1. PATHWAYS IN NEUROSURGICAL TRAINING IN THE REPUBLIC OF IRELAND Chris Lim Specialist Registrar, Department of Neurosurgery, National Centre for Neurosurgery, Beaumont Hospital, Dublin.

2. Neurosurgical Centres in Ireland 2 Neurosurgical Departments in Republic of Ireland –Beaumont Hospital, Dublin –Cork University Hospital, Cork

3. Neurosurgical Centres in Ireland Cork University Hospital : Munster Region 25 dedicated N/S beds and no dedicated ICU beds Beaumont Hospital : Rest of Country 67 dedicated N/S beds and 10 dedicated ICU beds

4. Medical Staffing Dublin 6 Consultant Neurosurgeons NCHDs –1 Senior Registrar –1 Spinal Fellow –3 Sp. Registrars –1 Visiting Sp. Registrar (Belfast) –1 Visiting Registrar (USA) –1 Registrar –6 SHOs –4 Interns 1 in 6 rota without prospective cover Cork 3 Consultant Neurosurgeons NCHDs –2 Sp. Registrars –1 Registrar –3 SHOs –2 Interns 1 in 3 rota without prospective cover

5. Typical Neurosurgical Training in Ireland Medical School Internship Basic Surgical Training (including some time spent as a N/S SHO) Research +/- 1 to 2 years as a Registrar Specialist Registrar Fellowship +/- Senior Registrar (Post CCST) Consultant

6. Typical Weekly Activity for Specialist Registrars MondayTuesdayWednesdayThursdayFridaySaturdaySunday 0730 Endorsement 0800 Ward Round (General) Ward Round (Team) 1300 OPD 1800 Pre op Activities 2000 Consultant Round 0730 Endorsement 0800 Ward Round (General) Theatre (All Day) 1800 Post op Activities and Round 0730 Endorsement 0800 Ward Round (General) Ward Round (Team) Paperwork 0715 Endorsement 0800 Neurovascular Meeting 0900 Ward Round (General) Ward Round (Team) 1700 Journal Club 1800 Pre op Activities 1900 Consultant Round 0700 Endorsement 0800 Neuropathology Meeting 0900 Neuroscience Meeting Ward Round (General) Theatre (All Day) 1900 Post op Activities and Round

7. Neurosurgical On Call Activities in Beaumont Hospital 1 in 6 Rota (1 Consultant, 1 Registrar/SpR, 1 SHO and 1 Intern) Number of referrals varies but typically 10 to 25 referrals a day. For each referral –History & exam findings –Review radiology –Discussion with Consultant –Advice or transfer patient care A/E assessment, resuscitation and theatre activities

8. Types of Acute referrals Trauma : Head and spine injuries Spontaneous intra-cranial haemorrhages Tumours Hydrocephalus Infection e.g.. IC abscesses Others

9. So why be a Neurosurgeon ? ?

10. Consider ! Patient subgroup may be more acutely or critically unwell. May be more mentally and emotionally demanding. Modern Neurosurgery employs cutting edge technology (real time MRI, real - time Neuronavigation technology, etc) Majority of pathologies can be visualised by modern radiological methods to allow for better decision making and planning of patient management.

11. Thank you