reason I say I'm unorthodox is that wh it's good to try and do that. It's also important that you're, you know, getting the basics done first, which is ensuring you're getting into co surgical training. I've met people who have like 200 cases on their logbook, but then they haven't done publications or they haven't done audits, they haven't done teaching or the courses. So then they're just doing an F three F four trying to get into CST. And when I hear those stories in my mind, I'm just like, why are you wasting all your time in theater when you can't get, you know, at the end of the day, it's a game and you have to play it. Uh I'm not saying be absolutely bad at operating and don't go to theater at all. I'm saying there's a reason that they ask for 40 cases and not 200 cases on the application. It's because they want you to come in as trainees who have a wide range of skills who they can mold into good surgeons as opposed to somebody who can go and you know, do a hip replacement on day one. They don't, they don't necessarily need that. They have people who can do that, uh which is the registrars. So I would rationalize it in that sense. Uh Look at the scoring matrix, see how much time you need in theater and get that. And of course, if you enjoy it and there are opportunities, go and spend as much time as you can and make sure you're doing a balanced approach where you're ticking all the other boxes as well. I think what I've heard is that because there's so much paperwork and board work as an F one that you don't, you don't get that time in theater. So would you say that you disagree? And you said that you can kind of just go in for an hour, it make time if you're like, if you're efficient, you know, a lot of, if you're efficient, you can get a lot of your work done as an F one quickly. So by about 2:03 p.m. given the job, it could be that you're in a very difficult rotation. But most jobs I feel like by two or 3 p.m. you can get done with it if not every day, at least, you know, two days a week. So that means you have four hours in a week to, to use yourself. And what I'm saying, like that's a guarantee, right? You're not going to be working 8 to 5 p.m. every day, five days a week with no breaks where it's just like, so busy. It's just not possible. So there will be some specialties where you have at least four or five hours a week of free time whilst you're at work and then you can choose them, you can spend them wisely. You don't have to spend all five hours sitting in theater, you know, take two hours to go to two or three cases and spend the other two hours maybe working on a project or something. And trust me, like in surgical jobs, you'll have like you'll be done with ward rounds and your ward rounds and things by like 12 1. Ok. Thank you. That's, that's quite reassuring cos that was something that I was worried about too. Um We have another question so we have an attendee from Dubai as well and asking if you could just clarify what you said about not being able to do an F three. So II, I'm born and brought up in Dubai. Obviously, I'm Indian, but I'm born and brought up in Dubai and I came over here at the age of 18 to study medicine, which I did at the University of York. And then I did a year of masters at Kings after which I just did F one F two. And um you know what I'm doing now, but what I meant about the visa thing is that if you so I don't have a English passport. A UK passport. So I'm on a, initially I was on a student visa and then I was on a work visa. So to stay in this country, I need to be on some visa of some sort. So after I finished F one F two, I was on the foundation program, visa. But after that I need some visa to stay here. Right. So I can't just take a locum year where I'm living and I'm doing like local jobs because they don't give you a, a work visa. Whereas my friends who have a British passport, they can just take a year out and do locums because they live in the home country. So if that was an option, um what I'm saying is you can always do that, take some time out to yourself, travel, make a lot of money doing locums and then see what you want to get into. I was trying to say that it's not a race where you have to like smash everything out in F one F two because a lot of people, I think that's a counterproductive. If you put that kind of pressure on yourself, a lot of people don't end up performing well. So you should take it easy at the end of the day. Thank you. Um And I think that that answers that question too. Um So I think my last question uh for you probably was, you know, there's a lot of talk about having a good work life balance. Um, and, you know, having good side space away from work and home. Um, so other things that you are passionate about outside of medicine. Yeah. Yeah, there's, uh, there, there are quite a few things. Uh, this is something I'm having to deal with because my first two years as an, I've been pretty chilled. Um, I've, I, uh, work out quite a few times a week. I try to stay in good shape and I play a lot of chess. I have a very high reading in just so I play online and I'm in like a 0.3 percentile on chess.com, which is the highest number more flexing. I'm just saying, like, who don't un like nobody gets it. But, um, that's something I enjoy doing and, um, I play the piano, but that's so these are like little things that I've started to realize are being lost from my life. So, like, I don't get that much time to play the piano anymore, which is a bit sad. And apparently when I go on the reg in August, it's like super busy and, you know, you at times you're doing 70 hour weeks and what and whatnot. So that's a bit scary, to be honest because I like looking after myself, uh, and, you know, doing the things that I enjoy doing, but it is neurosurgery at the end of the day. And, um, when I'm on the red road. I don't know if I'll have the time to do these things. So, yeah, I don't have the answer to that man. Work that balance. We'll see how I get on. I mean, that I lose all my muscle mass, you know, and all this stuff. I mean, you know, I think it is quite important. A lot of people do emphasize that and, you know, for good reason too. So I hope you do, you know, manage to find that balance even as you progress. Um There's another question, I think we'll make it our last question. Um Are there any kind of subspecialties with neurosurgery? And I guess my question following on from that is, you know, do you have a, an interest in a subspecialty at the moment? Yeah. So in your surgery there is uh there's pediatric neur surgery oncology. So, like brain tumors and stuff and then you have spine, which is a big thing. It's called Great Private Practice. And then you've got vascular neurosurgery for like, uh, you know, vascular malformations and aneurysms, et cetera. And you've got uh trauma near surgery, um which is a person never dying specialty because people will always get hurt unfortunately, um, from head injuries, et cetera. Uh So, yeah, vascular trauma, spinal pediatric oncology. Um I have mixed up this in uh pituitary as well. Uh So there's AAA variety of them. Uh Personally, I think I'm too early on you know, right now I do anything and I find it very cool and interesting because I, it, it's kind of all new and exciting. Uh, so I wanna give myself some time, keep an open mind and see, uh, what I think I can be an expert in, you know. Ok. And you know, that's fair too. Um, so there are any, I don't have any questions left. I don't think there are any on the chat. Um, so it's up to you if you want to wait for a few minutes, if people have questions, if you're happy to and I'm, I'm happy to wait if uh if anyone has any questions and again, like if you have any questions with regards to applications or whatever, like feel free to ask them. And would you be happy for me to share your email if anyone, you know, asks me you have my email, right? Yeah. Yeah. Yeah, go ahead. Sorry, I just kept you in the hospital for a lot longer than you were supposed to be. Don't worry. So after this, I'll go and see that patient in recovery, make sure he wakes up and then I'll go home. I was initially wanting to go home and do this from there, but I completely forgot about having to review him after the operation. That's a good, I guess this also kind of speaks to, you know, how you're supposed to have like what an 8 to 5 and then it just kind of 530. Yeah. Yeah. And then, like, just unexpectedly you still have to stay in for like, a couple of hours later. So I think that affects work life balance too. To be fair. Yeah. Yeah, it does. But like, I'm quite good at leaving on time unless it's something that I'm getting something out of. So, like, this case has helped me, you know, for down the line. So, uh, you're not wasting your time by staying back. But if you're not good with time management, I see a lot of F two s who stay up to like 8:09 p.m. on a regular day. And that's something I would absolutely not do as an F one F two. and I don't condone that at all. But if you're getting something out of it, like if you're staying back to do a case or something, then it, it makes sense because you're doing it for your personal game, right? I guess it is like for F one F two anyway, it is hard to say no or like to, to set those boundaries. So how did you manage that? You just have to be efficient. Like, II rarely used to remember a point where I would not be done with my work by, you know, five. And if there was some niggling thing, you should hand that over. But I see a lot of people who are like kind of slow and then they're talking and chatting and, you know, and then they're staying till 7:08 p.m. as well. And I just look at them and I feel bad because it's poor planning, you know. Yeah. Um, I think one more question. Is there any stage of training where you're examined on surgical skills? That's a very good question, actually. Yeah. Ironically there's not much MRC S part B has a bit of surgical, uh, assessment where they get you to like suture and drain something. But yeah, you could be absolutely bad at handling instruments and doing surgery and getting to like training. That makes it sound a bit bad, but there's no formal assessment, let's just say it that way. But dexterity is a skill that's learned. It's not something that people are born with. So you could be absolutely shit when you first start. But with time you could improve if you put your mind to it. Thank you. Um I don't think there are any more questions. I think we'll end it there. Um Thank you so much for joining us and for, you know, talking to us about neurosurgery and the application process and foundation of training. It's been really great. No, you've been very nice. It's been very nice to talk to you and I hope uh I can help people out. Um Oh, sorry, we have one more question. Is that ok? Yeah. Yeah. Uh we have a first year student who's really set on getting into neurosurgery. Uh what should be the steps to get started? So, this is a preclinical student. Sure. That's incredible. Um, I guess, try and so you're quite early on. So, yeah, actually this is a good, uh good thing that we didn't talk about. There is a lot of like essay competitions and, and, you know, uh anatomy competitions, et cetera that are done that you just have to again Google and find. Um and in your preclinical years, if you're interested, you know, it's hard to go to the hospital and do research or whatever, you can do these things and win some awards and prizes. Um And you know, as a proxy that you also develop your knowledge and you gain a little bit of an edge in comparison to people who probably got interested a bit later on. So I think in your preclinical years start by finding some essay prizes, some anatomy competitions study for them, try to win a few. And then in your clinical years, you can go and explore your interest in your surgery and then get involved in research and so on and so forth because those awards and prizes will help you no matter what you do, you know, you could wanna do rheumatology at the end of the day. But if you have a national prize, it will count in points for whatever. Uh So that would be a good user for your time. OK. And that you know, that sounds very helpful. So I think that question has been answered. Awesome. Yeah, so I will let you get on with your evening. Thank you so much again. No problem. Ok. Um Yeah, have a lovely evening. Yeah, you too. Thank you.