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Neurosurgery (2015)

Overview Key Topics Professional/Leadership Skills Initial Intermediate Final Special Interest Training
LEVELS ST1 ST2 ST3 ST4 ST5 ST6 ST7 ST8

Final

There are a number of online resources for Neurosurgery, available through ebrain. Neurosurgery SAC has mapped Final Stage syllabus topics to ebrain, which are available here. ebrain is a resource that can be used by both trainees and trainers to support continuous professional development. (Please note that the ISCP is not responsible for the content of external sites)

Final Stage ST6 - ST7

The final stage syllabus is not intended to be a comprehensive training guide. Due to the nature of neurosurgical practice there will be conditions and procedures that are not individually specified in the syllabus and that will form part of a trainee's experience. This clinical and operative experience will be taken into account when assessing the overall quality of advanced training.

However, by the time that trainees apply for special interest training or to take the FRCS (Neurosurgery) they must be competent in all aspects of the clinical management of patients presenting with the following essential conditions:

  • Cranial trauma
  • Spontaneous intracranial haemorrhage
  • Hydrocephalus
  • Intracranial tumours
  • CNS infections
  • Spinal trauma
  • Benign intradural tumours
  • Malignant spinal cord compression
  • Degenerative spinal disorders
  • Emergency paediatric care

They must be competent to undertake the full range of operative procedures specified in the final training stage of the essential operative competency schedule (Table 1) without supervision and have sufficient operative experience to be able to manage operative difficulties and complications (Competence level 4).


Paediatric training

Before completing their training all trainees will undertake a six month placement in a paediatric neurosurgery service under the direct supervision of paediatric neurosurgeons with a full-time or major commitment to paediatric surgery. The service must provide a comprehensive range of paediatric neurosurgical care (with the exception of supra-regional services) and have a minimum annual operative workload of 250 cases. On completion of general paediatric training trainees will be competent to assess and undertake the emergency neurosurgical management of the critically-ill child with raised intracranial pressure.


Special Interest Training ST8

To ensure the quality of emergency and continuing care of neurosurgical patients with appropriate liaison and cross referral all trainees are expected to have a basic understanding of the specialist areas of neurosurgical practice. During final stage training all trainees will undertake selected specialist operative procedures under direct supervision to consolidate their advanced operative skills. Trainees in special interest training will develop a comprehensive and in-depth knowledge of their field. The special interest training year is allocated to ST8 in the stage overview for convenience. However this year may be undertaken at any time in the final stage at the doscretion of the programme director. By the end of special interest training they will be competent to undertake selected operative procedures relating to the common presentations in their specialist field without direct supervision. They will be competent to undertake other procedures in their field under the mentorship of a senior colleague. The specialist interest summaries indicate the breath and depth of training required in a specialist interest fellowship


Table1. Schedule of Essential Operative Competencies

This table summarises the level of operative competence which should be attained at each stage of training using the four point scale: 1 - has observed; 2 - can do with assistance; 3 - can do whole but may need assistance; 4 - competent to do whole without assistance and manage complications.

Initial

Intermediate

Final

  • Surgical Approaches
  • Burr hole
  • Craniotomy - convexity
  • Craniotomy - pterional
  • Craniotomy - midline supratentorial
  • Craniotomy - midline posterior fossa
  • Transsphenoidal approach
  • Lateral posterior fossa
  • Lumbar fenestration
  • Laminectomy


3
2
1
1
2
1
1
2
2


4
3
3
3
3
2
2
4
3


4
4
4
4
4
4
4
4
4

  • General Procedures
  • Insertion of lumbar drain
  • Tapping/draining of CSF reservoir
  • Application of skull traction
  • Image Guidance/Stereotaxy set up


3
3
2
2


4
4
4
4


4
4
4
4

  • Management of cranial trauma
  • Insertion of Intracranial (ICP) monitor
  • Burr hole evacuation of CSDH
  • Elevation of depressed skull fracture
  • Craniotomy for traumatic haematoma (ICH)


3
3
2
2


4
4
4
3


4
4
4
4

  • Management of spontaneous intracranial haemorrhage
  • Craniotomy for spontaneous intracerebral haematoma (ICH supratentorial)
  • Craniotomy for spontaneous intracerebellar haematoma (ICH infratentorial)



1

1



3

3



4

4

  • Management of hydrocephalus
  • Insertion of ventricular drain/access device
  • Insertion of VP shunt
  • Revision of VP shunt


3
2
1


4
3
2


4
4
4

  • Management of intracranial tumours
  • Supratentorial tumour biopsy
  • Craniotomy for supratentorial intrinsic tumour/metastasis
  • Craniotomy for posterior fossa intrinsic tumour/metastasis
  • Craniotomy for convexity meningioma


2
1
1
1


3
3
2
3


4
4
4
4

  • Management of intradural spinal tumours
  • Excision of intradural extramedullary tumour


1


2


4

  • Management of degenerative spinal disorders
  • Lumbar microdiscectomy
  • Anterior cervical discectomy


1
1


3
3


4
4

  • Emergency paediatric care
  • Insertion of EVD
  • Evacuation of intracranial haematoma (ICH)


1
1


2
2


4
4

Click on Workplace Based Assessments to view the assessment forms including DOPS and PBAs

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