Neurology: Dr Gerald Finnerty
Neurosurgery: Professor Keyoumars Ashkan
Clinical Neurophysiology: Dr Joel Winston
The Clinical Neurosciences centre based at King’s College Hospital is internationally-recognised for its work on diseases affecting the nervous system. The breadth and depth of expertise offers unparalleled training opportunities for academic trainees in Neurology, Neurosurgery and Clinical Neurophysiology. Each subspeciality has its own dedicated training program.
The Department of Basic and Clinical Neuroscience at King’s offers research opportunities across a broad range of neurological conditions in a world-leading research centre. ACFs and CLs are hosted at the newly built state-of-the-art facilities of the King’s Clinical Neuroscience Institute (KCNI). The KCNI sits within an NIHR Biomedical Research Centre. ACFs and CLs have the added benefit of close integration with psychiatry research teams based at the Institute of Psychiatry, Psychology and Neuroscience and at the South London and Maudsley Trust.
Extensive infrastructure is available to support development of both clinical and academic competencies. King’s provides regional services for: neurodegenerative disorders such as Parkinson’s disease, amyotrophic lateral sclerosis; epilepsy; neuro-oncology; traumatic brain injury and stroke (King’s has two “A” rated hyper acute stroke centres). There are specialist services for headache, demyelinating diseases, neuropathies, neuro-ophthalmology, rehabilitation, neuropsychiatry, and neuromuscular disease. The research base offers world class facilities for genetics, neuroimaging, neurophysiology, proteomics, transcriptomics, epigenomics, metabolomics, microbiomics, bioinformatics, cell models (including iPSCs), and animal models. First in man, and Phase 2 to 4 clinical trials are also strongly supported with state-of-the-art clinical research facilities and clinical trials offices.
Formal training in research methods and statistics is available through taught research modules in the MSc Clinical Neuroscience and the MSc Neuroscience, which trainees may attend at no cost. Statistical and computing training is also available in house or through courses at the Institute of Psychiatry, Psychology and Neuroscience. Academic Trainees are free to choose a supervisor and project.
The training programme allows ACFs to achieve all competencies sufficient for CCT or CESR (CP) in Neurology. ACFs commence at ST1 - 3 and complete Integrated Medical Training (IMT) before joining the Neurology Higher Specialist Training Programme in ST4. Neurology training is based at King's College Hospital and partner hospitals in South London. Clinical posts are, therefore, the same as for non-academic positions with the difference that academic trainees have protected research time during their Fellowship. The research time is usually allocated as 3 monthly blocks per year for ACFs. However, it may be possible to combine research blocks providing clinical training is not affected.
There is an extensive postgraduate teaching programme at KCH including a weekly Grand Round (2 hours) and a wide variety of weekly lectures and teaching sessions including clinico-pathological conferences, academic round, and Journal clubs. Once at ST3, the ACF will also attend the pan-London neurology training days. Fellows typically have separate Academic, Educational and Clinical Supervisors. Study Leave is available.
The combination of internationally recognized research teams, a regional clinical neuroscience centre and state-of-the-art facilities offers a unique speciality training scheme. Academic trainees are closely mentored throughout their training by their Project Supervisor, Educational Supervisor, and Clinical Supervisor to ensure that they achieve their clinical and research ambitions.
The department of Neurosurgery at King’s is considered as one of the premier neurosurgical departments in the UK. With over 20 consultant neurosurgeons, all sub-specialist in their chosen discipline, it provides a comprehensive service to the 4.5 million population of South-East London and Kent, as well as attracting national referrals.
The diversity and large volume of the pathologies treated provide an ideal environment and supreme opportunity for basic and clinical research. In functional neurosurgery, neuromodulation, deep brain stimulation and epilepsy surgery, there are close links with the neurology, neuro-radiology and neurophysiology departments at King’s as well as with other leading national/ international teams and the industry. This allows the trainees an excellent opportunity to learn about intra and post operative deep brain and cortical neurophysiology, functional imaging, big data and AI. The links with the bio-engineering department at King’s allow innovative research towards next generation hardware and devices.
In neuro-oncology and skull base surgery, there are unique opportunities for research at multiple levels. For genetic research, there are close links with Genomics England and access to nationwide data. At cellular level, there are facilities for live brain tumour physiological and morphological studies. The links with the neuropathology department provides additional strength here. The department has a big focus on pre-operative and intra-operative brain mapping research, including tractography and trans-cranial magnetic stimulation. Improving intra-operative visualisation of tumours, using novel imaging techniques, is actively researched through links with the bio-engineering department. There is also a big emphasis on patient reported outcome measures and qualitative/ epidemiological research.
In terms of acute neurosurgery, as a major trauma centre in London, there is a major interest in research to optimise the management of patients with head injury and intra-cranial haemorrhage, including the use of state of the art micro-dialysis. Research into traumatic spine injury, including restorative and stem cell techniques, are actively pursued with excellent infrastructural support.
Paediatric neurosurgery service includes the national referral centre for deep brain stimulation, located at the Evelina Children Hospital at GSTT. With the largest patient population and data set in the World, research opportunities are truly unique. Collaboration with the foetal medicine department provides rare opportunities into intra-uterine surgical research. Minimally access and endoscopic tumour surgery is also actively researched.
ACFs typically enter the program at ST1 and ACLs do so at ST3/4. The clinical training includes rotation within the neurosurgical units in the South Thames training program (King’s, St George’s and Brighton). The trainees will have protected academic time throughout their training, with academic and educational supervisors overseeing their progress. They are able to access the full academic support and teaching programs offered by the Department of Basic and Clinical Neuroscience as covered in the Neurology section above.
The Department of Clinical Neurophysiology is the ideal centre to pursue integrated academic training in clinical neurophysiology. The clinical department is the busiest in the UK with the largest consultant body and a rich history of contributions to academic clinical neurophysiology. Integrated academic training in Neurophysiology at KCH affords the trainee the luxury of being based at a single centre for the entirety of both their academic and clinical training.
From a research perspective, the full gamut of facilities for neuroscientific study at KCL are available – from laboratories pursuing molecular and cellular methodologies, through animal models and translational human studies to clinical informatics and AI. Depending upon the interests and research plans of the trainee, almost any conceivable technique would be available to address their research questions. Links to psychology and psychiatry and to KCL’s biomedical engineering departments are strong and offer further opportunities.
Research methods training is an integral part of IAT, and access to relevant modules on KCL’s MSc programs is available. This would include training in relevant research methods and more general education in statistics.
Clinically, the department offers multiple strengths. It supplies neurophysiology diagnostics to a large number of referring hospitals, conferring the opportunity for collaborative work across a wide geographical area. It has a high throughput pathway for presurgical evaluation for epilepsy and is part of epilepsy surgery workup for both adults and children, including a full intracranial EEG program. The department has an international reputation for the development of home video-EEG telemetry. Nerve and muscle evaluation is performed by subspecialists and covers all aspects of the clinical training curriculum. Subspecialty interests in this area include microneurography and an extensive program in autonomic neurophysiology.
Intraoperative monitoring is led by a subspecialty consultant with a growing team of fellows and dedicated physiologists.
The training program allows attainment of all relevant competencies essentially on one site, although trainees with an interest in paediatric neurophysiology have the flexibility to spend more time training at the Evelina London Children’s Hospital (GSTT). This makes the specialty and site even more attractive for integrated academic training as research and clinical work can be conducted side-by-side.
ACFs are expected to join the at ST3 or ST4 level and will have protected research time during their Fellowship (equivalent to three months per year). CLs would typically join at ST4 or ST5 level and will have protected research term amounting to 50%. IATs attend the Association of Trainees in Clinical Neurophysiology training days on a quarterly basis, and have standard study leave arrangements available.
KCH offers an extensive postgraduate teaching program in both general medicine and the clinical neurosciences. There is a general grand round as well as neurology grand rounds, a weekly clinical neurophysiology departmental academic meeting and a weekly academic meeting in epilepsy. Several MDTs include neurophysiology input and confer further opportunities for postgraduate training.
Academic trainees will have an Educational Supervisor for their clinical training towards CCT, a Clinical Supervisor to further support their clinical training needs and a Project Supervisor with relevant expertise to support the aims of their research project.