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Speciality: Clinical Neurophysiology

Programme Description
GMC Reference: WOS/391

Clinical Neurophysiology is a small specialty which offers excellent career opportunities for anyone interested in clinical neurosciences along with work life balance. This is a 4 year training programme entering from ST3 level leading to CCT in Clinical Neurophysiology on satisfactory completion of training. At present trainees are non-resident on call for 1 in 5 weekends for Clinical Neurophysiology with no acute medicine or neurology on call commitments.

Clinical neurophysiology is a largely diagnostic speciality but requires clinical skills and judgement to plan and carry out investigations and to interpret results in a relevant useful manner. The main investigations are nerve conduction studies/electromyography, electroencephalography (EEG), evoked portentials and intra operative monitoring.

There is exposure to a wide range of central and peripheral nervous system disorders. We investigate patients from the new born to the elderly and interact witha wide range of medical and surgical specialties.
Clinical Neurophysiologists may carry out Neurological clinics in relation to subspecialty interests – for example for epilepsy and neuromuscular clinics, providing diagnosis, investigation and management. For further infromation:
http://www.bscn.org.uk/


Contact Arup Mallik at arup.mallik@ggc.scot.nhs.uk for information or taster sessions.

1 a. What particular specialty learning opportunities does this program provide e.g. sub-specialty exposure, especially those which are not available elsewhere?

This programme is based in the Regional Clinical Neuroscience Centre at the Queen Elizabeth Hospital in Glasgow which covers a population of around 2.75million. This programme offers great opportunities for experience in all aspects of CNS and neuromuscular disorders. Facilities include an epilepsy monitoring service which is part of a national managed clinical network for epilepsy surgery and there are opportunities to develop specialist knowledge in intracranial EEG electrode recordings as part of epilepsy surgery workup. We work closely with neurologists who have specialist interests in muscle disease, motor neurone disorders, myasthenia and peripheral nerve disorders and trainees are encouraged to attend these specialist neurology clinics. We provide most of the neurophysiological service to the National Brachial service based in Glasgow and work closely with surgeons interested in peripheral nerve trauma. We do a significant amount of intraoperative neurophysiological monitoring such as awake craniotomies and are part of national surgical services for movement disorder surgery (deep brain stimulation) and paediatric selective dorsal rhizotomy surgery for cerebral palsy. We benefit from the Royal Hospital for Children now being on the same site as the adult hospital and the Institute for Neurological Sciences. Once clinical neurophysiology consultant regularly reports paediatric EEG and there are opportunities to attend paediatric nerve conduction clinics with a paediatric neurologist. Attendance at paediatric epilepsy clinics and MDT meetings is encouraged. 

b. How do trainees access these opportunities?

24 months experience of a wide range of neurophysiological techniques provides comprehensive training in almost all aspects of the specialty.
Clinical attachments for a total of 12 months are spent in neurology with an emphasis on exposure to neurology subspecialties appropriate to clinical neurophysiology.
There are regular sessions at the Royal Hospital for Children for paediatric neurology and neurophysiology skills
The remaining 12 months of training are individually tailored for each trainee and may include additional subspecialty training, in Glasgow or elsewhere and also provide further opportunities for research.


2 a. What opportunities are there for research, audit and teaching?

Research and audit - The department is closely allied to all the main universities in Glasgow, particularly the University of Glasgow which is one of the UK’s oldest medical schools. There are strong research interests in epilepsy, muscle disease, myasthenia and peripheral nerve disorders.
Audits are a regular part of departmental activity both for service and clinical care.
We are part of the National Scottish MCN for epilepsy surgery, and National Scottish MCN for muscle disease.
Teaching - University of Glasgow - medical student teaching, student attachments
Teaching and training of student physiologists on Bsc course. 

b. How do trainees access these opportunities?

Encouraged at all times to participate.

3 a. How are rotations are hospital sites organised?

The programme is currently based on a single site at the Queen Elizabeth University Hospital. Paediatric Sessions are at the Royal Hospital for Children on the same site.

b. Which hospitals are involved?

Queen Elizabeth University Hospital, Glasgow, and Royal Hospital for Children, Glasgow.

c. What degree of choice is there for trainees?

Trainees normally enjoy being based on one site. Rotations to other hospitals in other cities may be considered but would require prospectibe GMC approval

4. What teaching (e.g. day-release or exam preparation) or learning opportunities (e.g. e-learning, OOPE), are unique to this post or a key feature in the West?

Regular study time is included in weekly timetables. Trainees can participate in the monthly neurology training day release programme.
All UK trainees in clinical neurophysiology are encouraged to attend at least 2 of 3 mandatory study days held in various UK locations. There is no exit exam at present.  

5. What can trainees expect of their trainers in this post?

All educational and clinical supervisors are NHS consultants and experienced trainers. New trainees will be encouraged to develop their clinical neurology skills and undergo basic training in electrophysiological testing. Supervision and advice will always be available, with trainees acquiring more complex skills and more responsibilities as training progresses.

6. What are key markers of success? (e.g. exam pass rates. MD, PhD, papers)

No exit exam at present. Progress is assessed by work place based assessments and supervisors reports.

7. What additional information would you like to include that may encourage trainees to apply for specialty training in this programme in preference to similar programmes in other parts of the UK?

Compared with many neurophysiology departments elsewhere in the UK we are a 'large' department with 6 consultants who are enthusiastic trainers. You will also benefit from being part of a team of three specialty trainees in clinical neurophysiology. Most clinical neurophysiology departments in the UK have fewer trainees. There is a very close clinical and academic working relationship with neurology. There are also excellent working relationships with other relevant specialties including orthopaedics, rheumatology and critical care. We serve a large catchment area ‑ mainly the West of Scotland; but Glasgow is also a national centre for epilepsy, myasthenia, muscle and peripheral nerve disorders as well as providing the national service for some types of intraoperative monitoring. There are currently no rotations away from Glasgow but if a trainee has an interest in undergoing some of their training elsewhere in Scotland this would be actively encouraged. There are excellent opportunities for obtaining a UK consultant post in clinical neurophysiology on satisfactory completion of training. Clinical Neurophysiology also offers excellent opportunities for less than full time working and a good work‑life balance. Glasgow is a vibrant friendly city with great cultural facilities some of the UK finest countryside and outdoor activities very close by.

Research, audit, teaching and management opportunities

Clinical Neurophysiology presents good career opportunities for anyone interested in clinical neurosciences.

Clinical Neurophysiology is an allied specialty to Neurology, with close associations with all Neuroscience departments. It is primarily an investigative specialty; using computer, electrical, magnetic and electronic means of recording the function of the brain, spinal cord, spinal roots, peripheral nerves and muscle to diagnose disorders of the function of the nervous system.

Dependent on the local needs and subspecialty interests of the medical staff, Clinical Neurophysiology may be used to monitor function during surgical operations on the brain, spinal cord and peripheral nerve. It has roles also in the monitoring of the progress of disease, and the effects of therapy, working in conjunction with the clinician in charge of a patient to define the most appropriate management.

Dependent on needs, interests and time resources, Clinical Neurophysiologists may carry out Neurological clinics in relation to subspecialty interests - for example for epilepsy and neuromuscular clinics, providing diagnosis, investigation and management.

This programme is based in the regional clinical neuroscience centre at the Southern General Hospital in Glasgow which covers a population of around 2.75million. There are great opportunities for experience in all aspects of CNS and neuromuscular disorders. Facilities include an epilepsy monitoring service which is part of a national managed clinical network for epilepsy surgery, and also there are national specialist interests in muscle disease, motor neurone disorders, myasthenia and peripheral nerve disorders. Intra-operative work includes deep brain stimulation for movement disorders, and brachial plexus monitoring. Paediatric experience is also available at the Royal Hospital for Sick Chidren (Glasgow).

We are a relatively 'large' department with 5 consultants all of whom are enthusiastic trainers. There is a very close clinical and academic working relationship with neurology. There are also excellent working relationships with other relevant specialties including orthopaedics, rheumatology and critical care. We serve a large catchment area - mainly the West of Scotland; but Glasgow is also a national centre for epilepsy, myasthenia, muscle and peripheral nerve disorders. There are no rotations away from Glasgow but if a trainee has an interest in undergoing some of their training elsewhere in Scotland this could be considered.

24 months experience of a wide range of neurophysiological techniques will provide comprehensive training in almost all aspects of the specialty. Clinical attachments for a total of 12 months will be spent in neurology with an emphasis on exposure to neurology subspecialties appropriate to clinical neurophysiology. There are regular sessions at Yorkhill for paediatric neurology and neurophysiology skills. The remaining 12 months of training are individually tailored for each trainee and may include additional subspecialty training, in Glasgow or elsewhere and also provide further opportunities for research

The department is closely allied to all the main universities in Glasgow, particularly the University of Glasgow which is one of the UK's oldest medical schools. There are strong research interests in epilepsy, muscle disease, myasthenia and peripheral nerve disorders. Audits are a regular part of departmental activity both for service and clinical care. We are part of the National MCN for epilepsy surgery, and national MCN for muscle disease.

All the training currently is delivered at the Southern General Hospital in Glasgow, with 1 day a week at RHSC (Glasgow) at later stages of training.

All educational and clinical supervisors are NHS consultants and experienced trainers. New trainees will be encouraged to develop their clinical neurology skills and undergo basic training in electrophysiological testing. Supervision and advice will always be available, with trainees acquiring more complex skills and more responsibilities as training progresses.

Where is the training delivered?
This programme involves placements in some or all of these Health Boards and hospitals:

The Royal Hospital for Children Glasgow, The Queen Elizabeth University Hospital Glasgow

Contacts and Useful Links
Programme Type Deanery based or National: National
Administration office West of Scotland
Lead Dean / Director Professor Alastair McLellan
Responsible Associate Postgraduate Dean or Assistant Director (GP) Dr David Marshall
Specialty or Sub-specialty Specialty or Sub-specialty: Specialty
Date of GMC recent approval August 2010
Associated Royal College - Faculty
Joint Royal Colleges of Physicians Training Board (web site)
Curriculum and Associated Assessment System https://www.jrcptb.org.uk/specialties/clinical-neurophysiology
Programme Administrator: Named Programme Administrator: Thomas Healy
Address: NES, 2 Central Quay, 89 Hydepark Street, Glasgow, G3 8BW
Tel: 0141 223 1432
Email: thomas.healy@nes.scot.nhs.uk
Programme Director Programme Director Name: Dr Arup Mallik
Address: Dr Arup Mallik Queen Elizabeth University Hospital 1345 Govan Road Glasgow G51 4TF
Tel:
Email: arup.mallik@ggc.scot.nhs.uk
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