By Kat Whitehouse, Mike Canty and Paddy Grover
There are a few areas that you might not usually consider needing to revise, such as:
- Medications, side effects and indications
- Neurological conditions and differential diagnoses
- Landmark neurosurgery papers, especially high-impact recent ones
- Guidelines. Here is a good place to start, but remember more up-to-date guidelines such as the WHO Tumour Classification, RCP Stroke guidelines, Society for Endocrinology Pituitary Apoplexy Guidelines
- DVLA guidelines
- Ethical issues, especially including recent issues and SBNS position statements, for example on the transfer of emergency patients; Duty of Candour; Montgomery v Lanarkshire ruling
- Medical school physiology – eg coagulation cascade and drugs, ABG interpretation
There are 8 weeks-ish between the first exam results and second exam. The Aberdeen FRCS course was one month before the exam, and we highly recommend it, as it directs your learning well. It teaches you how to concentrate your examinations and speed up in the short cases. There is a London course too.
You should attend clinics and discuss cases/topics with allied consultants – ophthalmology, electrophysiology, ENT, neurology, paeds, parkinson’s, neuroradiologists. Go to epilepsy-, neurovascular-, neuro-oncology-, spinal-, and skull base-MDTs; and any others that may be appropriate. Practise examinations properly on patients – ask for good patient examples from the neurology team and your neurosurgical colleagues. Talk through how you do operations – simple stuff like ACDFs, lumbar microdiscectomies, craniotomy, FMDs etc. A lot of people recommend doing this out loud in front of a mirror – that’s good to get you used to saying things out loud and seeing what your body language is like.
There are a lot of things you won’t find in textbooks, because they are out of date, such as guidelines and new reviews.
Things you may need to know but might not have considered (definitely not exhaustive!)
- Pituitary apoplexy guidelines
- Stroke guidelines (more recently the RCP including decompressive craniectomy)
- Massive transfusion protocols
- DVLA guidelines
- NICE Head injury guidelines including paediatric
- Ways to measure cerebral perfusion including transcranial doppler
- Different methods of measuring ICP including PRx
- ICP waveforms
- SIADH vs cerebral salt wasting
- Complex regional pain syndrome guidelines from RCP
- Parkinson’s guidelines for diagnosis and treatment (inc mechanisms of medications)
- CJD/TSE guidelines
- How shunt valves work
- Epilepsy surgery work up
- C-spine imaging guidelines (Canadian and NEXUS) and spine clearance
- Seizure classification system
- Spinal conditions – eg rheumatoid, ank spond, achondroplasia, Klippel-Feil
- TLICS/SCLICS – although in the clinical they generally just need to know if you are able to accurately classify a fracture as stable or not, so the AO system should be ok.
- Spinal trauma eg dislocated spine
- Draw a sarcomere
- Draw and interpret the reflex arc
- Draw and interpret an action potential
- Draw and interpret a synapse
- Brainstem testing guidelines (try to talk to your friendly local ITU docs)
- How does the body sense and modulate pain?
- How does MRI work?
- Paeds emergency guidelines including fluid management
- Management of the sick child
- Developmental milestones
- Non-accidental injury
- Doses of drugs including lignocaine, bupivacaine, mannitol and how they work with side effects
- Mechanism of action of the anaesthetic drugs
- Outcome scores – MRS/GOS/eGOS
- Tumours – awake craniotomy/gliadel/gliolan/PFS and life expectancy after surgery +/- RTx +/- chemo
- Coagulation cascade and how warfarin, heparin, rivaroxaban, dagibatran, aspirin, DIC, clopidogrel affect it
- You’ll need to interpret ABGs, visual field tests (Humphrey and Goldman), BAEPs, PTA (pure tone audiometry), as well as the standard radiology scans