Neuro-critical care: A valuable placement during foundation and early neurosurgical training

Abstract

Introduction. Neurosciences critical care units (NCCUs) present a unique opportunity to junior trainees in neurosurgery as well as foundation trainees looking to gain experience in the management of critically ill patients with neurological conditions. Placements in NCCUs are undertaken in the early years of neurosurgical training or during neurosciences themed foundation programmes. We sought to quantify the educational benefits of such placements from the trainee perspective. Methods. Thirty-two trainees who had undertaken placements at Foundation Year 2 (FY2) to Specialty Trainee Year 3 (ST3) level between August 2009 and April 2013 were invited to take part in an online questionnaire survey. Competence in individual skills was self-rated on a ranked scale from one (never observed) to five (performed unsupervised) both before and after the placement. Trainees were also asked a series of questions pertaining to their ability to manage common neurosurgical conditions, as well as the perceived educational rigour of their placement. Results. Twenty-three responses were received. Eighteen responses were from FY2s and seven were from ST1–3 level trainees. Following their placements, 100% of respondents felt better equipped to deal with neurosurgical and neurological emergencies and cranial trauma. Most felt better equipped to manage hydrocephalus (95.7%), polytrauma patients (95.7%), spontaneous intracranial haemorrhage (91.3%) and spinal trauma (82.6%). Significant increases were seen in experience in all practical skills assessed. These included central venous catheterisation (p < 0.001), intracranial pressure (ICP) bolt insertion (p < 0.001), ICP bolt removal (p < 0.001), external ventricular drain (EVD) insertion (p = 0.001) and tapping of EVD for cerebrospinal fluid sample (p < 0.001). Conclusion. Our results clearly demonstrate the educational benefits of NCCU placements in the early stages of a neurosurgical training programme as well as in the Foundation Programme. This supports the incorporation of a four- to six-month NCCU rotation in early years training as educationally valuable.

Keywords::

• education
• intensive care
• neurosurgery
• resident
• rotation

Acknowledgements

EWD has been supported by an Academic Foundation Programme, Clinical Academic Training Office, School of Clinical Medicine, University of Cambridge. AGK is supported by an NIHR Academic Clinical Fellowship, a Royal College of Surgeons of England Research Fellowship and a Raymond and Beverley Sackler Studentship. PJAH is supported by an NIHR Research Professorship and the NIHR Cambridge Biomedical Research Centre. DKM is supported by an NIHR Senior Investigator Award and the NIHR Cambridge Biomedical Research Centre.

Declaration of interest: Edward Dyson and Angelos Kolias have undertaken NCCU placements. Rowan Burnstein is the Clinical Director of the Neurosciences Critical Care Unit, Addenbrooke’s Hospital. Matthew Garnett is the Training Programme Director for Neurosurgery, Health Education East of England. Rikin Trivedi is Foundation Training Programme Director (FY2), Addenbrooke’s Hospital. The authors alone are responsible for the content and writing of the paper.