This on-demand teaching session will discuss the daily duties of a neurosurgeon, what it takes to become one and the various subspecialties it covers. It also covers an interesting case relevant to medical professionals as well as the importance of medical protection and the role of women in neurosurgery. The speaker is the first female from Northern Ireland to be appointed a consultant neurosurgeon and aims to inspire the next generation of surgeons. Attendees will be able to ask questions and receive a certificate of attendance at the end of the talk.
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Welcome to part 2 of our Widening Participation Women in Surgery Series on MedAll!!!

Surgery still has a long way to go with regards to inclusivity and diversity. WPMN strives to be a part of the change and brings you a monthly series delivered by inspiring women from different surgical specialities. Each speaker is a leading women in their field AND from widening participation backgrounds. Join us and surgeons that look just like you and explore how they have navigated a surgical carer and created a work-life-balnce.

Session 1: Miss Emer Campbell MBChB FRCS(SN) BSc(Hons)

"I grew up in Northern Ireland and studied medicine at University of Edinburgh, graduating in 1999. I completed basic surgical training in the south east of Scotland and gained my MRCS in 2002. I spent a year working as a neurosurgical registrar in Dunedin, New Zealand and then returned to the UK to start higher surgical training in neurosurgery at the (then) Southern General Hospital, in Glasgow. I passed the FRCS (surgical neurology) in 2009 and gained my CCT in 2011.

I have completed fellowships in the Alfred Hospital, Melbourne and the Birmingham Children’s Hospital as was appointed as a consultant neurosurgeon at the Royal Hospital for Children, Glasgow in 2012.

I am the first woman from Northern Ireland (and the second from the Ireland) to be appointed to a consultant neurosurgeon post.

In 2020 I was awarded a BSc(Hons) in Mathematics and Statistics, from the Open University and am the clinical lead for Paediatric Neurosurgery. My research interests include patient safety and outcome measurements and I have presented my work at national and international meetings.

I am the national audit lead for the British Paediatric Neurosurgical Group.

In 2021, I was appointed as Clinical Director for Surgical Services and Gastroenterology at the Royal Hospital for Children, Glasgow and hold the position of Honorary Senior Clinical Lecturer at the University of Glasgow.

I am a very keen runner and compete at regional and national level."

We hope you enjoy the catchup content!

We have 2 webinars per months. If you enjoyed this event, please check out our page for more events!

Additionally follow us on social media @WPMedicsNetwork and become a member of the organisation for free and get our latest news and events emailed to you... www.wpmedicsnetwork.com

Learning objectives

Learning Objectives: 1. Identify the different types of pathologies of the brain and spine treated by neurosurgeons. 2. Understand the different specialties within neurosurgery and how to specialize. 3. Build an understanding of the importance of adequate indemnity protection for medical professionals. 4. Develop strategies to appropriately assess and manage a case involving medical decision-making. 5. Gain an awareness of the progress being made for women in neurosurgery and identify potential areas of improvement.
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Computer generated transcript

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

all right. Hello, everyone. I'm Isabel. Welcome to and two of, uh, women in surgery series. Um, so first we just got a talk from Jonathan and from our sponsor from MPs, so I'll hand over to him. Thank you, Isabel. So hello, everyone. I heard all well, my name is Jonathan Darn medicine, and I'm you're dedicated relationship manager at M ps Medical Protection Society. So I just wanted to quickly touch base and introduce myself to on what MPs are if you've not heard of this before. So MPs, medical protection. We are medical defense organization, and we provide medical legal protection for you when things go wrong. So we provide you with the right to request assistants who claims complaints, disciplinary proceedings, GMC issues and coronary court hearings and much more. In the UK, it is a GMC requirement to have adequate indemnity in place, the key word being adequate. So I'll quickly explain that a little bit further. So before I explain a little bit further, we are the world's leading medical defense organization for healthcare professionals. More doctor's trust us than any other medical defense organization. And we support our members from university and beyond retirement and were non for profit and member owned. So we'll run by our health health care professionals for healthcare professionals. So everything we do is that you are are members are at the heart of all decisions that are made. So when I mentioned adequate indemnity apologies, the slides are a little bit slow. You are. While working for the NHS, you are covered by something called an HSS committee, which would be considered adequate in the GMC eyes. However, as you will be aware, you are strongly recommended by your colleagues and by your seniors and buy all to have your own medical defense or organization membership. And that is simply because, um, NHS and Deputy really only covers the patient with regard to the financial consequence. It doesn't cover you for your legal representation if you are. If you do have a claim made against yourself, doesn't cover you for advice and help with responding to complaints. Coronary inquest GMC proceedings. Um, and just to give you a statistic, eight out of 10 doctors that do go to the gym GMC hearing if you are. If they are faced with that unfortunate event, Um, and they do not have a medical legal representation. Unfortunately, out of 10 of those people are taking off the register. Do make sure that you do have your protection in place and you can see they're all the benefits. What makes us different? So I understand there may be a mixture of students F ones, um, and over grades in the audience today. So what makes us different with the world's leading medical defense organization? Were the only medical defensive organizations are F ones with free membership? Um, so if you are an F one, do take advantage of that even if you are with another or another organization, utilize our benefits as it is free membership for your F one. And also we are the most price competitive medical defense organization, um, as well. So our prices are most competitive. And that's not just because we want to claw you in as members that because we worked really hard with our members to provide them resources to help us reduce the risk of claims which therefore make our price is cheaper. But you'll see a QR code there and for anyone that is interested in joining, if you're a student, it's also free. And if you do need any further information or questions, my email address is on the screen. But thank you so much for your time. Awesome. Thank you so much, Jonathan. Okay, so now to introduce the series, so Hi, everyone. My name is Isabel. I'm currently an F two in north London, and I'm working with W PMN to bring to you a very exciting set of webinars. Um, so we're really, really excited, actually, to be back for the second season of the Women in Search series after the huge success of the first season. Um, the name of this series is really to inspire the next generation of surgeons and give you surgical role models that look like you. Um, So each month, we have women from different surgical specialties from orthopedics, plastics, breast surgery from hospitals across the UK, um, and Ireland and each surgeon will talk about their journey into surgery. What a typical day a week looks like for them. Some tips were applying, um, and some interesting things that they have seen after the talk. We have a Q and A with the speaker. So please, please, please. Um, any questions you have in the chat, Um, and I will go through them at the end, um, to ask our lovely speaker. Um, and I also just want to remind you please to fill in the feedback for me at the end of each talk. Um, and you'll get a certificate of attendance with that. So to kick off season to, um I'm really excited and intrigue to introduce the speaker. As it's a field of surgery. I'm sure many of us won't have had any exposure to, um, so she was the first female from Northern Ireland to be appointed to a consultant. Neurosurgeon post. Um, she works as the clinical lead for pediatric neurosurgery and the clinical director for surgical services and gastroenterology at the rural hospital for Children in Glasgow. So, without further ado, um, I welcome miss the McCampbell. Thank you, Isabel, for that night. Let me just see if I can get my can Everyone see my slides there? Is that come up as a bell mind a little bit delayed, but I think it's Yeah, it's up there now. Okay, so we'll get started. So thank you very much for that very warm introduction and thank you for giving me this opportunity to speak to you all this evening, and I have not done anything like this before. And so bear with me as I'm a little bit nervous and a little bit unsure what exactly I had to tell you, but we'll go through. This is what I had planned in terms of sort of taking you through what neurosurgeons do and what a typical day is, how I became a neurosurgeon and then also how you could become a neurosurgeon, which is actually quite different now, given that I'm quite old and I've been doing this for quite some time, I'm going to take you through an interesting case that I was involved in. Um, and it's quite a good example, particularly for as a surgeon, thinking about it's not a case of what can you do? But what should you do? And then finally, I'll do a bit on sort of like women in neurosurgery. And what sort of progress is being made, if any at all, which we'll get to the end. Please do feel free to ask questions, and as we go through and I'm sure it is, Isabel can let me know what's come through. So what is your surgery? So it's an old joke, but it's a good joke. It isn't rocket science at What is it? It's the diagnosis, assessment and surgical management of brain and spinal pathologies. So what sort of stuff do we actually look after? Um, in the brain, we would be looking at trauma. We also look after intercranial tumors, so those can be primary brain tumors. But they can also be secondary metastasis. We also have a role in looking after some CNS infections. Now that would be things like brain abscesses and subdural. Empyema is where there's a collection of puss within the actual cranium itself. We also look after hydrocephalus. It's a very common disorder and takes up a lot of our work. That's where your brain isn't handling CSF as it should do, and we have to try and restore the actual process of handling of CSF and also in the brain. We look after spontaneous interest. Cerebral hemorrhage, so spontaneous bleed, often because of an abnormality of the blood vessels, so that would include subarachnoid hemorrhage is, and also other types of bleed as well. Then in the spine. There can be quite a bit of overlap with spinal orthopedic surgeons, and so there we again also look after trauma, both injuries to the bony spine, but also to the spinal cord. We look after them tumors of the spinal cord that can be part of the actual spinal cord or intrinsic tumors. They can also be extrinsic to the spinal cord but pressing on it. We also treat a condition called malignant spinal cord compression, where your cord is being compressed by something that's causing you to lose your cord function. And that's a neurosurgical emergency. And then finally, there's degenerative spinal disorders, which is the generalized sort of wear and tear of what happens just as part of the aging process. And as you go through your training as a neurosurgeon, you will get experience in looking after all of these conditions, but you then have to choose to specialize. And so these are some of the sort of different types of sub specialists that you get in neurosurgery. So if tumour your thing, you can become a neuro oncology neurosurgeon. Neurovascular neurosurgeons look after patients who've suffered hemorrhage or have abnormalities of the vasculature of their actual brain. So arterial venous malformations aneurysms that might be causing subarachnoid hemorrhage is skull base. Neuro surgeons work on getting into the skull base, which is that probably the trickiest part of the brain to actually reach. And they might be treating, For example, patients who've got acoustic neuromas or tumors of the cranial nerve pituitary surgeons work at getting into the pituitary, which is also part of the base of the skull. But they work quite closely with Ian, ear, nose and throat or ENT surgeons by actually doing an approach and as a transsphenoidal approach, going up through the actual face to gain access. Here, functional neurosurgeons are trying to adjust the function of the brain, so this might be deep brain stimulation for movement disorders such as Parkinson's disease. They will also treat conditions, for example, epilepsy that is resistant to drug or two drugs where the patient is continuing to have seizures and there's a focus of the particular part of the brain that's causing that seizure. We can discuss whether or not it should be removed, Um, as well. Then there's complex spinal surgeons, which deal with actual instrumentation and fusion of the spine, and again they will work quite closely with orthopedic surgeons and finally and possibly well, in my point of view. Most importantly, there's also pediatric neurosurgery as well, which is what I do. So what do they look after? Well, in the UK, Pediatrics is diagnosed is defined as anyone up until the age of the 16th birthday at the time of their 1st 1st referral. So if you already known to us, we might keep you a little bit beyond your 16th birthday. And the common conditions that we look after the big one is hydrocephalus. And that makes up almost a half of what we do sort of day today in terms of managing that condition and restoring the normal flow of CSF for Children to ensure that they've got normal development. Unfortunately, lots of Children also get injured, so we look after quite a bit of trauma, and also tumour of the brain and the spinal cord are also relatively common. It's the second commonest tumour that you'll actually see in childhood after hematological tumour like lymphomas and leukemias. That's not the case in adult patients, but it is the case in Children. We also look after congenital anomalies. Where you're basically your central nervous system hasn't been put together right, for example, spina bifida, but also congenital hydrocephalus. And we also see some newborns have been diagnosed with brain tumors in utero as well. And finally, infection is also quite common, treating the consequences of the meningitis. There's sinusitis that, um, then also leading to collections of infection within the brain. So it's really quite varied, specially particularly in pediatrics with what we do and looking after the kids. So what's a typical day for a neurosurgeon? It's pretty much the same as most surgeons, so you'll do a mixture of operating sessions and outpatient clinics. You've obviously got word rounds to do, and you're also due MG T s, for example, even your oncology MG T. And we also do some specialist clinics as well. For, um, we have a spinal bifida clinic that's not just neurosurgeons, but also orthopedic surgeons and neurologists, because those are other specialties that these Children need to see. One thing about pediatric neurosurgery is, however, that the on call frequency is really very high. It's a one in four on call that I do, and most units would be one in four to about one in six. By and large, it's a dedicated unit just for pediatric neurosurgery. So all the adult patients go to the adult hospital. But all the Children will come to me now. That's not to say that I'm in every night, all night, one in four. Most of the time I am at home with my register on call, giving me a call. But if a child is found in your pretty much going to be coming in, and that can be quite a strange just sort of your work life, balance and so on, and it helps to have very supportive colleagues who can help you out if you're needing to take a bit of a break. Things that are slightly different between, for example, a pediatric neurosurgeon and maybe an adult neurosurgeon is first of all, a lot more of what I do Day to day is unplanned. What that means is, is that about 60 to 70% so nearly two thirds of the operations that we do are not elective. They're actually urgent or emergency operations where the child hasn't come up to a clinic. We've met them. We've said Hello. We've said You're coming in on this date and the operation goes ahead. That's only about one and three. The rest of them. The child's either been admitted as an emergency or urgently presented, saying, with the parents saying, We think there's a problem, for example, with the shunt if we treated the hydrocephalus and we need to get on and get them treated swiftly now, what that means as a consultant is that you have to have quite a lot of flexibility in your job plan to be able to react to that. And so most units have a sort of a duty consultant, which is what I am this week here in Glasgow, whereby I'm on the shop floor Monday to Friday until six. And I'm just meant to react with anything that's happening for all of our in patients and also any referrals that are coming through as well. And what that can then mean is that the other weeks I am not sort of designated to do that and can have a little bit more flexibility with my time. But this week I have to be dedicated purely to looking after the kids that are with us at the moment. We don't do the full. I don't do on call out of ours at night as well. And one of my colleagues do that, and they hand them back to me in the morning because seven nights straight on call would be really quite a struggle to recover from. The other thing that anyone who works in pediatric surgery might do so that might be pediatric surgeons or pediatric urologist is that they will also do some antenatal counseling. So this is where we meet with parents before their baby is born to discuss with them what the diagnosis is, because we can now do both. Antenatal ultrasounds are extremely good, but we also do antenatal MRI scans as well. And in the vast, vast majority. It's not about discussing whether or not the parents want to continue with the pregnancy. It's just explaining to them what's likely to be ahead of them after their baby is born. So they understand a little bit of the process and, for example, that their baby might be staying in hospital for two or three weeks after they're born, before they will be able to go home so they're prepared for what's ahead of them. Also, more recently, we are now offering surgery, um, anti in Italy, in in London, in Great Ormond Street through for open spina bifida is we're also counseling parents and offering them at the surgery, whereby if the child's got an open, um, spina bifida surgery can be done while they're still in neutral to close over there defect, which does actually improve their neurological outcome. They subsequently come back up here to Scotland again, and we help with the delivery. So we're closely involved in that process as well. So it's a very interesting and very varied in the job and that you're often dealing with patients who, technically, you haven't actually been born yet. Um, so it can be you have to sort of switched very quickly from from one scenario to another. Yeah, so one of the most commonest questions I get asked, Our most neurosurgeons get asked. If you've never seen us do this before, is But how on earth do you actually open somebody's head? So this is a quick step two step guide to remove the mystery as to how we actually do this. So, first thing is and we have to think about is your reasons for going in? What were you trying to get to? So come some of that will come from anatomy and looking at the scans, and that's part of the neurosurgical training. But we've also got some image guidance systems that we can use in theater as well known as Neuronavigation. And this is really it. When visitors come into theater and they sort of go, Wow, this is really quite impressive, and it is impressive technology. What we have is you have a set of MRI, a computer system in which the patient MRI scans are loaded up, too, and it comes with a camera. We then have to register the patient after they're asleep to a fixed marker, and we then scan their face with the camera switched on using a special pointer. And it takes the information from the contours of the patient's face and to what's already known about the scan, because that will include their face, and it then means that you can marry the two together. So with your pointer, you can point to a particular part of the patients head, and it will show you on the actual scans where you are relation, for example, where your tumor might be, or where your blood clot or your abscess, whatever is or you're trying to hit the ventricle, you can plan your trajectory in terms of doing your biopsy. So it's another way of basically ensuring that we're trying to plan where we're going to make an opening in the skull and then when we plan our incision as well. So with that all in mind, this is the view that we would actually get so the patients is upside down because you're likely to be standing. And that's the view, because you're at the top of the head and we make our incision where we are actually planning it to be within the hairline, so that when the hair grows back, it's actually hidden rather than, for example, if you're making it in the forehead, that may not be cosmetically acceptable because it can give quite a bad score, particularly in Children. That's very noticeable. And so you plan your incision and you have to bear in mind the neurovascular supply of the scalp. So that's coming from the heart and coming up this way, so you have to make the flap as wide as possible at its base. So you make your incision and then you fold back the skin, and with that, you're going to expose the underlying skull. So this is the frontal bone with the zygomatic process of the frontal bone. And then we've got the temporal bone here and the skin edges. We put little clips on them called rainy clips, and they pinch the skin edges. And that is to achieve some homeostasis, just simply because otherwise you might get a lot of just little trickles of blood coming into your wound and deeper into your into the actual skill once you get it opened. So it's important that we control that as possible. Having done that, you then drill a burr hole and a burr hole is about the size of your fingernail, your little fingernail or thereabouts, and you can make as many burn holes as you want. And from that you're going to connect them up to create a trapdoor of bone that you'll actually sort of lift off. And we do that using a high speed drill so it's just slipping in underneath the bone after you've made your your whole and on top of the dura, and it's just making you make your cut and you just connect the dots of your birth holes and simply lift the actual bone flap off. And what you'll then see underneath is the juror. So if you have an extra dural hematoma from the trauma that will be sitting between the bone and the and the jurors, and it's sitting right here, and you can simply remove that just with gentle suction and you've done your operation and then you can close them back up. But for a lot of operations, you've obviously got to open the juror and the jurors is a tough, fibrous envelope, and so it has to be directly open to you in size it open and you flip it back and you're into the subdural space and you will see the brain. And so, if you had a subdural hematoma, it would be sitting here, and you have to gently remove that because you've got the brain directly underneath it and you don't want to cause any further injury. For other occasions, you may need to open up the actual brain doing what we call a court economy, and they're using your image guidance, but also you often from your knowledge of anatomy as well. You can then make a small incision within the actual brain, and you simply dissect down and you may find your tumor or your blood clot will then sort of be released out because it's likely to be under pressure. And people often sort of say, Well, what's what is the brain actually sort of feel like or what's its consistency? And it's like a very fine mozzarella cheese, very expensive one. But it's got that sort of thing where you can make an opening in it and then just sort of gently prize it apart. I hope I'm not putting anyone off their dinner. Other things that we might do, um, is that we can, for example, in this we're separating the temporal lobe here from the frontal lobe on the side. It's called splitting the Sylvian Fissure, and you often do that to actually reveal where the blood vessels of the Sylvian fissure, particularly internal carotid artery and the Middle Cerebral Artery, where you might be, for example, treating an aneurysm and putting a clip on it. And it's also a common approach to some tumors that within the base of the skull anteriorly as well. So having them done your operation, you will then close up so you get homeostasis. We've got a stitch. The jurors back closed again because it's a very effective barrier against infection. It's also stop CSF from sort of splashing out into the sort of into the subcutaneous tissue as well, which can be quite helpful. So you stitch it closed, and then the most important step of closure is putting the bone flap back again, which you either stitch in place by drilling some small holes. Or we also have plating systems as well. And that's really important because it basically defines the shape of your head. And if you don't put it back in again or it's not put in the correct position, the patient will actually notice that. And they may say my head no longer look symmetrical, so it's a key bit to get back in, and then you stitch up the skin, and that's essentially how you actually open ahead. So moving on, How did I actually get to do this? So this is This is the but I feel possibly most uncomfortable with my life story. But anyway and some of you might have picked up from my accent that I am from Northern Ireland. Um, I was born, and also I grew up in a small town called Glargine, just outside Belfast, and when I was about 13 or 14, I took the notion that I wanted to be a doctor, Uh, other than really enjoying the science subjects and being a bit useless at the art subjects, particularly music and art. I have no idea why I chose to do that. But I decided then that I was going to be a doctor and, um, to go to university. I did what we refer to Northern Ireland as I moved across the water and you go across to Scotland and I ended up in Edinburgh, chose Edinburgh simply because I like the city. My older brother was already over at university in Saint Andrews, so it's sort of one of those things where there's family nearby as well, which we always think of. And even then I don't even remember thinking of surgery or even let alone neurosurgery when I was an undergraduate. Um, I do remember thinking that it was hospital medicine for me rather than, for example, GP or psychiatry or lab based. But actually, um, I remember I went. I did my elective in Sydney an emergency medicine and had an absolute ball, and I thought, This is what I was going to be. I was going to do E. D. So after graduating, I did house jobs in Edinburgh and I went through orthopedics and general surgery and really enjoyed it, just like the sort of the got to do some practical skills. I was allowed into theater. It was just the atmosphere I just enjoyed, and it was always better being for those that are students in the audience. It's always better to be to be qualified than it is to being a student. Each time you climb up the ladder, it gets a bit easier. More responsibility is a good thing, and it's more interesting after I've done my surgery, which you do for six months back in the day. You then went on to medicine for six months, and I got moved from general surgery to geriatrics and went into doing 4 to 6 Hour War drowns, which the comparison and the contrast from surgery really didn't sit well with me. And that's probably what made up my mind of thinking. I think I wanted to be a surgeon. I then went on and did cardiology for the last three months, and that was actually quite a lot of fun. So it may. My mind may have been changed if I hadn't gone directly into geriatrics in the first instance. But I'm off the school of thought were award round as an hour at most, and hopefully not much longer than that. So I was still thinking of E. D. At that time, and this was now the early noughties. I graduated in 1999 so in the year 2000, I was now fully registered with the G M C. And you had to apply for senior House officer posts. And we did what was called Senior House Officer rotations, which were between two or three years, and you could go into surgery. You could go into medicine. You could also go into GP training or psychiatry or anesthetics as well, and I was still thinking of E. D. At the time, and one of the sort of advantages of the system back then was that you didn't have to specify immediately where you were going to. You could hedge your bets a little bit. And for E d. You could actually do surgical S H O training. You could do medical S H O training. You could even do anesthetics if you wanted to as well. So I did six months of emergency medicine in Edinburgh and thought, Yeah, this is for me and then applied onto the surgical rotation and went back to Edinburgh to the southeast of Scotland and started off. I had to do a year of general surgery, which wasn't terrible, Wasn't for me. Didn't particularly enjoy it that much. And particularly this sort of opening up Abdomen's late at night. Sort of wondering, Is this going to be a simple anastomosis or not? It was all I just It's just one of those things and it's a personal preference. And then I moved into orthopedics as an s H. O and really enjoyed it. Um, I work with a great bunch of guys, um, and also female surgeons. I was encouraged to get into the theater and to do. And I like getting these practical skills and that sort of trying to fix it mentality. So I thought maybe orthopedics. And then the last two bits of my s h o, I got my MRCS at this stage. So I was walking around and calling myself Ms Campbell, as opposed to Doctor Campbell. And I went off to do six months of cardio thoracic surgery and then six months of neurosurgery. And this was my first taste of neurosurgery. The six months of cardiothoracic despite being, you know, MRCs positive. I was still the most junior member of the team. So, for example, on call, I was still expected to be riding up Card X is, you know, prescribing laxatives, examining little old ladies who have fallen out of bed and so on. And when you're four years out of being graduated, you're sort of going I'm a bit too overqualified for this, whereas when I still got into theater and I got to learn how to open a chest and things like that, but it just wasn't one of those things that really sort of stretched me too much. And then I went to neurosurgery. And they said, You're the S h 03, You've got your MRCS. You're now on the middle grade rotor. You're going to be at home. You have an S h o Who's helping you out. But you've got a consultant. So we need to train you up so that you can actually take people to say two by yourself at the end of all this and do simple operations. And that was just a revelation to me. It's like, Oh, wow. And so I got stuck in and I got to do as much as I possibly could. I really enjoyed the pathology that I was seeing, but also the sort of process and the this sort of how can we fix this person? Can we? So we bring them across who not etcetera, and so on. It just really sat with me and I thought, Yeah, this is what I want to do. And my trainers there also really encouraged me and said, We think you're quite good at this. You should be thinking about this. So I was not at the end of my S h 03 and I was not ready to apply for specialist registered training. I needed to get more clinical experience. And there's two ways you could do that. Either you could go and do a period of research, perhaps getting an MD out of it and still trying to sort of hold your clinical skills by doing as much work, particularly out of ours within a particular units. That was one option. Or I could go abroad for a year and try and work as a neurosurgical register there. So I didn't need to be told twice. And I headed off to New Zealand for a year and spent a year living out in Dunedin and had an absolutely awesome time. I am not talking about the job, Um, so any trainee or anyone who asks me, what do you think about taking a year abroad and working? I say, Go do it. You will have the time of your life and you'll also get a fantastic clinical experience and it will help you as well. But I've never regretted doing any time that I've spent both my electives, but also in New Zealand, and then also subsequently when I was on my fellowship year as well, and I was working in the Dunedin, in the South Island here in a small little district General Hospital, where there were two neurosurgical consultants and me as their register. And so for eight months, I was in every single theater and operation, also doing clinics, looking after patients on the ward, and I got it was a fantastic experience. And, um, I got to develop my surgical skills. I also had to still do a bit of general surgery out of ours on call, which confirmed me that I was never destined to be a general surgeon. I didn't enjoy it, however fabulous as New Zealand is, the weather is brilliant. You can surf in the summer, which is what I learned to do, and also you can ski. It is a very, very long, long, long way from home. It's a 24 hour flight, and so I was in the same thing. I'm going to go back to the UK to get on with my actual training, but it's neurosurgery that I want to do, and Scotland was calling the West of Scotland, based here in Glasgow, public are advertised for a specialist register training. So again, this was 2004, and at this stage it wasn't a national system as it is now. Each individual dean very simply advertised at different times of the year, how many training posts that they had and Glasgow had to. So I am applied and got shortlisted. And it was one of I remember going into the interview. There's sort of like the where you sit before you can get called in for the interview and realized that I was probably one of the youngest people there. I was also probably one of the least experience. So there's people sort of sitting there with their sort of PhD thesis on their lap, sort of been having that polite chit chat where they're sort of saying explaining, Oh, yes, no, I'm I'm already doing a locum appointment for training, and this is my fourth interview, and I think I'm getting really good. I was, you know, the reserve last time, and I was sort of sitting there going Well, I don't think I've got enough qualifications for this. I just spent a sort of a year learning how to ski and drink good wine, so this isn't going to go terribly. well, so I was chalking it up to interview experience. Um and so perhaps that changed my frame of mind where I was going. All right, well, let's just relax and chill and see what happens and went in and chatting away for the duration of the interview and then was absolutely gobsmacked when they found me back and said, By the way, we would like to offer you the job. I really I did actually have to check with them and say, Are you sure? And they said yes. Interestingly, they actually appointed it to the two youngest or least experienced people. It was, uh, my colleague nearly now works in Belfast. He's known as my neurosurgical twin because we trained together and he also was the exact same stage. And I asked one of the one of the consultants who were training me afterwards and said, Why did you? And said, When you get to the interview, it's a flat plane, for everyone is the same, and you got you went in. You seem to be extremely keen. You had a very positive experience in New Zealand and you were ready to step into the training. You just seem to be someone who would fit into our department, so it's always bear that in mind. It's not just that, the particularly the psyching people out in the interview beforehand, it's all a game. Don't listen to anybody. You're you're as good as you as you think you are and have some confidence with that. So I was. This was in September 2004. I got 18 years ago, and for the first year, I was sent up to Nine Miles Hospital in Dundee. And then I came back down to the Institute of Neurological Sciences in the Southern General Hospital in Glasgow, which, for those of you don't know, is basically one of the homes of neurosurgery in the world. Because this is where the Glasgow coma scale came from in 1970 for from Teasdale and Jeanette. And it is an extremely busy unit because Glasgow generates an awful lot of particularly head trauma. And so you get a vast experience, it very and you learn very quickly how to open ahead, uh, to deal with various things during the middle of the night. With that, um, I also got my you have to see your exit exams, your fellowship at the Royal College of Surgeons. I got that in 2008, and this was again something else that they have now unfortunately abandoned. You were also encouraged to take a year out and do a fellowship in a certain subspecialty. And I headed off to the Alfred Hospital in Melbourne for my second year in Australia and again had a fabulous time because, um, I was living in a city where it never rains, which is just when you grew up in Northern Ireland. And then most of your training in the West of Scotland is just a complete and utter novelty. And again, you have the attitude of where, Yes, I'm here to work hard, and I did. But you also are there. I'm here to enjoy myself as much as I can and experience as much outside of the hospital as I can. So again I would fully recommend taking time out and going and working abroad, particularly Australia and New Zealand. Um, at that time, in terms of my sub specialization, I was actually thinking of complex spine, Um, in that the Alfred Hospital is the largest trauma unit in the Southern Hemisphere, and so it does an awful lot of instrumentation for trauma. And so I got a lot of experience, but basically putting screws into people's spines and fixing them. I came back to Glasgow and got my certificate of completion of training in March 2011. No, in that final year when I came back, I hadn't really been. I've always enjoyed pediatric side of neurosurgery, but I often thought that the pressure was so intense because you always have someone who is patiently waiting outside for you to finish to ask how the operation is actually gone and that I sort of felt that's too much pressure. I don't think I can cope with that, but in that final year, and I work very closely with some of the pediatric neurosurgeons here in Glasgow, and I got as I got more experience, I got more confidence and realized that actually really enjoyed working with kids. Kids are fantastic. Kids get on with life, you know, they you know, if their leg doesn't work, they still need to get around so they make the damnedest just actually getting around. And it's good fun. You can get to have a laugh with them as well. Yes, we have tragedies, but often you you have enough good memories to sort of cancel out what doesn't work quite work out quite so well in the end. And so at that stage, I was also aware that there was going to be some consultant post coming up in Glasgow because there was a major reorganization of pediatric neurosurgery services. And so my philosophy quite a bit is that you should work to live, not live to work. And I had built a life for myself in Glasgow, and I was in my mid thirties and I wanted to stay in Glasgow and so, uh, sort of realized. Well, there's jobs coming up. I need to sort of do what I can to make myself a point toble. And so I went off and said, Right, I'll get some more pediatric experience. So I did a second fellowship in Birmingham Children's Hospital for the first time, working in a a standalone Children's unit, and I had a great time down there, made some great friends and some colleagues, um, as well, who I know you see on a regular basis at meetings and the job came up in Glasgow. Um, I applied. And, um, I got appointed, um, along with one other consultants. Who is Some of you, particularly those of you who work here in Glasgow, will know of rodeo Cane, my colleague, who is either famous or infamous. Um, if ever you hear of him and he and I were appointed here in Glasgow at the same time in March 2012, and the original plan was that we would only be spending a quarter of our time doing pediatrics based at the Royal Hospital for sick Children at York Hill and the other three quarters of the time would be adult practice at the Southern General Hospital in Glasgow. Now, these hospitals, we don't know we're about three miles apart, and it is actually very, very difficult to have practices and split sites because you can't just pop in and see a relative or see a patient when they happen. When it suits you, it actually takes, even though it's only three miles, it takes you the best part of an hour to do that. By the time you go down and get your car, you know, drive over Park, then go and see etcetera. There's no nipping out, and that became more. What became apparent was we were actually spending. All of us were spending a lot more time doing pediatrics and was ever anticipated, and it was getting more into sort of 50% pediatrics and then actually nearly up to 75. And so I made the decision in 2014 to go. Actually, I'm going to focus on pediatrics. I'm not going to do any more adult emergency on cold, but I'll continue to do some elective an adult and both in clinics and also in theater. Life got a bit easier for us in 2016, when they moved the They built a new. They were in the process of building a new Children's hospital, and we're now all on one site known as the Queen Elizabeth University Hospital with the Royal Hospital for Sick Children. So life got a little bit easier at that stage. What else is happening in my career? And I became a Panelist in the national selection for neurosurgical training. That was in 2018 and in 2019 year before the pandemic hit. Um, I actually decided that I had enough going on in pediatric neurosurgery to step back entirely from adult elective. I sort of my practice had dwindled down to sort of simple degenerative spine work because I wasn't doing any on call, which generates the interesting cases, and it was getting pretty tedious and unrewarding. And so I just decided I'm going to step back completely, which when the pandemic hit, I was really quite glad, because in pediatrics we were able to keep or to restart much faster and and sort of avoid the sort of shut down that actually happened with adult surgery and across all specialties. Other things that we did because we were actually doing 300 plus cases a year in Children. We actually established our own department of pediatric neurosurgeon within the Children's Hospital. So we were no longer this little sort of offshoot of the adult department, which has got 14 consultants. We neither said, Well, actually, we're going to be our own group with in here. I'm also I work at the National Audit lead for the British pediatric neurosurgical group, and then last year, for I became the clinical director for surgery and gastroenterology at the Children's hospital and people, even my colleagues look at me and do sort of say, Are you absolutely crazy to be taking on such a role? Some of it a lot of the time you go. I was 10 years into being a consultant now, and you are looking for you need new challenges. You can't just keep doing the same thing. And the first 5 to 6 years of being a consultant is a massive challenge because you're learning constantly on the job, no matter what specialty that you actually choose. But you get a point where experience showed you. You've actually got an awful lot of skills and you start looking around doing well. What's the next step? What I want to do. And this was an opportunity that came along, and it plays to my strength of being hyper hyper organized, um, and sort of problem solving. And I'm learning new skills and sort of leadership and leading teams looking after somewhere between about 40 and 50 consultants here, organizing theater lists and ensuring that things are running as well. So it's a massive challenge, but it's people will do different things at this stage in their career. Some might go into academia and sort of more research. Other people go into teaching. It's you're sort of looking to see what's going to keep you wanting to come in to work every day. So that's where how I got here. But how could you get here? So it is all now completely changed, for better or for worse, and there are some advantages. But I would argue that there are also some disadvantages. You can quite clearly see that I really didn't decide. I wanted to be a neurosurgeon until I actually did it. And that's not an option. At the moment, you have to be thinking much more in advance. Also, I had a lot of flexibility with my training and what I wanted to do. And again, that's not often an option that comes through but just to sort of talk you through, and you're drawing in my experience as a national palace, of also what we're looking for for in neurosurgery as people who are applying the first thing to say so now, Um, neurosurgical recruitment is done through a national process which is run through the Yorkshire and hum bird injury and you're applying to initiate year training program for run through training for neurosurgery. We currently only recruit to ST One and S t two posts. Previously, we did recruit to S t three, but not anymore. And it is highly, highly competitive. It's one of the most competitive specialties we've actually the number of ST One Post is falling, um, in 2018 or it was 34 last year or this year. Rather, it was only 16, and the number of applicants is increasing. So we actually had 16 applicants for each post that come that came through and we interviewed 56 of those for those 16 posts at ST to Level, we only had one. Now the reason why the numbers are decreasing is that we don't have enough consultant posts for people. At the moment, you're finishing their actual training. Um, and I'll explain a little bit further when I go through what the process of training is now. We actually have individuals here, often after they get their CCT. We're waiting two or three years and doing fellowships to try and actually get a consultant post, and that's the reason why we're now, uh, it's been decided, that sort of work force planning that we're limiting the number of people who are now getting onto the training program. What's the pathway? So after getting your medical degree, you will then do your two years of foundation your training, and then you can have a choice. You can either apply directly for specialty training and neurosurgery or any other specialty. Or you can also consider doing course surgical training where you will go through, probably about between 3 to 4, maybe even five surgical specialties such as general surgery but also orthopedics. You might do some e N T. You may even get to do some emergency medicine and so on as well. And there's a lot to be said for going through course surgical training, as I sort of explain when I go through the application process. But you will gain an awful lot of both surgical skills or practical skills like suturing understanding how to put a patient on a table safely and what diathermy how to use it safely, etcetera and so on. Theater etiquette. But what you and and you also get an understanding of what those specialties do, even if you never actually are planning to work on them long term or training them. But you also get those non sort of technical skills. You learn to do things like time management. How to handle a busy on call, how to prioritize when sort of, uh, emergency phone calls are coming through. How you can discuss things you know, seeking help from different people. How to manage your patients. So there's a lot to be said for going through course surgical training. So the process itself. It's an online application. And to be eligible for ST one training, we don't count your your foundation, your training. So after your two years of foundation your training, you can have no more than 24 months and told so two years' experience and no more than one year of that should be a neuro specialties like in neurosurgery, like in neurology. But also, for example, neuroradiology to qualify as an s for ST to you basically have to have done a year as an S t one. So the equivalent of a clinical fellow or a lot at ST one level in a unit that offers neurosurgical training in the UK So you feel like you're online applications. It normally the process starts early November, and it finishes in early December and the applications go through there, then sort of collated and standardized and anonymized, and we then do short listing, which is done at the first week after Christmas. And it's done with two assessors. So two people who have been trained in doing that look at a batch of applications and what we're looking at, both your medical student, uh, sort of time and what you've done. And then also what you've done is the foundation, your doctor or in those two years afterwards. And these are sort of areas that we look at, what publications and presentations that you might have any audits that you might have done if you've got other degrees, particularly if it's related to the neuroscience, is we Look at your teaching experience. We also look at your practical in your psycho motor skills, and what that really is talking about is your extracurricular activities what you do outside of medicine. So, for example, do you do a sport to a high level? Do you play a musical instrument? You know things like that. If you're in a band. That's the type of information that you look for. If you do, a lot of you know, arts, Kraftwerk, whatever showing what you do other than simply actually turning up to work every day. We also look at sort of what leadership and organizational skills that you have as well and sort of working our way through both your clinical experience but also the extra stuff that you've done. So that's all sort of scored and then independently verified as well. And then the second part of this sort of process before interview is something called a multi specially recruitment assessment. This is an online exam where you're going through different clinical scenarios based on your professional dilemmas and also clinical problems, problem solving skills with what you've already experienced in your foundation, your training. With that, the scores are weighted, so it's about 60% for your application form, and then it's about 40% for your what's called the M S. R. A. And then the top slice. So, for example, the moment it's 55 56 candidates are then invited for interviews and before the pandemic, we did the interviews in person, down in leads and you would go through five stations, which would last between approximately 25 minutes. And they're about one would be on your CV and also your understanding of sort of what a neurosurgical career would be in some of the challenges that there might be within that career. You then also had to go through a scenario of it's called the telephone Scenario. It's basically a busy on call, and it's watching you. How you sort of juggle these new information is given to you and how you can react to that in the in the appropriate way. You also have to do a difficult patient consultation, which is with an actor. You're actually you take this very, very seriously and they really do home their craft. To do this about a consultation in terms of where something has gone wrong. There's a scenario where you're sort of talked through a clinical professional judgment. It's basically worst day at work ever, where everything just seems to go wrong and people are sort of colleagues are fighting and not turning up and not doing what they're expected to do. And we also look at some of your technical skills as well. And so if you've got experience, and particularly at a sort of a surgical level as a junior, register, for example, during course surgical training, even if not much of it, is being done in neurosurgery, this will actually stand you in good stead for this. And you can often actually see, even though we don't know the background of the candidates, you can actually begin to spot in some of these scenarios, like the difficult patient consultation, who is actually a little bit further ahead and their clinical experience, and someone who's just come straight out of foundation your training. So the scores and then added up again with your short listing scores. And with that, the offers are then made and the successful candidates, for example, this year it was. 16 of them were then asked to write their choices. And if you get the top score, you can get your first choice, and then they just simply go through allocating to the different units. So that's how you get onto the actual training process. Then the fun really begins. So what's run through training? So run through training starts as initial training is your fundamentals of surgery. So you're going through. You're learning surgical skills. You will be both on the ward and also in theater. You will also spend some time in some of our allied specialties. For example, neurology, perhaps neuro intensive care. Also, for example, maxilla facial surgery ent as well. And in that time, you're expected to sit your MRCS, then the middle bit or you're intermediate years s T four and five is your general neurosurgical training. You will be in the shop floor in a neurosurgical unit, doing on calls with your consultants at home gaining skills both in, for example, spinal neurosurgery, oncology, vascular neurosurgery. You will go through the whole gamut in the final part, which is S t 60 s, t eight. You then go through advanced, um, neurosurgical training. This is where you're spending a lot more time in theater and developing your sub specialist interest. You also do your pediatric stent in this bit as well, and at the end of your S t six level, you're also eligible to apply for your F. R. C s and at the end of the year S t. Eight year your specialist advisory committee, who's supervising your training makes a recommendation to your to the G M. C. That you have completed your specialist training. You get a certificate of that and you get put on to the specialist registrar. You're not eligible to apply for consultant posts. However, as I said before, there's actually a shortage of consultant posts at the moment. And so a number of people are now doing fellowship, sometimes two, sometimes three often working abroad to gain extra experience to make them, then more attractive candidate when they do actually then apply for the consultant posts. So there is a bottleneck at this stage at the moment, which is what the workforce planning are trying to do by trying to limit the number coming through at the top end at the moment, moving on to my interesting case. So, as I said, this is a case that I was involved in, and I still don't know if I did the right thing. I'm going to warn you in advance. This, unfortunately, does not have a happy ending. Um, but I think it's a really good understanding because you go through your surgical training, getting all these skills, and often you're asking yourself, What can I do? What? What what? What can we know? Can I do this? Can I do that? And actually, a much more difficult question is sometimes what should I do? Um, and that can be very difficult. And sometimes there is no right answer, as this case probably illustrates. So the background is This is a 12 year old boy who was previously fit and well with no past medical history. And he collapsed at Judo Club one sort of late afternoon. There was no head injury. He hadn't bang his head. And he was taken to his local emergency department where they know that they found that he was hemodynamically stable. But he was unconscious. He was only flexing to pain. He had no I and no verbal response. And his left pupil was fixed and dilated. So they intubated and ventilated him, and they got a CT scan, and this is what it showed. So this is actual CT scans, and they're plain CT. And on this one half of the brain should look like the other half. It should be as if you can draw a line down the mirror and this is a clearly abnormal scan. There's this very bright white area in the left basal ganglia in the global global pallidus and also, uh, Putamen. This is a hemorrhage. This is acute blood, and he has ruptured into his lateral ventricle, and he's got radiological signs of raised intracranial pressure. Um, in that he's got features of his brain is looking tight. This is just something that you learn when you look at a lot of scans. But he's also got some midline shift across to the right hand side as well. He's also got clinical signs of raised intracranial pressure. He's unconscious, and he's got a fixed and dilated pupil on the left hand side. So treatment of raised intracranial pressure This is a surgical problem. If you find a neurologist, they will say, phone a neurosurgeon right now, And the underlying principle is treat the cause if you can, so if it's a tumor, take it out. If it's a blood clot, suck it out. If it's hydro, careful is treat the hydrocephalus. So this kid has had a spontaneous intracerebral hemorrhage. We should be thinking of surgery, but my colleague, who was not sorry, my colleague, who was on call that night because it wasn't me came through and said, Okay, but why has this previously well, 12 year old child had a spontaneous intracerebral hemorrhage? He's not got any. He's not on anticoagulants. He's not on warfarin. He doesn't have any past medical history that we know of. He's not 75 years old and a smoker who is at risk of having a hemorrhagic stroke. So in addition to arranging for the patient to be transferred across here to the Children's Hospital in Glasgow, he then arrange for the child to have a CT angiogram where we did a repeat CT scan, with contrast, where we're looking at the blood vessels and these are the pictures that we got. And what we're looking expecting to see is a circle of Willis. You know, the standard sort of appearance, but we don't have that. This is not the blood clot which is lighting up here. The blood clot you might be able to make out is just sitting next to it. This child is a very, very abnormal circle of Willis. He has got an arterial venous malformation, so he's got an abnormal connection between an artery and a vein. So rather than blood flowing from an artery into an arterial into the capillaries and into the venue ALS and then back into the veins again, it's actually going high pressure. High flow arterial blood is going directly into a vein, and that then becomes dilated and weakened. So this I don't know if you can see with my Pointer. There's a big sort of swelling here. That's a dilated vein. It's like a varicose vein, basically, and so this This is a weak point, and that is what's ruptured and caused his blade going back to the original CT scan. We're now looking at this clock. It's in this child's dominant hemisphere, and it is deep. It's at least 2 to 3 centimeters through his dominant cortex. Uh, that we would have to move through to get to the clot, And we now know from the CT angiogram that the bleeding point is that the deepest part of this clot cava so you're not going to be able to control any bleeding until you've actually taken out all of the clock and the bleeding is directly coming from his circle of Willis. And so, in attempting to actually control this in a high pressure situation where he maybe bleeding out you will actually probably destroy the circulation to his actual brain, and he will simply have a massive stroke. This is effectively we cannot operate on. We cannot evacuate this child's blood clot. Um, it would probably the risks of the surgery or two. Great, and he would likely die on the table. So my colleague said, Well, we can at least try and treat his intracranial pressure. Are there any other nonsurgical or non direct ways that we could do that? So we can put in an intracranial pressure monitor so at least get a number that we can then see how effective are treatment has been? We could give some hyperosmolar therapy, such as hypertonic, saline or mannitol, so we're going to concentrate his actual blood so that we can reduce some of the swelling within his brain if we control his ventilation by keeping him intubated and ventilated and gently lower his CO2 not crashing down, but to the lower end of normal. That may also help lower his ICP if we keep him sedated, and particularly if we use certain drugs, for example, propofol rather than midazolam, is an anesthetic drug to keep him asleep. That might also lower his ICP, and my colleague did one other thing as well. He put in an external ventricular drain, which is where we're going to put a small little tube into the actual ventricle on the right hand side, and we can siphon off some CSF, and that can also just lower his pressure. So this was the management plan initially for this child, and his intracranial pressure was sitting at about 20. It would gradually go up a little bit, and we would, for example, just tweak his ventilation or maybe give him a little bit of hypertonics ceiling and we'll come down again. But over the course of about 24 to 48 hours, it gradually began to climb, and then it wouldn't come back down. And this was when I got involved, as I was the on call consultant, and I got told that his ICP had risen to over 70 so it was much, much higher than that hand be, and that is critically raised intracranial pressure. If you don't do something, he's going to start having massive in fortune of his brain. I repeated his CT scan to be absolutely certain that he hadn't had a rebleed because that would have been important to know and he hadn't. But what the scan is now showing is that the midline shift is getting worse and there's no more CSF to let out from his ventricle. The DVD cannot do anything more, and we're at the limit of what we can do with ventilation. With his hypertonics feeling as well, we still can't operate on the actual, um, take out the blood clot because we haven't managed to control the actual A VM we had discussed with our new radiologist. Is there something that they could do? And there wasn't he was not well enough for us to do anything. The only other treatment that I could then think of is something called a decompressive craniectomy. So a decompressive craniectomy, I put it in the nonsurgical options for the management of ICP. It is an operation, but you're not treating the cause of the raised intracranial pressure. You're simply effectively trying to sort of relieve the pressure itself. So it's not a direct treatment and what it involves doing is removing part of the skull. So if you think of the skull as a rigid box, the pressure is climbing inside of the box because of the bleed. If we take off the lid of the box, we may well actually be able to control the pressure or stopped having an adverse effect on the rest of the brain. Now this is used in traumatic brain injuries, where there's been a very severe brain swelling. It's also been used in large ischemic strokes as well in adults and the clinical trials that have done it. And the evidence is that it does prolong the patient survival so more people will survive. But these patients will have a very significant disability, and only a small proportion will have any form of an independent existence. So it is not a sort of an easier, straightforward thing to do, and it may not be overall in the patient's best interest if they're completely dependent and require nursing care for the rest of their days and can't communicate with their family. Also, my other worry was in that there is a risk that, as I take off the side of the side of the skull that I then sort of remove the pressure that's actually controlling a V M. And it may start to bleed again. So there was also a risk that the child could actually bleed out on the table and would not survive. And so I had to sit down with, um, I spoke to my colleagues, but we also have to sit down, obviously with his parents and explained that his pressure was critically raised and that there was really very little that the surgical, the nonsurgical options were not working. So we were considering this operation, but there was a possibility that he could die on the table. There was a possibility that would make no difference at all, or we would still be left with a very significant disability. And and they did what all parents will do in this or the vast, vast majority will do in this situation, which is, please do whatever you can to save his life, and that's an entirely understandable and very, very reasonable thing to say. So we did, and we took him to theater and I did a decompressive craniectomy and he there were no major incidents in theater just to give you an example. This is what the size of the skull defect that we did. These are his scans POSTOP, just showing you the size of the defect that we have created in his actual skull. Um, so it's a very big operation. And what we've got here on the right hand side, that's the ICP monitor going in. And that's our drain. That's just what it looks like from the CT scan. His picture still appear, and we got him off the table safely. His ICP was again reading sort of less than 20. So his numbers were much better and we took him back around to the intensive care unit and my plan was for 48 hours. We are going to do absolutely nothing other than support. So keep him ventilated, keep him sedated. Don't let his BP change too much. Don't adjust his ventilation. Let's see. Oh, to stay where it is and just give his brain arrest and see what recovery is going to make. And my plan was that after those 48 hours, we would then re scan him. And now you can, actually, because you've taken away the skull. Uh, the skin is closed again, so the skin is all closed. But you've got this soft area on the left hand side of his head where you can actually then palpate the brain because there's no skull underneath anymore and you can actually get a little feel. And if it feels a little bit soft, you're going. That's normal brain. On the morning that we were planning the scan, we got a phone call to say his ICP had shot up. It was higher than 70 again, and when you actually felt the left hand side of his head, it was rock hard, whereas previously had been soft. So something had then happened. So we repeated the CT scan, and this is what we saw. He had a massive rebleed. You can now see that because he's not. He's missing part of the side of his head of his skull here. It's now her needing right that way. And so both myself and my colleagues and the intensive care team all felt that this was not unsurvivable. He had had a devastating bleed into his dominant hemisphere. It was extending all the way down into his brain stem and that he would make no meaningful recovery from this and there was no further surgical options. And so, um, it was with his parents permission. We withdrew treatment and he died 10 minutes after we extubated him. And so, as I said, it wasn't happy ending. But it is important with these cases that you sit down and think, Well, what could we have done differently? What what might we have done differently the next time this comes around and I still don't know and it's been a couple of years now. If I actually did the right thing and it didn't change the patient's final outcome, he's still real glad. I don't know if I would do the same thing again, particularly in pediatrics. There is always hope, because Children brains can make a remarkable recovery and so there's always a chance you go well, let's see what will happen even though it looks like the odds are stacked against them and we have had Children who we have managed to bring back, and actually they've made a fantastic recovery. I don't know if I would want a member of my own family to have this sort of treatment. That's a really big question that you sometimes have to ask yourself. Would you would you want someone that you know you love and care for You will be for the rest of you know and will be part of their life for the rest of the days to actually go through this. I also don't know what the family feel as well. We always offer when a child dies and circumstances like this to meet with the family 4 to 6 weeks afterwards to see if they have any questions or anything that they want to ask us. And we did offer that to this family, but they didn't want to take us up on it, which is is perfectly within their rights. So I don't know if they have any comfort in knowing that we did everything that we possibly could for this child. I don't know. And so this is what I mean about it being an example of. This is a question of what should I do in these situations? Not what can I do? And these are just really difficult. And you have to a certain extent, except that you're not actually often going to find the answer to that and it can be quite difficult to to deal with it equally is something that, in terms of with the sort of the career and the job of medicine, but surgery in particular is that you often do. You have to. These things do haunt you. It's a personal grave graveyard that you go around with knowing what what might have been, what you could have done slightly differently. And you have to be prepared for that. It does. It's one of the unique features of actually being a doctor of actually having these, because you were. Anyone who works in any other areas often doesn't have to deal with these actual dilemmas and being learning skills as to how to cope with this and the sort of the most emotional fall back that comes from. This is quite an important part of your training that you don't actually find in any textbook or even on any course as well. So, um, I will leave it there with that case, but you can, by all means come back at me. In the chat session afterwards, I'm nearly done finally, so women in neurosurgery. Are we making any progress? Well, you could argue that we are making some progress. Um, in when I in the 1991 This is when I was first thinking of medicine and probably none of you were born. But that's by the way. 3% of the consultants surgeons in the UK were female in 2020 it's up to 14%. So you could argue that progress has been made. We significantly increased the the proportion of the surgical work force that is female. Um, in that period of time, however, the vast majority of medical schools now, I have more female, um, undergraduates than they do have males. So the progress itself has probably been relatively limited. Um, and we need to begin to explore and sort of look into that. Where does neurosurgery sit in the grand scheme of things and we are at the bottom of the league table. We're propping it up with the orthopedic surgeons. Um, there are 22 consultants, female neurosurgeons in the UK ophthalmology and pediatric surgery are doing much better. There are nearly a third, but that's still nowhere near the parity of 50% that we really should be achieving at this stage. So is it changing with neurosurgery? I'm afraid it's not over the last 10 years. So the number of women that are in in the neurosurgical work force and total fluctuates between about 15 and 20% and the number of consultants it's not really changed. It's still sitting at sort of 7%. We're not in the last 10 years. Any progress is pretty much stalled, unfortunately, and this is why the headlines like this are, unfortunately not that surprising. Um, this this come around. It's often in March, which is when International Women's Day is, and these are from The Irish Times, and they have greatly upset my mother because this was in March 2021. This is apparently the first female neurosurgeon from in Ireland, and there's actually three of us have come before her. But that's by the by. None of us actually work in Ireland, but it's still upsets. My mother and Taffy is the first female pediatric neurosurgeon in Ireland. This was in March of this year, and, um, again, I'm the first one myself and again. So my mother was about to write a letter and I complained to the actual editor of The Irish Times. To be fair, I don't work, so okay, that's fine. And Mary Murphy is the in the Queen's Square in London is the original and first ever neurosurgeon who was a woman who comes from Ireland. So to be fair to Taffy, who I met shortly after this and did went up and say and explain how much she upset my mother. She was very apologetic and wanted to correct, and I said, I don't mind at all, but every year it comes around and, um, in a similar sort of. Then there was the the focus. Neurosurgical Focus, which is a subsidiary. The Journal of Neurosurgery in March of last year also dedicated their issue to international women leaders. And there's a fantastic editorial written by a group of female neurosurgeons in Australia. And they extrapolate that when being asked the question, Why do we need female leaders in neurosurgery? Why do we need female neurosurgical consultants? They extrapolated on an argument by this woman. This is Julia Gillard, who was the first and so far only female prime minister of Australia, and she gave an incredibly famous speech in October 2012 in to the Australian Parliament. If you get the opportunity and google it on YouTube, she for 15 minutes she reels against the misogyny that she has been experiencing as a woman in a man's job from the leader of the opposition in particular. And if, as a woman, you've had a bad day at work where the micro aggressions and the stereotypes has really warn you doing, I would urge you to read this because she vocalizes so eloquently the frustration of what you have to sometimes put up with when you are working as a woman in a male dominated profession. And her argument, basically is that for women's leadership, it's a moral one. A democracy should look and reflect the actual population that it serves. And what's the point of being allowed to vote if you don't have any real prospect of actually being voted for and in the editorial and Sara Olsen, Um, and her colleagues actually sort of say this idea? Well, why do we need to? Why do women have to even prove that they are worthy of being counted as being a consultant? Neurosurgeon? Why do we have to do this. That's utterly futile, actually a bit offensive because no man has to prove that. And they say that. Why do we need neurosurgical leaders? Because diversity in neurosurgery and in medicine in general is a very, very good thing. And it is the benefit of the profession that it's a moral imperative that those who provide their care should be representative in the fullest sense for whom they actually care. Now, if at the moment, if nothing else, for surgery as a profession, if more women are actually applying to medical school and being accepted and then graduating, and that is only going to increase the surgery as a profession, to even survive is gonna have to start and get it's act together and start attracting more women in. We can't let this sort of stagnation that has happened continue. So there's lots of sort of schemes and rationales that are put through, and this is it's a fairly standard about any minority group and so on. But you know, for example, eliminating discrimination. Making the application process is much fairer, which I would argue is one thing. That national selection and standardizing it is much better than it was in my day is a good thing. We should also be promoting women into leadership positions. We should be having role models and mentors and and things like what the, um the widening participation in Medicine Network is doing is all absolutely fantastic, and this is all important. We also, however, need to tackle unconscious bias and also sort of gender stereotypes. And this is my last bit that I'm going to say I'm nearly done. I'm I'm running over an unconscious bias in itself. I find absolutely fascinating and also, to a certain extent, also quite deeply ironic because the classic example of unconscious bias is actually known as the surgeons dilemma and feel free to use this on any of your colleagues. I've done it multiple times. So the story goes that a father and son are involved in a horrific car crash and the man dies at the scene. The child was rushed to the hospital, and he needs emergency surgery and is transferred to theater. And the consultant surgeon on coal arrives and says, I can't operate on this boy. He is my son. I have told this to surgeons. I've told it to trainees. I've told it to non medics. I've told it to Children. I've told it to adults and you can see in their heads. I did it last night to a colleague who was visiting from Germany, and I told him this story. I trained him and he still went through this process of going Now how could that be? The father has died. But yet the consultants surgeon on call has said that this is his son. This does not mean any sense, and people go through steps of going, Oh, well, he's his parents must be separated once his father and once his stepfather or he has two gay dad's and you know, it's just unusual, but that's it or he's been adopted. Or it's some sort of weird Mama Mia type thing where Mommy doesn't know who Daddy actually is. And there's some potential candidates, and only finally two people actually click and go. His mother is a consultant on call, the idea that a woman could actually be the consult surgeon on call, and I'm even telling this as a female consultant, I'm pointing out myself and people can Still male surgeons can still go Maybe, maybe he is. Maybe he's got gay's we, we, we we we accept that we're not homophobic. And, um, yeah, it's It's even 50% of the chance that his mother is actually the person who's actually on call. So what we need to do and what we need your help to do your old budding surgeons is actually getting more women into surgery. So this becomes obsolete. And it's not the way that you actually demonstrate. Psychologists use this to demonstrate psych sort of unconscious bias in a wide range of actual professions. And to do that part of it is my job to be here. I have to be honest with you about what a career in neurosurgery is actually like. This was a survey of members of the SBN S and also the which is the Society of British Neurological Surgeons and also the British neurosurgical Try Association that was published last year. They got about 300 replies, about a third were from consultants and two thirds from trainees. And there was about 91 women who responded. About 290 men and about 10 who either were identified as non binary or didn't stay with their gender was and just sort of interesting and asking people well, for example, are you married in a long term relationship that was much more common in the mail neurosurgeons? This is all grades compared to the female, and more interesting side was, for example, do you have Children? Which was much more common for the men versus the actual women. And even more interesting was when you asked, Well, who looks after your kids? And for the men. The majority of that work was done by their partner. That was not the case for the female neurosurgeons. They were still having to take on the role for some of them as being the actual sort of the lead parent for actual childcare. The number that sort of wanted had worked less time at some point in the career was much higher for female neurosurgeons as well. They also, they asked, everybody, Do you think men and women are treated differently? And overall it was. Approximately 44% said no. Men and women are not treated differently overall, but it was much more common. Over half the men said that, but less than a third of the women said that and when asked, Well, if you think people are treated differently, who gets treated better? And men, to their credit, said the men do as also did all of the women, only a very small minority thought that women are being treated are treated better than the actual men. So it is a tough job and things that when they were asked to elaborate, What are you talking about? They talked about issues of being sort of personally experiencing or witnessing, for example, inappropriate comments, for example, undermining behavior and sexual harassment, which should be stamped out. And by that I mean literally stamped out. They also sort of comments that were made, for example, about, you know, difficulties with, for example, family planning and, you know, wanting time off to have Children and so on. Equally, there was this age old atmosphere of a boys' club, and we need to defeat all of this by having more people and having more women and one of the things that I was putting together I've never heard of this phrase before. A genetic to have a genetic behavior is where you behave in a way in which you have the power to control his or her your own goals, your own actions and your destiny. This is something that men are permitted to do by society. It's something that they're actively encouraged to do as they go through their careers. It is not something that is recognized in women, and I actually think that women need to be doing a lot more of that, that they need to actually be thinking, not as an I'm going to think like a man does, but actually behaving in this way where you're acting in your own interest a little bit more, looking for opportunities and season and adapting them so you can actually make the most of them. You know, speaking up, raising your voice, getting your elbows out and saying when you're not. This isn't what I agree with. I'm going to disagree with you. I'd like to volunteer this where opportunities are coming through and also saying when you're not happy and calling it out for each other men to that when someone is being inappropriate in any shape or form that that should actually be publicly said that this can be tolerated anymore, um, in the last surgery is not It's not that old a profession. We only really been sort of surgeons for the last 100 years. You know, antibiotics only came in the 19 forties and, you know, over that period of time, surgery has lost too many outstandingly talented women, and we can't really afford to lose any more. So please, if you are thinking of surgery, do and explore it as much as possible and get as much experience as possible talking to people but also coming and spending time with with in your local departments as well, so that if you do want to join the profession, you will be more than welcome. And that is all I was going to say to finish up. So thank you very much. I've also included my email address work here. If anyone wants to get in touch as well. But please do. But I will leave it there. Thank you. Oh, can everyone here me? Sorry. Thank you so much. That was a really, really interesting talk. I don't know much about neurosurgery, and I feel like I know quite a bit now, and I really appreciate it. This section on the the women in surgery because really interesting. The surgical dilemma. I've never seen that before. I'm going to do it on all my friends and see what happens. So that research, yeah, the interesting thing about the surgical dilemma is particularly with non medics if you do it with Children. So I've done it with, like, 11 12 year olds and they go well, it's easy, obvious. His mother, that is, his mom, who's, you know, it's It's Mom who's going to do the operation. And older Children and adults don't do that. So there must be a period in where Whatever reason, kids get conditioned into going. That's not a woman's job. Yeah, it's really interesting. And even I've been in. When I went to, I remember going up to Dundee and I was the first female trainee doing neurosurgery in Dundee, and then the first week or so they did ask me. So what do we call you? Do we call you Mr Campbell? And I think you can call me Miss or Doctor Campbell Or you can call me anymore is actually much better. But on Earth made you think that you you, you know, and that was less than 20 years ago. So, yes, there's there's a fabulous Well, if it's okay with you if you want to hang around, we've got some questions, some questions as well. I'm going to scroll up a little bit. Um, so Maria to know she first. He says, thank you for such an interesting. But please, could you offer some advice or about neurosurgery? This is not a specialty. Every hospital, and not generally well, not especially at every hospital. And not generally talk to medical school. Um, so, yeah, any tips you have? Yeah. So your medical school should have, um, certainly where you can get a little bit of choice in terms of options and so on and even doing what we sort of like taster weeks and so on. So the thing to do is simply to get in touch with the actual neurosurgical department. There is an element of you don't ask. You don't get so if you simply email and say, Listen, I've got you I've got to do a special study module, or you can even do it during your holidays. We've had people email us and say, Listen, I just come and spend a couple of days with you, you know, seeing in clinic and doing war drones. I'm a medical student, but this is when I'm on holiday and we go, Yeah, that's absolutely that is no problem at all. And you can get just a bit of a flavor of what we do in terms of spending time in theater with us and also in clinic doing wardrobes and so on as well. I agree. It's only done in certain units. They tend to be within the big city. So it's not done in District General Hospitals, for example, here in Scotland, it's only done. There's the Edinburgh Well, infirmary. And then there's the Queen Elizabeth Hospital here in Glasgow and then Aberdeen and Dandy, but nowhere else. So there's about 20 other 25 other hospitals where there is no neurosurgery. We feed in. So simply getting in touch and asking is probably the easiest way departments. We want to encourage people to come in, so you email and then, by all means, just ask. And if not, they'll point, you know, and sometimes you know we don't do that or offer you say well, is that one of your colleagues who could perhaps maybe would be willing to sort of take take me on and come and spend some time. Let me spend some time with them. So ask Yeah, definitely. And I echo that, like the taste of weeks are really easy to sort out in foundation. Especially, you'll definitely be able to find a neurosurgical taste a week because you can go anywhere. Really. It's really flexible. Um, do scrolling. So the cash Know what your thoughts on the future of neurosurgical train recruitment? Do you think training numbers are transient low, Or is this a new normal? Um, I think they do change. So sort of NHS consultant work force planning is, um, an art and not a science. And there is an awful lot of it's sort of reacts quite a lot. So, for example, in when I was a neurosurgical training so 20 odd years ago, it was decided that cardiac adult cardiac surgeons would no longer be needed, wouldn't need as many because everyone was going to be having cardiologist doing interventions, and that then led to an actual reduction in the number of cardiac surgery trainees. There was actually individuals who were on training programs, you were told you need to leave, You're never going to get a job. And that then went full circle and we turned and discovered. Actually, no. The cardiologists country, anything we do actually need to continue to have cardiac surgeons as well. And so I think it is likely to fluctuate because, as I said, it's an art and not a science. And it's a generational thing as well in terms of people then deciding, for example, how long they're going to be working as a consultant. Do you want to be doing it? You know, beyond the age of mid fifties sixties, etcetera and so on. All of those factors come in, and the the medicine as a whole is not good at that planning. And so I imagine it will go back up again because we'll realize that we've overshot and reduce the number, and then we're going to need to increase it again afterwards. So it is likely to change again. Um, I'm Reggie not a question, but just wanted to say that she kind of reflects on everything you were saying in the last part about women in surgery and, um basically during lectures. A lot of the lectures would say mentioned boys to be surgeons and would just be a bit Yeah, Oh, yeah, it's ridiculous. And it's, you know, So I've had comments like Oh, well, you know, for example, you are telling patients Patient just really needs to man up a little bit. For example a. That's inappropriate as a child. And I like Excuse me, what exactly do you mean by man up? What, precisely, But, you know, toughen up a little bit and you're like, Hang on a second here. You're telling female, Am I going to do an operation? It's just this off. I'm not going to do that, you know? What's the difference between manning up and warming up? Phrases like that are ridiculous, and they are redundant. And I just go. Excuse me. No, I don't buy that at all. What exactly do you mean by that? And sometimes that's I mean, it's a trick that I use. There's people trainees have asked me. Well, what do you do when you hear people making comments like that? And you know, and I often say, if someone cracks a joke because, yeah, hang around with a lot of men and I just played dead pan and just I'm sorry. I don't understand. Could you repeat that, please? And they and I said, Then again, could you repeat that again, please? I still don't understand. It's a bad joke. And B, it's actually offensive. And the more times you say it, the more it actually sounds obvious that it's offensive. And I think, particularly as I was getting more senior of actually just going, you know, and particularly there is sort of more junior doctors around and actually saying, Guys know, Stop. That is absolutely wrong to make that comment about a woman or anything else you you know, I heard somebody say, Oh, I went over for an interview and another unit and the local candidate got the job and someone one of my colleagues, This is awful, said, Oh, I bet it's because she's sleeping with the consultants, and I just excuse me, that is appalling. The reason why you didn't get that job because she was better than you suck it up and get on with your life cough. Short answer. It's appalling that men think like that, and it's not got to the stage where they realize if they say that to me, I will give them an earful and they will walk away. Yeah, any tips for people? Obviously you're in a position of power, being a consultant for us on the other end, who are to use medical students who here, like registrars, TB or senior doctors saying things like that and don't necessarily want to say anything there. And then have you been in a position where you've done something else or, um so So I would hope agree? That's an incredibly difficult thing to say. I think that there should always be know with their should be mechanisms in which you are able to give feedback in a constructive way to your department, to the seniors in your department and and actually sort of saying saying Listen, I've been hearing inappropriate comments and if it has been personally directed at you, you have a right to make a complaint about that, and that will be taken seriously. Um, a lot of the time men, God bless them, don't even realize when they're being offensive because, you know, that's just what they do, etcetera, and some of them it's often quite easy to bring it back to them. Um, and you know, you can do it If someone you know, I would hope that someone could come and say to me that this is what has been said And then I would be able to take action to that and finding supportive members to actually say That's not always the case. And, you know, some women don't help each other, um, as well, but actually saying no one should be in the same sense that we shouldn't be hearing anything that is discriminatory or offensive to a minority group. Whether that's, you know, racism, homophobia, we need to go hang on a second stop. That's unnecessary comment so it can flip it around the other trick, too. Sometimes, if you hear something someone saying something derogatory about women, um is I remember one of my first day it was It was when I was a surgical S h O training and this really sort of up his own are consultants surgeon in Edward, which will remain nameless. It was like where you're only in surgery to find a rich man in Merriam, aren't you? And my response was I'm sure you have the same hopes and dreams for your daughters. They went Oh, yeah, Yeah, right. Because if you if I have to put up with this, your daughters will be putting up with this sort of crap as well, you know? So there's little ways that you turn it around, But if you just make it a little bit more personal and say, yeah, you got daughters, I'm sure they have to deal with this crap. And if they come home and we'll get you, all you have to say is there there, dear. That's boys being boys. You see how you see how you cook with it, and it's a member of your family. So there's there's different ways that you can sort of take around, but God, it's difficult. And I wish that we didn't have to deal with it. But we unfortunately do. Yeah, yeah, but yeah, I can look at my hospital. There was, um we found it really easy to report. And some people that actually report on the sex is, um, in the surgery department, and they really did investigate it thoroughly. So if you are worried about speaking up and just just do it to do so I would like to No. Why do you think that the numbers in terms of the proportion of female to male neurosurgeon, I think we've got complacent. I think it's where we've we've hit a mass where most departments have probably one neurosurgeon consultants. And so it's that sort of, well, you know, we've broken the glass ceiling. There's nothing more that needs to get done, and I think that it is, it's it's become it's we need to. We've made a huge effort to get there, and then we sort of step back a little bit. I am relatively hopeful with, for example, with what's happened with the pandemic. How remote. How the NHS has embraced remote working that that will actually mean that the old fashioned Well, how can you possibly, you know, leave work at one o'clock and go and pick up your Children? You can't be a surgeon if you're doing that, and you're like, Well, you live at six. What's the difference? Um, you know, and sort of that sort of actually what most people now actually spend a lot more time at home than they do at work, and you can actually work remotely and work very flexibly around that. You know, around your kids, that's much more accepted. All also, working less than full time is also becoming much more accepted as well. And so there is that possibility. But we I think we've taken off the gas. That's why it's stagnated. And so when you know this, um, and, uh, had put me forward for this opportunity to do this, it's like, Yeah, let's go out and just start talking about it because we need more women in neurosurgery because it's a moral reasons for the good of the exactly. So Emily wanted to say thank you very much. Um, and as a female medical student from Northern Ireland, it has been so encouraging to hear your career journey. Any advice for someone heading into F one F two next year? How to use this time to maximize the chances of getting into neurosurgical training? So, um, if you if you have the possibility of spending doing a bit of your foundation, your job in a related neurosurgeon neurology, that's a good thing. If not, you should get taste a week, so it should come and spend some time and get to know your neurosurgical department. If you're working in Northern Ireland, you'll be based in bed fast, where there are some excellent people. And there's my neurosurgical twin brother, Neal Sims, think his head of the training program there, he's someone to get in touch with. There's also, uh, Nicola Brown, who is the one of the She's an oncology neurosurgeon there, who is great fun, too. There's another guy called man. Oh, I'm going to mess up his man, who is a pediatric neurosurgeon there, and he also is great fun. And he would be someone to go and speak to you and say, by all means said, I heard talk from your Campbell. She said, I should get in touch, Just name, drop away and see if you can spend some time with them getting to know them. And then also, once they get to know you sort of thing because there any project or a case report that I could write up or if you got an audit that I might be keen to present on. So those are all things that you can do in terms of focusing mainly on your surgery. There's also the other sort of generic stuff that looks good on any CV for any train. So, for example, if you've got an opportunity to take on a bit more responsibility, organizing some teaching, whether it's for medical students and getting a sort of a regular program up, whether it's also organizing you know your Wroten having an administrative role whether you take on any additional responsibilities, for example, the hospital organizing committees, the B m A. Whatever it happens to be sort of liaison with medical students, looking for those opportunities that just allow you to develop some skills and get some more experience. Yeah, awesome. So I just have one question from me. Do you have, like, a favorite pathology or condition that when you see you get excited about or I well, my I really enjoy spina bifida? So it's particularly doing open spina bifida and newborns because the anatomy is completely screwed, and it is You're sort of sitting there trying to figure out, you know, which is the spinal cord, you know, because it's all it's not the right shape. It's not the right size. It's not in the right position. You know which bits do I need to preserve? How do we close this etcetera and so on? So that's it's sort of technically interesting and challenging surgery. And now we have this, um, this. In the last sort of five years we been developing antenatal surgery where these mothers are, some others have been operated on before. The baby is actually born, and that's absolutely fascinating. And that's a bit of a game changer as well. Unfortunately, we are not doing it here in Glasgow. It's done actually done down in London, where you're based, um, Great Ormond Street and at King's do a little bit. But it's mainly great Ormond Street and Donny Thompson. And if you get the opportunity to go and watch them, I would be extremely jealous because it's one of those ones you go. Wow, this is pretty impressive. Yeah, that's the one that puts my vote. So you think the spine of that? We'll we'll final, thank you because it's been really interesting. I'm sure you'll find a lot of people in the audience. Thank you for your little section of women in surgery because we didn't ask you to do that and actually It was really, really interesting. And I find it really interesting to thank you. Um, and just a final reminder to everyone please fill in the feedback form for us. Um, And for Ms Campbell. And then also, please sign up to our medical page, because again, we have these women in surgery talks going on for the rest of the year. We have some really great speakers coming up, so please do come. And so the other thing I was going to say is, um uh if you keep a copy of my slides, which I'm absolutely fine with, but my email address my work email address is on that if anyone wants to get in touch and whatever I do what I can to try and help support you, it's no problem. But thank you very much. It was It was fun. Good. It was nice to meet you. Say thank you so much. Okay, No problem. Take care. Have a good night. Everyone, Have a good evening.