Welcome to Clinical Neurophysiology at Severn Postgraduate Medical Education (PGME), an exciting and varied specialty.
This comprehensive training programme consists of a 4 year ST3-ST6 training programme in Clinical Neurophysiology based at the North Bristol NHS Trust. Severn PGME covers Bath, Bristol, North Bristol, Cheltenham, Gloucester, Weston-Super-Mare. It is a great place to live, train and work. You will spend 2 years training in Core Clinical Neurophysiology, plus an additional 1 year in Advanced Techniques of your choice or Clinical Research, and 1 year in Neurology.
The hospitals in the region offer the breadth of training in Adult and Paediatric Clinical Neurophysiology. There is closely supervised exposure to general outpatient and inpatient Electroencephalography (EEG), Nerve Conduction (NCS) and Electromyography (EMG) studies, in addition to training in inpatient Ambulatory and Video EEG, along with intra-operative neurophysiological monitoring (IOM) of Evoked Potentials (EPs) and Sleep Studies. We are a Nationally Designated Paediatric Epilepsy Surgery Centre and have a National Reputation in Specialist IOM techniques, some of which are unique to Bristol. Please read through the questions below and for any further information visit the JRCPTB webpage.
What is Clinical Neurophysiology?
Clinical Neurophysiology is a diagnostic medical specialty concerned with recording and interpreting signals from the central and peripheral nervous systems: with the 3 main areas being EEG, NCS/EMG and EPs. Neurophysiological investigations are an extension of the neurological evaluation by providing objective results about nervous system function when clinical findings alone are confusing or do not lead to a confident diagnosis. They can help with classification of disease, prognostication and management decisions.
What makes Clinical Neurophysiology an attractive option?
Clinical Neurophysiology is in fact a vast topic creating a varied patient case mix and is one of the few specialties that deals with both adults and children, as well as lending itself to developing sub-specialty interests. Referrals are received from all Neuroscience specialties, General Medicine, Musculo-Skeletal, Paediatrics and Intensive Care, and increasingly from Primary Care. There are ample opportunities for research and audit. A typical department of Clinical Neurophysiology consists of Medically-qualified Clinical Neurophysiologists, Healthcare Scientists (Physiologists) and Administrative & Clerical staff, such that there are good opportunities for both management and team working. Being mainly outpatient based there is little ‘out of hours’ demand and on-call, lending itself to a good work - life balance.
What are the Entry Criteria for Clinical Neurophysiology?
Trainees hoping to make a career in clinical neurophysiology should have core general medical or paediatric competences. Experience in neuroscience is an advantage but is not essential as the training programme develops the necessary neurological skills. After successful completion of two years of Core Medical Training (or Core Neurological Training, the Acute Common Care Stem or Core Paediatric Training) and the acquisition of Full MRCP or MRCPaeds interested candidates may apply for allocation into Specialty Training in Clinical Neurophysiology.
What challenges face those hoping to specialise in Clinical Neurophysiology?
Clinical Neurophysiologists are not in charge of making patient management decisions, in general, and it would not suit someone who wants to be involved in direct continuous care of patients. It is a small, but friendly, specialty and there are therefore a limited number of centres in the UK with larger departments. Some colleagues may view you as more of a technologist than a clinician.
What is expected of those trained in Clinical Neurophysiology?
Consultants spend about half of their working time performing peripheral nervous system tests (NCS/EMG) where they take a clinical history and perform a targeted clinical examination to enable them to decide on the most appropriate investigation protocol for the patient’s complaint. After investigating the differential diagnosis they complete a report for the referring physician. The remaining working time is mainly directing Healthcare Scientists who perform EEGs and EPs for the consultant to report. EEG is used in the diagnosis, classification and management of epilepsy, the most common serious neurological condition. There are many opportunities for more specialized investigation and the job plans of consultant clinical neurophysiologists vary considerably. In some centres operative monitoring during spinal or neurosurgical procedures occupies one or two days a week, whereas others are involved with prolonged Video EEG telemetry as a part of an epilepsy surgery programme.
What does a Specialist Registrar Say?
"This is a good training programme involving a year of neurology and 3 years of neurophysiology. The year of neurology involves rotation in different neurology subspecialties and gives an opportunity to participate in dedicated epilepsy and neuromuscular clinics. Neurophysiology training is closely supervised. Apart from formal training days, there is informal teaching and discussion on most days. On call commitments are relatively less this makes life more civilised as compared to most acute specialities."
What does the future hold for Clinical Neurophysiology?
Currently competition ratios to enter training are low and consultant vacancies exist around the country, as we have been a growth specialty in recent years (~50% increase in the number of Consultants over the last 10 years). Trainees obtaining a CCT in Clinical Neurophysiology therefore have considerable choice of the location of their consultant future.