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Where there is no resident neurologist: a case for a neurology attachment for acute medicine trainees

Les Ala and Tom Hughes
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DOI: https://doi.org/10.7861/clinmedicine.11-2-204a
Clin Med April 2011
Les Ala
Consultant acute physician, Cwm Taf LHB, South Wales
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Tom Hughes
Consultant neurologist, University Hospital of Wales, Cardiff
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Acute neurological problems account for 15% of the general unselected medical take and where there are no resident neurologists, general physicians care for these.1 In one third, the diagnosis remains uncertain or is inaccurate.2 With the new acute medicine curriculum, there is limited scope for trainees to rotate outside the prescribed core specialties, and this is a potential training flaw.

The previous acute medicine specialist registrar rotation in Wales had a six-month ‘elective period’ for trainees to pursue other medical interests. One former acute medicine trainee (LA) spent two months of his ‘elective’ on attachment in a tertiary hospital neurology unit. The attachment included weekly participation at four outpatient clinics (neurovascular, epilepsy, rapid access and general neurology); neurophysiology and neuroradiology sessions, inpatient ward work and seeing urgent referrals from primary and secondary care. The case mix encountered is described in Table 1.

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Table 1.

Cases encountered during attachment in tertiary hospital neurology unit.

This experience has been invaluable in this former trainee's current role as a consultant acute physician, part of which is in the ambulatory care unit of a small district general hospital where, in eight months, 40% of the 730 patients seen were referred with a neurological problem. Of these, acute onset headaches were the biggest group (30%) and transient ischaemic attacks and first seizures accounted for 20% each. Of those presenting with acute onset headaches, the most common diagnosis (in one third of headache cases) was migraine.

Incorporating neurology into acute medicine training programmes is extremely useful. It helps the non-neurologist handle the immediate issues more confidently, and to refer appropriately. The increasing use of thrombolysis for acute stroke will only increase the demand for front-line clinicians who are confident in the diagnosis of acute neurological deficits.

Acknowledgements

We are grateful to the staff in the departments of neurology, neurophysiology and neuroradiology at the University Hospital of Wales, Cardiff, and in the neurorehabilitation unit, Rookwood Hospital, Cardiff, for their time and teaching during the two-month attachment.

Footnotes

  • Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references

  • Royal College of Physicians

References

  1. ↵
    1. Weatherall MW
    . Acute neurology in a twenty-first century district general hospital. J R Coll Physcians Edinb 2006;36:196–200.
    OpenUrl
  2. ↵
    1. Moeller JJ
    , Kurniawan J, Gubitz GL et al. Diagnostic accuracy of neurological problems in the emergency department. Can J Neurol Sci 2008;35:335–41.
    OpenUrlPubMed
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Where there is no resident neurologist: a case for a neurology attachment for acute medicine trainees
Les Ala, Tom Hughes
Clinical Medicine Apr 2011, 11 (2) 204-205; DOI: 10.7861/clinmedicine.11-2-204a

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Where there is no resident neurologist: a case for a neurology attachment for acute medicine trainees
Les Ala, Tom Hughes
Clinical Medicine Apr 2011, 11 (2) 204-205; DOI: 10.7861/clinmedicine.11-2-204a
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