Neurologist

[manuelm...@gmail.com]

Neurologists treat patients with diseases of the brain, spinal cord
and peripheral nerves and muscles. It is estimated that one quarter of
patients presenting to a medical out patient clinical have
neurological symptoms like blackouts, headache, giddiness, weakness or
sensory disturbance, yet for historical reasons, there are at present
only 300 neurologists in the United Kingdom. The next twenty years
should see an expansion of this number (if only to match the number of
neurologists in other European Countries). Common conditions like
dementia, stroke, epilepsy, Parkinson's disease and multiple sclerosis
are the province of the neurologists but, in the UK, only a small
number of patients with these conditions actually come under the care
of a neurological specialists.
A career in neurology requires an initial commitment to basic science,
the development of bedside diagnostic techniques, an understanding of
complex diagnostic methods and broad therapeutic ability. It is
unlikely that neurologists will ever be underemployed, and fascinating
advances in the field can be guaranteed.


What makes Neurology an attractive option?
During the last thirty years there has been a remarkable expansion in
the neurologist's therapeutic armamentarium: neurology has evolved
from a somewhat academic, diagnostic discipline into one which advises
a wide range of effective treatments for common conditions like
epilepsy, and rare disorders which can be cured by the appropriate
management.

Computed tomography and magnetic resonance imaging have allowed the
neurologist to visualise the brain and spinal cord in quite remarkable
detail during life, and functional techniques, like positron emission
tomography (PET scanning) help us understand the function of the
nervous system in health and disease.


What challenges face those working in Neurology?
Neurology has always been a competitive field, which combines the
intellectual challenge of understanding neural function in health and
disease, whilst caring for patients who have a wide spectrum of
complex symptomatology and physical dysfunction.

Neurology remains an essentially clinical discipline despite the
tremendous advances which have been made in diagnostic techniques and
treatment during the last thirty years.


What does the future hold for Neurology?
It is likely that the expansion in neurological diagnostic techniques
will continue to gather momentum and it is to be hoped that
conditions, like motor neurone disease, which are presently incurable
will soon yield to effective treatment.

There are now exciting treatments for common devastating diseases like
ischaemic stroke and it is to be hoped that stem cell transplantation
will be able to reverse the ravages of neurodegenerative conditions
like Alzheimer's disease and Parkinson's disease.
The explosion in molecular genetic understanding makes us hope that
many of the genetically determined disorders dealt with by the
neurologist, for example muscular dystrophy, will soon be treatable by
genetic engineering.


A Specialist Registrar's view of Neurology
London is well known for its neurological excellence. The neurological
rotations are based at Queen's Square and rotate to other centres in
London and the South East. Training covers all aspects of neurological
care. Trainees are encouraged to undertake audit and research either
as part of a larger project or one of their own.


Entry Criteria for Neurology
Length of training: 5 years. 6.5 years with clinical neurophysiology

Notes and alternative qualifications if relevant:

Not more than 6 months of the 2 year GPT period may be spent in the
neurosciences. Experience in neurology at the SHO grade is considered
desirable but not essential. Other valuable experience at the SHO
grade would be in psychiatry, neurosurgery or ophthalmology.

Royal College: Entry Criteria for SpR Training as specified by The
Royal College of Physicians

Notes:

Minimum entry requirements for all specialties:- All trainees must
undertake a minimum of two years in General Professional Training
(GPT) sometimes referred to as basic specialist training in approved
posts. GPT is part of 'specialist training' and its satisfactory
completion is therefore a requirement for the award of a CCST. It
should provide a wide range of experience at Senior House Officer
(SHO) level in a variety of specialties. Within the minimum two years,
not more than twelve months should be spent in posts restricted solely
to acute general medicine; nor should more than six months be spent in
a single specialty such as neurology or dermatology. At least 18
months of the 2 years GPT must be spent in posts providing experience
in admission and early follow-up of acute emergencies and 6 months of
these 18 months must be spent on a service or services on which the
emergency take is 'unselected'. 'Unselected take' is defined as acute
medical intake encompassing the broad generality of medicine i.e. not
restricted to any single or small group of specialties. If any major
component of acute medicine (e.g. cerebrovascular accidents,
myocardial infarctions) is excluded from the take, this experience
must be obtained in other posts. During the period on 'unselected
take' trainees should have an on-call commitment which averages no
less than 4 takes per month.

Those planning clinical as opposed to laboratory-based careers must
spend at least two years in approved posts involving direct contact
with patients. GPT may, of course, be extended for trainees wishing to
broaden their experience at SHO level and to sample additional
specialties, perhaps including a spell in general practice, before a
specialty programme is finally selected.

In addition to completion of GPT trainees must acquire a relevant
postgraduate qualification. In most cases this will be the MRCP (UK)
or (I) but some specialty programmes can be entered on the basis of
alternative qualifications as stated below. Applicants without the
MRCP (UK) or (I) or alternative qualification must provide evidence of
appropriate knowledge, training and experience, particularly in the
care of acute medical conditions.

Overseas qualifications currently recognised as being equivalent to
the MRCP (UK) are FRACP Part 1, FRCP Canada, MD Columbo, MHKPS Hong
Kong, M.Med Malaysia, FCPS Pakistan, M.Med Singapore, FCP South
Africa, US Boards of Internal Medicine.