The specialty of neurology is changing rapidly. Traditionally neurology had been thought of as an intellectual pursuit, concerned with diagnosis of rare conditions of the nervous system. The advent of accessible imaging, and the emergence of potential therapies, has led to neurologists concerned with the treatment and on-going care of disorders which are in fact very common such as stroke, epilepsy, multiple sclerosis and Parkinson’s disease.
Presently higher medical training consists of 5 years, one of which may be relevant research. Usually the training is based around regional neurosciences centres with rotation to other units. Exposure to DGH type neurology is mandatory. Entry to HMT is following a period of general professional training (usually with completion of MRCP or overseas equivalent). The training curriculum, approval of posts and training rotation is overseen by the Specialist Advisory Committee (SAC) in neurology answerable to the JRCPTB. Aspects of training, education and assessment are jointly developed with the Training Educational Subcommittee of the Association of British Neurologists. Membership of the SAC is through nomination by the Royal College of Physicians, Association of British Neurologists, an observer from Ireland, officials from the JRCPTB including the Medical Director, and the lead dean for neurology.
There has recently been a rapid increase in numbers of consultant neurologists and it is likely that new posts will continue to be developed. Most district general hospitals will require at least two neurologists responsible for GP referrals and seeing inpatient referrals from other specialists. Presently many neurologists have sessions as regional neurosciences centres, where they have access to inpatient beds, specialist investigational services (neuroimaging, neurophysiology, pathology) and onward referral to neurosurgical services. Some will develop regional subspecialty services in stroke, epilepsy, neuromuscular disease, dementia, genetics and movement disorders.
In future it is likely that there will be a shift in the emphasis of work towards district general hospitals so that neurologists will contribute more to acute neurological referrals and offer local neurological services for common disorders such as epilepsy, MS and stroke. The completion of specialist training in neurology will ensure competence in all aspects of general neurology so that trainees can take up posts in neurology at district general hospitals and regional centres. There will be opportunities to pursue all aspects of subspecialty training as a specialist registrar, but to practice additionally in a subspecialty it is expected that trainees will have acquired further training, either within their research posts or with intra or post CCT fellowships.