Health Education England, working across the East of England - Clinical Neurophysiology:
Clinical Neurophysiology is a branch of the clinical neurosciences which is concerned with the investigation of disease by techniques which depend upon the electrical properties of neural tissue and muscle.
The specialty is primarily involved with the diagnosis of neuropathies, neuromuscular disease, epilepsy, ophthalmological disease and multiple sclerosis. It also includes the intra-operative and intensive-care monitoring of the spinal cord and brain. It is featured in the BMJ Career Focus (326: 31 May 2003, s183).
Attractions of the Specialty
Clinical Neurophysiology is an expanding specialty with vacancies at the entry level of the Specialist Registrar grade and at consultant level. The specialty allows the development of specialist interests in many fields, including neurology, neurosurgery, rheumatology, orthopaedics, ophthalmology and paediatrics. Unlike some service specialties, Clinical Neurophysiology enjoys considerable direct patient contact. The subject also provides the opportunity for laboratory and collaborative clinical teaching and research. The procedure basis of the work and the association with orthopaedics and industrial medicine provide optional opportunities for private practice and medico-legal work.
The training programme is currently based at Addenbrooke's Hospital in Cambridge.
- Completion of a core medical training programme or equivalent.
- Documented evidence of achievement of level 1 competencies in general internal medicine (acute) and generic curricula.
- Documented evidence of completion of full MRCP(UK) Examination.
- Previous experience in clinical or basic neurosciences is highly desirable.
- An interest in basic neuroscience applied to clinical practice
- An interest in acquiring practical investigative procedural skills
- Aptitude for clinical interpretation and good contact with colleagues
|Dr Andrew Michell||
Training Committee Chair & Consultant Clinical Neurophysiologist
|Dr Fraz Mir||
Head of School of Medicine
|Health Education England, working across the East of England|
|Joseph Crowe||School of Medicine Administrator||
Norfolk and Norwich University Hospitals NHS Foundation Trust
Introduction to specialty from a trainee perspective
Congratulations and welcome to the deanery, you have chosen a great place to train in Clinical Neurophysiology.
As a trainee in this specialty, your rotations will be based in the Clinical Neurophysiology Departments at Addenbrooke’s and NNUH, alternating between those two sites yearly. Both departments offer the wide gamut of Neurophysiological tests; EEG, video telemetry, VEPs, SSEPs, NCS/EMG, Single Fibre EMG, TMS, and IOM. There are ample training and learning opportunities. You are lucky at this Deanery to receive balanced exposure to both EEG and NCS/EMG. There is a slight emphasis at Addenbrooke’s towards EEG, with a good workload from Paediatric Neurology, with NNUH tending a little more towards EMG/NCS and IOM.
Teaching in Neurophysiology is covered within the department itself, with dedicated sessions on Tuesday mornings at Addenbrooke’s, alongside Paediatric EEG meetings (every 3rd Tuesday of the month, early morning). Consultant sessions are often educational, with another dedicated slot towards performing inpatient NCS/EMG alongside Dr Andrew Michell on a Wednesday morning.
There is a strong emphasis to attend conferences and Neurology/Neurophysiology teaching outside the Deanery, with the Association of Trainees in Clinical Neurophysiology (ATCN) and British Society for Clinical Neurophysiology (BSCN) conferences being mandatory and very useful. They occur three times a year. The ATCN in particular is designed for trainees, and is normally the day preceding the BSCN conference.
For more details, please see http://www.bscn.org.uk/ (This also regularly advertises relevant courses and conferences one may attend throughout the year).
There is no regional teaching for Neurophsiology, however, once every 3 years, there is a 4 day training week for trainees up and down the country.
Additionally, while at Addenbrooke’s and NNUH, you are encouraged to attend Neurology teaching, as well as clinics. Regular teaching occurs lunchtime at Addenbrooke’s on Tuesdays, including a Grand Round and topic presentation. You are also encouraged to attend the regional CALMAN days for Neurology.
It is important to emphasise that, as a trainee starting in Clinical Neurophysiology, you will not be expected to know how to operate the machines and read EEGs off the bat. You will not be given your own clinics until you have sat in with and observed consultants and physiologists, and when you are initially booked in patients, they will only be triaged to you based on your level of experience. So do not worry! The department is very understanding of the fact that you will likely not have prior practical experience in the field. Roughly, you should expect to sit in with consultants for about 2-4 weeks, then start seeing patients for ‘NCS only’ up to 6 months, with EMG introduced thereafter. You will be expected to read up on EEG concurrently, and to report them under consultant supervision/sign off.
There will also be the option, in the fourth and final year, to gain some experience in subspecialty fields outside the Deanery.
Additionally, research is strongly encouraged. The Cambridge Institute for Medical Research and the MRC centre provide opportunities to participate in world-class research.
The East of England has a lot to offer and I am sure you will find your time in the deanery highly rewarding.
Training Programme director
Dr Andrew Michell; Email: Andrew.firstname.lastname@example.org
Dr Omar Al-Khayatt; Email: email@example.com
Chair of BSCN
Dr Nick Cane
JRCPTB Curriculum (2012 amendment):
JRCPTB (Joint Royal College of Physician Training Board): You will need to register with them to activate your eportfolio. www.jrcptb.org.uk/Pages/homepage.aspx.
Your E-portfolio will be assessed at ARCP. I would highly recommend keeping it up to date. ARCP normally takes place in June.
- Ensure that you have the correct number of assessments appropriately linked to the curriculum
- Logbook: You are expected to maintain a logbook record of all procedures you perform. There are a variety of apps available to help in this. Most trainees maintain this on an excel spreadsheet, which needs to be uploaded to your personal library. If you would like an example, please email Omar Al-Khayatt (firstname.lastname@example.org).
- Logbook procedures to record includes:
- EMG/NCS – common and less common nerve entrapments, generalized neuropathies, radiculopathies, myopathies, repetitive stimulation
- EEG - adult and paediatric
- More specialized procedures
- Audit: You will need to complete one audit per 2 years
Reading list/Helpful websites
BSCN - http://www.bscn.org.uk/
Clinical Neurophysiology general website for learning and updates by Dr Adrian Fowle - http://www.clinicalneurophysiology.org.uk/
Carpal Tunnel by Dr Jeremy Bland - http://www.carpal-tunnel.net/
Interactive EEG Atlas - http://atlas.ansuk.org/
ILAE Epilepsy Classification and Terminology - http://www.ilae-epilepsy.org/ctf/seizure_frame.html