cv amar for medico-legal april 2020 · cv mr amar saxena, consultant neurosurgeon, uhcw 2 personal...

CURRICULUM VITAE

AMAR SAXENA

MS, Mch(Neurosurg), FRCS (Eng), FRCS (SN)

April 2020

CV Mr Amar Saxena, Consultant Neurosurgeon, UHCW

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PERSONAL DETAILS SURNAME: Saxena FIRST NAME: Amar NATIONALITY: BRITISH (Indian) MARITAL STATUS: Married, 2 children ADDRESS: 23 Highgrove Westwood Heath Coventry CV4 8JJ TELEPHONE: 02476 - 467278 MOBILE 07771852449 Email address [email protected] [email protected] GMC REGISTRATION: Full 4390154 SPECIALIST REGISTER OF THE GMC Name included on 24 June 1999 FOR NEUROSURGERY Registration No. 4390154 NATIONAL INSURANCE NO: PA 58 75 59 D DEGREES AND DIPLOMAS MBBS Maulana Azad Medical College University of Delhi, India. Dec-1975

MS (General Surgery) University of Delhi, India - March l981 MCh (Neurosurgery) University of Delhi, India - May l987 FRCS Part I (London) - May l996 FRCS Part II (London) - May l997

FRCS (Surgical Neurology) – April 2000 Certificate of Completion of Specialist Training (CCST) 23 May 2001

PRIZES: Awarded merit scholarship twice during MBBS (July 1971-Dec.1972 and Nov.1974-Dec.1975) AWARDS: 7 Local Clinical Excellence Awards (CAEs) awarded by University Hospitals Coventry & Warwickshire Coventry, UK (maximum awards given are 9)


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PRESENT EMPLOYMENT 16/08/2001 – Till date Consultant Neurosurgeon, University Hospitals of Coventry & Warwickshire, Coventry, UK (Substantive appointment) PREVIOUS EMPLOYMENTS 01/06/1999 - 15/08/2001 Specialist Registrar in Neurosurgery, Leeds General Infirmary, Leeds, UK 13/09/1997 - 31/05/1999 Research Registrar in Neurosurgery, Leeds General Infirmary at United Leeds Teaching Hospitals, Leeds, UK. 02/08/1995 -12/09/1997 Visiting Registrar in Neurosurgery, Pinderfields General Hospitals, Wakefield, UK. 01/01/1989 - 01/08/1995 Consultant Neurosurgeon,

Sir Ganga Ram Hospital New Delhi, India (recognised by the Indian National Academy of Medical Sciences, for Higher Surgical Training in Neurosurgery)

01/11/1987 - 31/12/1988 Senior Registrar (designation - Pool Officer) neurosurgery G B Pant Hospital, New Delhi (Teaching Hospital). 01/04/1985 – 31/10/1987 Registrar (Senior resident) in Neurosurgery, G B Pant Hospital, New Delhi (Teaching Hospital) 01/09/1984- 31/03/1985 Preparing for entry to MCh examination in Neurosurgery 08/12/1981 - 14/08/1984 Registrar (Senior resident) in General Surgery, LNJP Hospital, New Delhi (Teaching Hospital) 08/05/1981 - 07/12/1981 Registrar (Senior resident) in Neurosurgery, G B Pant Hospital, New Delhi (Teaching Hospital) 01/04/1979 - 31/03/1981 Junior Resident (Post Graduate) in General Surgery LNJP Hospital, New Delhi, (Teaching Hospital) 01/01/1978 - 31/12/1978 Medical Officer (SHO) Orthopaedics and A & E (6 months each) Jeewan Hospital, New Delhi. 01/01/1977- 31/12/1977 SHO in General Medicine and Surgery (6 months each) LNJP Hospital, New Delhi, (Teaching Hospital) 01/01/1976 -31/12/1976 Intern, LNJP Hospital, New Delhi, (Teaching Hospital) . OTHER IMPORTANT APPOINTMENTS REGIONAL November 2014 till date Regional Specialty Professional Advisor in Neurosurgery, West Midlands, UK February 2005-February 2012 Chair, Specialist Training Committee (STC) in Neurosurgery, West Midlands, UK NATIONAL June 2016 – Till date National ST3 Simulation lead for SAC in Neurosurgery, UK (National Committee)


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September 2011 – Dec 2019 Member of the SAC Specialty Advisory Committee in

Neurosurgery (National Committee) for UK INTERNATIONAL 2013 to 2018 UK representative to the EANS Training Committee (European Association of Neurological Societies) From 2013 till date Faculty of the ACNS (Asian Congress of Neurological Societies) Teaching on ACNS courses. DETAILS OF NEUROSURGICAL EXPERIENCE Experience BRIEF SUMMARY: After my MBBS, internship, job as an SHO and then training as general surgeon, I joined neurosurgical training at the GB pant Hospital in New Delhi and completed my MCh in Neurosurgery in 1987 and worked for another year (until December 1988) at the GB Pant Hospital to get more independent experience as a Neurosurgeon. I worked as a Consultant Neurosurgeon at Sir Ganga Ram Hospital in Delhi, India (recognised by ‘Indian National Academy of Medical Sciences’ for training in Neurosurgery) from January 1989 to August 1995. I moved to the United Kingdom in August/September 1995. I received further training in Neurosurgery from 1995 to 2001, initially at the Pinderfields Hospital in Wakefield and later at the United Leeds Teaching Hospitals in Leeds. I obtained the Fellowship of the Royal College of Surgeons of England (London), FRCS (Eng.) in May 1997. I was granted neurosurgery Specialist Accreditation on 24 June 1999 when my name was included in the GMC Specialist register on the basis of my overall neurosurgical experience (including that from India). I was awarded the Intercollegiate Fellowship in Surgical Neurology, FRCS SN by the Intercollegiate Board in Neurosurgery (Combined Royal Colleges of England, Edinburgh, Glasgow and Ireland) in April 2000. I obtained CCST (Certificate of Completion of Specialist Training) in May 2001. I became a Consultant in August 2001. I completed 19 years as a Consultant Neurosurgeon on 1 August 2019 at Walsgrave Hospital (re-designated as University Hospitals of Coventry and Warwickshire, Coventry, UK). I have worked for the NHS for the last 24 years in August 2019. DEPARTMENTAL ROLE: I worked as Clinical Lead in Neurosurgery (May 2016- February 2020): Details of my activity as clinical lead are described under the heading of ‘Administrative experience’. However, as clinical lead I was in charge of all administrative issues involving the department from allocating responsibilities to my colleagues in different sub-specialities, recruitment of all levels on staff (Consultants to SHOs), Clinical Governance (Quality Improvement, Mortality and Morbidity, audits), trouble shooting and Business planning. I developed the Trust Guidelines for prevention of wrong level spine surgery in 2017, which has now in the process of being adopted by the Regional Spinal Network for West Midlands. It was to be presented at the next meeting of the RSN at UHCW in April but die to the Corona Virus problem it is not clear of the meeting would be going ahead. I also developed guidelines for ITU management of poly trauma patients with cervical spine injuries, which is in the process of being agreed to be on Intranet of the hospital.


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I developed Trust Guidelines for Back pain referral for GPs for referral of patients with back pain, neck pain and other spine related problems. This was on regional GPs website but it is being modified again. I also developed protocols for Initial management of patients with aSAH and Post treatment management (after clipping or coiling of aneurysms) of patients with aSAH. After the CQC visit in 2018, I developed the detailed action plan as per the CQC recommendations and also developed reorganisation of the department as part of departmental improvement programme. I was the Programme Director for SHO and Specialist Registrar training in neurosurgery until 2012. Details of my activities are described under heading of Management & Administrative experience. REGIONAL ROLES I am the Regional Speciality Professional Advisor in Neurosurgery for the West Midlands (appointed in November 2014). Brief description of my job is 1) to approve consultant and specialty doctor job descriptions. 2) To provide specialty advice to the Director for Professional Affairs about provision of surgical services. 3) To signpost surgeons to appropriate sources of guidance on professional issues, such as job planning and career development. 4) To signpost professional advice and support for surgeons in difficulty. For details please see domain Administrative experience.

I worked as the Chairman of the Speciality Training Committee in Neurosurgery for the West Midlands from 2005-2012. Details of my activities as Chairman are under heading of Management & Administrative experience. NATIONAL ROLES As ST3 Simulation lead: I have been organising a National ST3 Boot Camp in Neurosurgery since 2016. This is a ‘high fidelity simulation course’ for ST3 (Third year neurosurgery trainees). The SAC in Neurosurgery has approved this course as part of the ST3 national curriculum. I would be organising the 4th Consecutive National ST3 Boot Camp in Neurosurgery from 7-13 December 2020. For details please see domain teaching experience. I worked a member of the SAC (Specialty Advisory Committee) in Neurosurgery and ST3 simulation lead for the SAC. I was appointed in this role in September 2011 and was given three extensions. My term concluded in December 2019. This is a National Committee under the direct control of the Joint Committee of Surgical Training (JCST). The JCST is an advisory body to the four surgical Royal Colleges of the UK and Ireland for all matters related to surgical training and works closely with the Surgical Specialty Associations in Great Britain and Ireland. SAC in Neurosurgery decides the standard of Neurosurgical training in the Country, monitors National Neurosurgery Selection standards, Neurosurgery exit Exam results, Work force planning, Trainee issues, standard of training in different neurosurgery units across England, Wales and Ireland and certification of training who have completed there neurosurgical training. I am also ‘Bullying and Harrassment’ Lead, member of National Work Force Planning group and GMC visits. I am actively involved in all activities of the SAC. I was the SAC liaison member for three large units, Leeds, Sheffield and Hull and responsible for monitoring and guiding the standard of training in these units as well as for certification of completion of training for trainees coming out of these units. For details please see domains Administrative experience and teaching experience.


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I was a member of the ‘National Neurosurgery Selection Board ’ since its inception. This Board is responsible for National recruitment of neurosurgical trainees for the ‘Neurosurgery run through Programmes’ for England, Wales and Scotland. Details of this role are described under the domain Administrative and Management experience. I was on the faculty of the Royal College of Surgeons of England and used to teach on the ‘Core Skills in Neurosurgery course’ twice a year held at the College in London from 2004 for a few years. Details of this role are described under the domain Teaching experience.

INTERNATIONAL ROLES I was elected through voting [by members of the SBNS (Society of British Neurological Surgeons)] as a UK representative to the EANS (European Association of Neurological Societies) Training Committee in 2012. I was involved in teaching on the EANS training courses from 2012 to 2016 and also annual selection of British trainees for the EANS courses. I developed a good working relationship with European Neurosurgeons. I am on the faculty of the training committee of Asian Congress of Neurological Societies (ACNS) and am invited to teach on their courses. I have taught on ACNS courses in Tyumen (Siberia in Russia) January 2013, Chitwan in Nepal in February 2015 and Kolkata, India in February 2018. I organised ACNS course in Coventry in UK in May 2015. I have given lectures at ACNS conference in Surabaya in Indonesia in March 2016. This forum has given me a chance to develop good relationships with Asian Neurosurgeons. DETAILS OF PRESENT EXPERIENCE CLINICAL EXPERIENCE IN REVERSE ORDER (MOST RECENT FIRST) AS CONSULTANT NEUROSURGEON IN UK: I have a total of 19 years experience as a Consultant Neurosurgeon in the UK (will be completing 20 years in August 2020). I joined as a substantive Consultant Neurosurgeon in the United Kingdom at Walsgrave Hospital (now the University Hospital of Coventry and Warwickshire) on the 16 August 2001. This is a neurosurgical unit covering a population of 1.4 million people approximately. I used to share a 1:9 on call rota with my Consultant colleagues. In addition to this I shared a 1:3 cover for neurovascular work (intracranial aneurysms). I have given up on call commitments w.e.f.1 February 2019 to dedicate more time for administrative work as the then Clinical Lead. Areas of my special interest are complex spine (in particular cervical spine), neurovascular surgery (aneurysms & AVMs), Trans-sphenoidal Pituitary Surgery, Endoscopic Third Ventriculostomy for hydrocephalus and meningiomas. Spine: My special interest in spine includes, degenerative lumbar and cervical spine pathologies (degenerative, rheumatoid, trauma and tumours etc) and cervical spinal surgery for these conditions, including instrumentation. I established myself as a complex cervical spine surgeon in the region within a few years of joining as consultant. I have extensive experience in complex cervical spine surgery including anterior lag screw fixation for C2 fractures, C1-C2 lateral mass screw fixation for atlanto-occipital subluxation (due to rheumatoid neck or trauma), cervico-thoracic fractures and anterior screw fixation for odontoid peg fractures I have extensive experience in dealing with spinal pathologies. Clinic experience in NHS: I have 5 clinics every week in the NHS (UHCW in Coventry, GEH in Nuneaton


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and South Warwick Hospital in Warwick) and I see 9 [new and follow up] patients in each clinic, majority of which are spine (almost 99%). I therefore see approximately 45 patients (new and follow up) every week, and approximately 1890 patients (new and Follow up) every year in the NHS (in 42 weeks per year). [I have separate clinic for pituitary patients and special Neurovascular clinic for neurovascular patients]. In addition I have 6 additional clinics (two clinics each day x 3 days spread over two/three the weekend 7 days) in approximately 8 months of the year and I see 9 patients in each of these clinics (new and Follow up) i.e. I see additional 54 patients each months i.e., 432 additional patients. I therefore see approximately 2322 (1890 + 432) patients (new and Follow up) with spine pathology each year in the NHS alone. If we look at only new patient referrals, I see 5 new patients in each clinic and 25 new patients in 5 clinics per week. I see approximately 1050 new patjents with spine pathology each year (if I calculate only for 42 weeks). If the additional clinics are included over the weekend, I see 5 new patients in each of the 6 additional clinics per month i.e., 30 new patients every month, and 180 additional new patients in a year (in 6 out of 12 months). I therefore see approximately 1230 new patients with spine pathology each year in the NHS alone. I would have seen approximately 24,510 new patients with spinal pathology in the NHS alone in last 19 years. These are not exact figures but approximate figures. I was one of the first two persons in the region (West Midlands) to perform Total cervical disc replacements in patients with degenerative cervical disc disease. The first case that I did was covered on BBC West Midland News on the 12 June 2007. I have personally performed appx. 150 total cervical disc replacements in the last 12 years (since 2007) with prospective follow up and excellent results. These numbers include patients operated in private and NHS. I am prospectively auditing my results. Spinal Operations: NHS: I had 6-7 full operating days in the NHS (all Thursdays) and alternate Mondays until three years ago. I dropped Monday theatres and was operating on Thursday every week operating. Now I four operating theatre lists a month. I was also operating on my on call days as well. In addition to this, I have a full operating list every week at the BMI Meriden Hospital and occasionally at the Warwickshire Nuffield Hospital. Between University Hospitals and the BMI, I operate approximately 200 spine operations per year (42 weeks per year) of which about 140 lumbar spine (including emergency) and approximately 60 cervical spine operations every year. These are not exact figures but approximate figures. So far in 19 years (since 2001 and not including 2018-19 figures) I have operated approximately close to 3400 spinal operations (1100 cervical spine and 2300 lumbar) [in NHS (elective and emergency spinal operations) and Private sector (elective spinal work only) combined]. These include complex cervical spine trauma, rheumatoid cervical spine and lumbar spine complex operations. Of these I have operated approximately 360 cervical and 756 lumbar spine operations in the private sector alone in 15 years [(2003-2018 (not much private work in 2002)] (this includes NHS patients operated in private sector). These are only approximate figures. I addition to patients with cervical & lumbar degenerative disease and cervical trauma, I deal with patients who have sustained whiplash injuries as well. Neurovascular surgery is another area of my interest. I sub-specialise in neurovascular surgery and have been Neurovascular lead for more than 6 years. I used to share a committed 1:3 vascular (for aneurysm surgery) on call rota with one of my neurosurgical colleagues. However, at present, there is no on call rota for neurovascular but me and my colleague do take over patients from colleagues, who do not perform neurovascular surgery. At present four neuro-interventionists from Oxford are working in collaboration with us. Majority of aneurysms are coiled by the neuro-Interventionists but good number of aneurysms i.e. most MCA aneurysms and some pericallosal aneurysms require clipping by surgeons. I perform approximately 10-12 aneurysms in a year, majority of those that can’t be coiled. I used to share the pituitary surgery with one of the colleagues until January 2019. The patients are referred through a Joint Pituitary Clinic that I used to run with the Endocrinologists. We have a common protocol for treating such patients along with the endocrinologists in the true spirit of multidisciplinary approach. I have passed on my pituitary work to one of my colleagues since January 2019.


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I have a particular interest in neuro-endoscopy and I perform endoscopic third ventriculostomy for hydrocephalus in suitable patients. I have interest in Micro-vascular decompression for Trigeminal Neuralgia and Hemifacial spasm. My work also covers a wide spectrum of CNS conditions including cranial and spinal tumours e.g., Meningiomas. EXPERIENCE BEFORE BECOMING A CONSULTANT IN UK IN REVERSE ORDER (MOST RECENT FIRST) April 2000- August 2001: Experience after ‘FRCS Surgical Neurology’ and Certification of completion of training: I passed my Intercollegiate Speciality examination (exam was held in Nottingham) in Neurosurgery in April 2000; I gained wider experience in neurosurgery, particularly, in cranial and spinal trauma, aneurysms, complex spinal surgery, stereotactic surgery and paediatric neurosurgery. On the recommendation of the SAC (Specialist Advisory Committee) to the Royal College of Surgeons and the recommendations of the Royal college of Surgeons and the STA to the GMC in June 1999, my name was included in the Specialist Register of the GMC in Neurosurgery on 24 June 1999. However, I was awarded the Certificate of Completion of Specialist Training (CCST) in May 2001. I continued to work in Leeds till I joined my present post as Consultant Neurosurgeon on the 16 August 2001. September 1997-April 2000: Experience after FRCS Department of Neurosurgery at the Pinderfields General Hospital merged with the neurosurgery department at the Leeds General Infirmary in September 1997. I had to move to Leeds. This is the Regional referral centre for neurosurgery in the West Yorkshire region and a teaching hospital. It used to serve the population of approximately 3 million at that time. I initially worked as a Research Registrar in Neurosurgery, at Leeds General Infirmary from 13 September 1997 to 31 May 1999. My research involved ‘Clinical phase I/II trial of photodynamic therapy (PDT) of patients with recurrent pituitary adenomas’. To the best of our knowledge, this was the first clinical trial of PDT, in benign intracranial tumours in humans. The details of the research work are described under “Research Experience”. After completing my research, I was appointed as a Specialist Registrar in the department of Neurosurgery, at the Leeds General Infirmary, Leeds, in June 1999. I shared a 1:6 on call rota with the other five registrars. This helped me to further my surgical experience in Neurosurgery. At Leeds, I had good exposure to Trans sphenoidal surgery; neurovascular surgery and complex spinal surgery and I also had good exposure to new technologies such as neuro-navigation system, neuro-endoscopy as well as functional neurosurgery. August 1995 to September 1997: Move to UK: I moved to UK in August 1995 to further my experience in neurosurgery. My first job began as visiting Registrar in Neurosurgery at Pinderfields General Hospital in Wakefield. Pinderfields is a large district hospital, housing the regional specialities of spinal injuries, regional burns unit, besides dental, maxillo-facial and plastic surgery. At that time, the department was one of the three regional centres for neurosurgery, fully equipped with all required facilities including a dedicated Neurosurgery Intensive care unit. There were four registrars and I shared a 1:4 on call rota with them. I easily adjusted into the system of GP based NHS Hospital working and consolidated my already existing knowledge of the speciality, based on my overseas experience of over 10 years. Since the department at Pinderfields Hospital was a busy referral centre, I improved upon my overseas experience in all aspects of


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neurosurgical practice. I also learnt stereotaxy, microsurgery of spine, and spinal instrumentation. During this period I also passed my FRCS part I and part II examinations, both at first attempt. EXPERIENCE IN INDIA LNJP Hospital contributed to all 5 years of my basic surgical training in general surgery as well as training as an Intern and SHO. It is a 1600-bedded premier teaching hospital of the country and of Asia and is associated with Maulana Azad Medical College, which is one of the leading medical schools of the country and where I had my medical schooling. It provides for all the basic medical and surgical specialities. LNJP is a very busy hospital catering to a population of 8-10 million (patients come not only from within the city but also from most of north India). Training as an Intern: After completing my MBBS, I spent one year as an Intern when I was rotated through all specialities. One year that I spent as an Intern, which is equivalent to FY1 in UK. This gave me an extensive exposure to almost all specialities. I rotated through General Medicine (2 months), General surgery (two months), Gynaecology and Obstretics (2 months), Trauma and Orthopaedics (2 month) and one month each in ENT & Ophthalmologist and two weeks each in Preventive & Social Medicine and Family planning. I had a rural posting for one month when I had the experience of working in a village. Training as SHO in Gen surgery and General medicine: This is equivalent to FY2 in UK. After completing one year of Internship, I worked as an SHO for one year. I spent 6 months in general surgery learning basic surgical skills in treating patients with urology, general surgery, burns and plastic problems. I also spent 6 months in general medicine which gave me exposure to basic medical training learning to treat patients with chest, cardiac and gastrointestinal problems. Surgical experience before obtaining degree of MS in Gen Surgery: During my pre MS basic surgical training in general surgery, I had extensive supervised training to improve my surgical skills in urology, Gastroenterology surgery and Paediatric surgery. After completing the requirement (three years of junior residency and submission of thesis entitled ‘Cytological and Histological changes due to Urinary Calculi’), I passed the examination and qualified for the degree of MS in general surgery. Surgical experience after obtaining degree of MS in General Surgery: After obtaining the degree of MS (General Surgery), I worked as a senior resident (Registrar) in general surgery and obtained supervised higher surgical training in general surgery as well as in urology and paediatric surgery. I provided cover for emergencies with 1:3 on call rota. This gave me an opportunity to further my surgical experience and perform more complex elective and emergency procedures in paediatric surgery, liver and chest trauma as well as in urology, under supervision. Neurosurgical experience before and during MCh in Neurosurgery: G B Pant Hospital contributed to the first 4 years and 5 months of my higher surgical training in neurosurgery. I was initiated into neurosurgery in 1981 when I joined as a senior resident (Registrar) in May 1981 for 8 months. I went to general surgery at LNJP Hospital as a registrar for two and a half years, to join the department of neurosurgery again in April 1985, as a higher surgical trainee in neurosurgery. G B Pant Hospital is a super speciality hospital and one of the leading centres for training in neurosurgery in India. The department performs about 1300-1500 neurosurgical operations including head trauma (operated at LNJP Hospital), each year. It is a 500 bedded teaching hospital and provides only super speciality care in Neurosurgery, Neurology & Psychiatry, Cardiothoracic surgery & Cardiology and Gastro-enterology surgery & medicine. Basic medical and surgical care is provided by LNJP hospital. Maulana Azad Medical College, G B Pant Hospital and LNJP Hospital are situated in the same campus, are associated with each other and are affiliated to the University of Delhi. At the time of my training, the neurosurgery department was a 32-bedded fully equipped neurosurgical unit with a 6- bedded neurosurgical ICU (both have been further extended since). The department had an


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excellent teaching programme. During my training, I was also sent to the National Institute of Mental Health and Neurosciences (NIMHANS) at Bangalore, for one month, to get an exposure to neuroanatomy, neuropathology and neurophysiology. The neurosurgical training was structured and well supervised as in UK. At the completion of higher surgical training in neurosurgery and submission of a Thesis entitled “Intracranial Aneurysms, A Five Year Study” to the University of Delhi, I passed the exit examination for neurosurgery in 1987 and qualified for the degree of MCh in Neurosurgery. Experience after obtaining MCh in Neurosurgery: After completing 3 years and 3 months as registrar in neurosurgery at G.B.Pant Hospital and passing my MCh (neurosurgery), I worked as a Senior Registrar (Pool Officer) for a further period of one year and 2 months at the same hospital. During this period I increased my solo experience in more complex operations like clipping of aneurysms, posterior fossa surgery and paediatric neurosurgery. Experience as Consultant Neurosurgeon Ganga Ram Hospital After completing a total of 4 and half years of supervised higher surgical training at G B Pant Hospital, I joined Sir Ganga Ram Hospital in January 1989 as a Consultant Neurosurgeon. Sir Ganga Ram Hospital is a 500-bedded multi discipline hospital catering to a population of 4-5 million people. The department of neurosurgery is a regional referral centre for neurosurgery but attracts patients from all over the country. It is recognised by the Indian National Academy of Medical Sciences (on the pattern of American Board) for higher surgical training in neurosurgery. The hospital in 1989-1995 was a 30-bedded fully equipped neurosurgical unit with a 10-bedded ICU (mostly occupied by neurosurgical patients). The department has an excellent teaching programme. During this period I improved my surgical experience in all areas of neurosurgery, particularly trauma, paediatric neurosurgery, spinal surgery, neurovascular and posterior fossa surgery. I continued to work as a Consultant neurosurgeon till I moved to UK in August 1995. MANAGEMENT AND ADMINISTRATIVE EXPERIENCE LOCAL AS CONSULTANT NEUROSURGEON (2001 till date): I have been managing my own practice as well as my firm for last 20 years. 1) DELIVERING A HIGH QUALITY SERVICE: I provide a high quality service to patients: CLINICS: I spent time with patients to develop trust & partnership by active listening, engaging them in decision making, being open, & honest and copy all correspondence to them. Overall response from the patients in 360 degree feedback in March 2019 is excellent. OPERATING: I am a safe surgeon and maintain a log book with outcomes. In 360 degree feedback from March 2019,, my diagnostic skills and performance of practical/technical procedures were rated above the National average while in other 8 domains I was at par with National average. COMPARISON WITH PEERS: My results are published through ‘National Neurosurgery Audit Programme’ (NNAP) on NHS England public website and compared with my peers. My 30 day adjusted risk mortality is within expected range. CLINICAL GOVERNANCE: I have annual appraisal and Revalidation. My mandatory training compliance is 94.1% and attend the M&M and QIPS with evidence of good attendance. As Clinical lead I am in charge of clinical Governance.


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DUTY OF CANDOUR: I follow the principles of Duty of Candour to the spirit. I acknowledge mistakes, apologise, document, put in a Datix, discuss in M&M, learn and reflect. As CLINICAL LEAD (May 2016 to February 2020): I have achieved the following: 1). DEVELOPING A HIGH QUALITY SERVICE: As clinical lead I engage with my neurosurgical colleagues and also other sub-specialities like critical care group, Trauma and Orthopaedic spinal surgeons, radiologists, Neuron-interventionists in developing guidelines and pathways. I developed: 1)a. Trust Guidelines on i) ‘Prevention of wrong level spinal surgery” (a significant event) published on Intranet. The incidence of wrong level spine surgery has gone down. This involved engagement with T&O spinal surgeons and radiologists and neurosurgocal colleagues. These guidleines are now being adopted by the Regional Spinal Network for West Midlands. ii) ‘Clearance of spine in Intensive care unit in unconscious patients with poly trauma, approved by Spinal Ortho surgeons and Neurosurgery QIPS. It has been presented to GCC QIPS and they wosh some mlore modifications before publication on Intranet of the UHCW trust. 1)b. Pathways: I developed i) ‘Trust ‘Back pain referral pathways for GPs’, which were now on GP website called ‘GP Gateway’. These will hopefully increase clinic capacity and save costs in the long run. I have engaged with the CCGs extensively while developing these pathways. The pathways are now being revised again. ii) ‘Trust pathways for post discharge follow up of neurovascular patients’. Neurovascular clinic waiting has gone down significantly, improving patient access. iii) Guidelines to discharge patients from the clinic to improve capacity in clinics. iv) ‘Pathways for management of Fragility fractures’. This is under progress. 1)c. Protocols: I have also developed i) Pre and Post treatment protocols for aneurysmal SAH have been approved by Neurosurgery and GCC QIPS and have been uploaded on the UHCW Intranet. 1)d. Recent Audits: I carried out i) Annual audits on ‘Clip and coil Neurovascular Audit’ since 2012 until 2018. This idenitified the need for a data clerk & Neurovascular Specialist Nurse, both appointed (2015 & 2016 respectively) making the service safer Besides many other audits, I supervised i) National GIRFT ‘Surgical Site Iinfection in cranial & spinal Neurosurgery’ audits in 2018. I received a certificate by GIRFT (Getting It Right the First Time). ii) Audit ‘Compliance of Antibiotics policy in Neurosurgery’. Presented to QIPS late last year. This identified non compliance. The policy has been simplified and presented to QIPS in June 2019. iii) ‘Impact of increasing elderly population (referrals and admission) on neurosurgical service’. This is complete but is to be presented to M&M in July and we aim to publish it in either BMJ or BJNS. This audit has demonstrated that the referral pattern has signifiantly changed in last decade with many more elderly patients over 75 years are being admitted and operated by us. Their length of stay is longer with increasing cost. This also demonstrated the need to have an elderly care physician in neurousurgery ward. This is to be presented to the department QIPS.


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2). MANAGING AND LEADING A HIGH QUALITY SERVICE: 2)a. LEADERSHIP TRAINING: After taking over as clinical lead in May 2016, I completed ‘UHCW Leading Together Course, cohort 8’ (6 modules) on 18 May 2018 (started 18 May 2017). 2)b. FINANCE: Starting in May 2016, I have converted all locum SHOs & Registrars posts to substantive posts & incorporated ward doctor cover as part of normal rota (was locum previously) leading to significant cost savings 2)c. SAFETY: As lead I established i) a Web based online referral system in Neurosurgery called ‘referapatient’ (starting in September 2016) for all referring hospitals. This has improved standard of referrals & accountability, reduced complaints and created a referral database. ii) Safe ‘Neurosurgery Consultant on call model’ with robust morning handover, consultant led ‘Ward Board Round’, safety huddle and recording morbidities on database PWC commended this a ‘Role model for the trust’ Both above led to improved patient care. 2)d. CLINICAL GOVERNANCE: Institutionalised QIPS (Quality Improvement Programme), M&M (Mortality and Morbidity) and Business meetings and made them regimented, fair, transparent and effective. I developed a monthly rota for mortality review and ensured that all reviews with NCEPOD category of B, C, D, or E are discussed openly in the M&M meeting as secondary mortality review. This maintains transparency and eliminates bias. 2)e. CQC (Care Quality Commission): I developed CQC action plan for Neurosurgery based on the recommendations of the CQC following its visit in March/April 2018. I was praised by the ‘Trust CQC lead’ at ‘Relationship manager meeting’ 3 May 2019, in presence of the CQC inspector 2)f. SERVICE DEVELOPMENT: I restructured the department in November 2018, appointed sub-speciality leads and gave them ‘time targeted tasks’ including clinical audits, pathways, protocols, guidelines and information leaflets for their respective sub-specialties. The progress of work carried out by sub-speciality leads is monitored regularly in Clinical Governance meetings. They are constantly reminded of any delays. This work is still in progress. 3) CONTRIBUTING TO THE NHS THROUGH RESEARCH AND INNOVATION NEW TECHNOLOGIES: 3)a. TOTAL CERVICAL DISC REPLACEMENT IN DEGENERATIVE DISC DISEASE: I Introduced new technology of ‘Total cervical disc replacement’ instead of fusion in patients with degenerative cervical disc disease in June 2007. The first cervical disc replacement operation that I performed, was telecast by BBC West Midlands in their news extensively at that time. I have performed over 150 cervical disc replacements since then with excellent results. Selection criteria are strict. The advantage to the patient is motion preservation at the operated segment and prevention of adjacent segment disease saving future admissions and operations and saving money to the trust. 3)b. AUTOLOGOUS CRANIOPLASTY. After decompressive craniectomy for brain swelling following head trauma or aSAH, the bone flap used to be thrown away. All methods of sterilising the bone (boiling, antiseptic solutions, radiation etc.) before storage could lead to bone necrosis. Acrylic cranioplasty has a high risk of infection and titanium is expensive. I introduced a method of preserving the patient's own bone flap in the patient's abdominal wall (subcutaneous pocket) before my last reward. The advantages are that the bone flap is trailor made to the defect, it belongs to the patient, has least risk of infection (comparative audit in 2010) & has no added


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cost. It has saved thousand of pounds to the UHCW trust over the years. It has been adopted by most of my colleagues now. The chage has occurred silently. 3)c. RETRACTOR LESS BRAIN SURGERY: I stopped using brain retractors in aneurysm clipping (aSAH), Microvascular decompression or meningioma surgery since 2013 (retractor pressure is 25 mmHg & affects cerebral perfusion adversely). This has improved the outcomes significantly and reduced morbidity particularly in patients with aneurysmal subarachnoid haemmorhage. 3)d. I introduced the USE OF INTRAOPERATIVE ICG (flourescine dye) in 2013 in place of angiography (which is expensive) in the department after clipping to improve the accuracy of clipping. This technique is well established and is useful in confirming correct occlusion of the aneurysm but also ensuring that no branch is taken by the clip. This has improved outcomes & saved money to the trust. 2. REGIONAL: 1) I am the Regional Specialty Professional Advisor in Neurosurgery for the West Midlands: I was appointed in November 2014. The RSPA is a Specialty Association Specialty appointment endorsed by the Royal College of Surgeons. It is one of two key roles in a partnership between the Specialty Associations and the College to create a unified voice for surgery locally and to provide advice and support on professional matters to surgeons in the workplace. Role Description: The RSPA sits on the local Professional Affairs Board and supports the work of the Board by providing specialty input into local NHS decision-making about service provision within the region, ensuring consistency and maintenance of standards through approval of consultant and specialty doctor job plans and providing professional advice and signposting for surgeons in difficulty. The formal role of the RSPA in revalidation is yet to be defined and may include advising surgeons on revalidation requirements and signposting appropriate sources of guidance and support. Core Activities: To approve consultant and specialty doctor job descriptions To provide specialty advice to the Director for Professional Affairs about provision of surgical services To signpost surgeons to appropriate sources of guidance on professional issues, such as job planning and career development To signpost professional advice and support for surgeons in difficulty 2) I was the Chairman and Training Programme Director for the Speciality Training Committee (STC) in Neurosurgery for the West Midlands from February 2005 and stepped down in February 2013. As Chair I was in charge of one of the largest Neurosurgery training Programmes in the country. I had total of 33 trainees at different stages of training spread over four Neurosurgical Units in West Midlands. I had to liaise with the Dean, the head of School of Surgery, the TPDs of the four neurosurgical units in the region, some times the Chief Medical officers or Chief Executives of the four trusts, with the SAC in neurosurgery and the Royal Colleges for training purposes. I was responsible for arranging regional rotations for all of the trainees (there are two rotations- one for ST1-ST3 and the other for senior trainees ST4- ST8). This is done twice a year. Role as Chairman & Regional TPD: I was involved in a) Validating all trainees. b) Allocating their placements c) Setting global objectives (a, b and c twice a year) for them. d) Arranging their interim and annual review i.e., ARCP, all on ISCP website. e) Arranging training of Trainees and trainers on ISCP. I was also responsible for applying for additional training posts within the region and calculating exactly how many run through or FTSTA posts each year need to be advertised through National Selection.


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I chaired all the ARCP panels once (sometimes twice) a year. I had to advice minutes of ARCP panel meetings and ARCP outcomes after review of each trainee and populate the outcomes on ISCP website with the recommendations of the panel. For trainees in difficulty I had to organise special ARCPs by inviting Head of School of Surgery, SAC chair etc. to take a decision about trainee’s progress. Action on Trainee surveys: I had to analyse the GMC and other trainee surveys with other panel members and take appropriate actions after discussion with different neurosurgery unit representatives and CMOs. 3. NATIONAL: I have many National roles that require administration and management as mentioned below. 1) As Member of National Neurosurgery Selection Board: This board is responsible for national selection of neurosurgical trainees for all the run through training programmes for the entire country (England and Wales). I was involved with the national Neurosurgery Selection Board from its inception in 2008. I used to sit on the panel for a) Short-listing and b) Interview once a year for National recruitment of trainees. I was actively involved in developing the concept of National Selection and developing different scenarios and stations for National Selection Interviews. I was involved in the short listing and Interview and selection process for many years. The last time I was involved in National Neurosurgery Selection Board meeting for Short listing neurosurgery candidates for National Neurosurgery Selection, in Sheffield on 11 January 2013 and in Neurosurgery National Selection Interviews at Leeds. 1 February 2013. 2) As member of the SAC in Neurosurgery, I had to attend at four meetings of the SAC in a year. I was also a member of the subgroups for ‘Work force planning’ and was actively involved. I was also the ‘Bullying and Harassment Lead’ for SAC. I have to submit my report as SAC liaison member for three large neurosurgical units in Yorkshire. 3) As Liaison Member of the SAC in Neurosurgery for three large Neurosurgical Units (Leeds, Sheffield and Hull). I had to attend the ARCP (Annual review process) once a year and occasionally an additional ARCP. Based on the ARCP, I have to submit a report to the SAC in Neurosurgery with my comments and recommendations. I had to review the trainee logbooks to recommend them for CCT (Certificate for Completion of Training). I along with SAC Chair, advise if a trainee has completed all requirements for recommendation for CCT. I also took decisions about recognition for fellowships in different sub-specialities (skull base, spine etc.) in these three units. The recognition for fellowship by the Royal College is on the basis of my report and recommendations. I recommended ‘Skull base and Pituitary fellowship’ in Leeds and advised recognition of Paediatric Neurosurgery training in Sheffield. INTERNATIONAL: A). UK representative to the EANS training committee (2012 to 2016): Review trainee application for EANS course: I had to go through all application of trainees applying to the EANS courses. I had to prepare a short list of trainees according to a set selection criteria and submit this report to the EANS training committee. The committee then decided which trainee would go onto the course for a particular cycles (there were two cycles and one course each year for each cycle i.e., two courses each year. Each cycle is for four years covering four sub-speciality courses (vascular, neurotrauma, spine and peripheral nerves and oncology).


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Attend EANS Training Committee meetings: I had to attend all the meetings if I was attending the course. These meetings are held during each course and discuss the content and the format of future courses. Prepare lectures for each course I attended. I usually had one or two lectures to prepare and in addition prepare for interactive sessions on different topics. Please see domain on ‘Teaching Experience’. TEACHING EXPERIENCE I have extensive teaching experience in different capacities Locally, Regionally, Nationally and Internationally and organise several National and International courses. A. LOCAL TEACHING At the University Hospitals Coventry and Warwickshire: 1. Undergraduates: a) Medical Student clinical attachment: The Hospital I work in now is attached to The Warwick Medical. In my present position as a Consultant, I often get a batch of two medical students for a period of 8 weeks, which is shared by general surgery. They attend my clinics and operating theatre. They attend the departmental teaching on Friday. When I get time, I teach them on neurosurgical topics of trauma, spine, subarachnoid haemorrhage and brain tumours. c) During my early years as consultant, I was involved in the selection of candidates for admission to the Warwick Medical School based at Warwick University in the past but I do not get time now due to my other engagements. 2. SHOs During my earlier years as consultant, I turned around SHO training by developing a proper Induction tool, regular structured combined teaching programme for neurosurgery and neurology SHOs. As Chair of STC, I organised training recognition for two ST1 trainees, one ST3 trainee and one FY2 trainee posts. At present, all these trainees do rotate through the department regularly although instead of two ST1 and one ST3 trainee, the new Chair of the STC has been sending two ST3 trainees only. In my capacity as departmental training programme director, in my early years I used to attend the “University Hospital Educational Committee” which meets regularly to decide the new ways of training of the SHOs and the Medical Students. This role has been passed on to another colleague. 3. Specialist Registrars in Neurosurgery. a) I was the Departmental Programme Director for training of Neursosurgical Specialist Registrars at University Hospital, Coventry for initial 10 years after my appointment as a Consultant. I took over the training programme in January 2003 after the visit of the SAC in Neurosurgery. This was a difficult time for the unit. At that time the SAC had threatened to withdraw the only Specialist Registrar that the department had on rotation from Birmingham. I was not only able to retain the existing registrar but also get approval for the second trainee during the informal visit of the SAC member in April 2004. The visit of the SAC in April 2004 confirmed the approval to have three trainees (two trainees one in year 1-2 & the third in year 3-4). However, over the years and during my tenure as STC Chair, I was able to get recognition for all three training posts to the highest level of training. We now have Educational approval for training up to ST8 (till CCT) for all the three training posts.


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I developed a very good teaching programme for SpRs in the department, which runs every Friday. At present it is co-ordinated by another colleague of mine. I attend these teachings along with my colleagues. I also teach in these sessions. In addition when I was on call I used to provide bedside interactive teaching to SHOs and registrars. I have given up on call commitment to concentrate on my clinical lead responsibilities. During my tenure as departmental training programme director, I had developed a departmental Induction Programme for the specialist registrars and implement the ‘trainee contract’ as well as in their regular formal and informal appraisal as per the guidelines of the Deanery. However, this role has been passed onto one of my colleagues now. B. REGIONAL TEACHING: 1. As STC Chair: a) I developed the concept of a monthly Regional Teaching Programme in the form of a ‘Regional Study Day’ for trainees with active participation of all the four neurosurgical units in the West Midlands. It is a compulsory full day teaching by rotation in the four neurosurgical units of the region. It includes lectures, MCQs, VIVA sessions, short and long cases and seminars on topics.

This proved to be very popular among the trainees and had been able to overcome the problems of reduced working hours on training. This has increased the co-operation amongst the various units within the region and introduced a spirit of healthy competition. Although I am not the chairman any more but the ‘Regional Study Day’ is still continuing.

b) I also developed a rolling ‘Curriculum based teaching programme’ for the whole region for three years to be repeated every three years. Each unit had to prepare their study day based on the allocated topics for that day as per the curriculum based teaching programme. This programme is still being followed. c) I organised ‘Mock Exit examination in Neurosurgery’ twice. On 2 March 2012 and 2 November 2012. It received excellent feedback from trainees and trainers across the West Midlands. All trainers participated with lot of enthusiasm. The Mock exam was based on the actual exit examination in Neurosurgery. Unfortunately, after I stepped down as Chair, the mock exam ran for two more years but then stopped. 3. NATIONAL TEACHING: A. I run a ‘National ST3 Boot Camp in Neurosurgery’ annually. The first course was in 28 November - 4 December 2016 and since then I have organised this course in December every year as shown below. i) First National ST3 Boot Camp in Neurosurgery was held on 28 November - 4 December 2016 at the University Hospitals Coventry and Warwickshire, Coventry, UK. ii) Second National ST3 Boot Camp in Neurosurgery was held on 11-17 December 2017 at the University Hospitals Coventry and Warwickshire, Coventry, UK. iii) Third National ST3 Boot Camp in Neurosurgery was held on 11-17 December 2018 at the University Hospitals Coventry and Warwickshire, Coventry, UK. iv) Fourth National ST3 Boot Camp in Neurosurgery is planned for 09-13 December 2019 at the University Hospitals Coventry and Warwickshire, Coventry, UK. ST3 Boot camp is now recognised by the JCST (Joint Committee of Surgical Training) as part of their curriculum for ST3 trainees. Concept: As part of curriculum incorporating simulation, SAC in Neurosurgery has introduced mandatory ‘National Boot Camps’ at three levels of training: a) ST1 - for beginners b) ST3 - before graduating as registrars and c) ST8 - before completion of training.


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ST3 Boot Camp aims to provide structured high fidelity simulation experience to ST3 trainees to prepare them for the next level. This course is based on ‘Basic Skills in Neurosurgery’, which I have been organising since 2011. Course Content: The course covers the whole spectrum of training for the following approaches with lectures in regional anatomy, consent simulation (role play), positioning simulation (synthetic heads, spinal tables) followed by ‘hands on exercise’ on cadavers. Cranial approaches include Bifrontal, Pterional, Parasagittal, Occipital & Posterior Fossa and Spinal approaches include anterior cervical discectomy with instrumentation, posterior cervical laminectomy, foraminotomy, Lumbar laminectomy & micro-discectomy. Operating microscopes, neuro-navigation, high-speed drills & Sonopet for cranial approaches and Image intensifiers for spinal approaches were used to simulate real life experience. Industry provides significant monetary and material support, with balance contributed by SBNS. Registered trainees complete on line ‘pre-course and post course questionnaire on their knowledge’ (using ‘e-brain’) and ‘feedback form’ for course evaluation. Results: ST3 Boot Camp has been running successfully for three consecutive years. The answer to two main questions 1) Has the ST3 Boot Camp improved your knowledge and skills required at ST3 level? & 2) Has the ST3 Boot Camp made you better prepared for an independent Registrar role? Has been 100% in the affirmative. Conclusion: ST3 Boot Camp is useful in improving the confidence of trainees graduating to more senior and independent role. B. Invited Guest Speaker to the Autumn Meeting of SBNS (Society of British Neurological Surgeons), Coventry, UK, in Autumn 2014. Audience: British trainees and National faculty from England, Wales and Scotland. I covered the following subject. i) CME Lecture: Management of Cranio-cervical Trauma C. I was invited to the Debate at the Synthes cervical and lumbar Pro-disc cadaver course, Surgical Training Centre Newcastle upon Tyne, UK 4 & 5 February 2010. Audience: Neuro and T&O spinal surgeons. I covered the following subject. i) Debate: Biomechanics of Cervical Disc replacement - Is there an advantage of Disc replacement compared to fusion. I argued in favour of cervical disc replacement. D. I was invited Guest faculty at the cadaver course in Oxford, UK 21 September 2009. Audience: Orthopaedic and Neurosurgery Consultants and trainees from UK. I covered the following subject. i) Lecture: Dynamic Stabilisation in Degenerative Disc Disease Indications of cervical disc arthroplasty: E. Presented at the Grand Round University Hospital, Coventry in November 2008. Audience all staff (all consultants from different specialities, all middle grade doctors, nurses, Chief executive, Chief medical Officer from within the hospital. i) Case discussion (presented along with a Cardio-thoracic surgeon). Management of cervico-thoracic fractures in a patient with ankylosing Spondylitis (combined cervical and transthoracic approach) F. I was Faculty at the ‘Core Skills in Neurosurgery’ course between 2004-2009 at the Royal College of Surgeons, London, UK. Audience: Higher Neurosurgical Trainees (Year 2-4) and faculty (Neurosurgeons from across UK). I covered the following subject on several occasions between 2004-2009. I now run my own Cadaver courses and therefore I do not attend this course any more. My lectures were mainly on cervical spine.


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i) Lecture: Anterior (anatomy) approach to cervical spine. ii) Lecture: Posterior cranial approach including for cranio-cervical decompression: 4. INTERNATIONAL TEACHING: EANS (EUROPEAN CONGRESS OF NEUROLOGOCAL SOCIETIES) COURSES: 1) Teaching on EANS Courses: I was on the EANS Training Committee for 4 years (2013-2017). I taught on the following EANS Courses until 2015 as part of the EANS faculty. A) EANS Training Course- module - Neurotrauma and Epilepsy in Lisbon, Portugal, 31 August – 3 September 2015: Audience: All Trainees (appx 300) and faculty from Europe and UK. I covered the following subjects i) Lecture: Management of Poly-traumatised patient (including spinal injuries) ii) How I do it: Decompressive Craniectomy. B. EANS Training Course - module - Neurovascular in Upsaala, Sweden, 25-29 January 2015: Audience: All Trainees (appx 300) and faculty from Europe and UK. I covered the following subjects i) Lecture: Epidemiology of aneurysmal Subarachnoid haemorrhage ii) Discussion groups: Intra-cerebral haematomas in elderly C. EANS Training Course – Module- Oncology. Nicosia, Cyprus, 14-18 September 2014. Audience: All Trainees (appx 300) and faculty from Europe and UK. I covered the following subjects. i) Lecture: Simulation in Neurosurgery D. EANS Training Course - module - ‘Spine and Peripheral Nerves’, in Barcelona, Spain, 16-20 February 2014. Audience: All Trainees (appx 300) and faculty from Europe and UK. I covered the following subjects i) Lecture: ‘Management of Occipito - Cervical Trauma’. ii) How I do it: Cervical Arthropplasty. iii) Interactive session E. EANS Training Course – Module - Neurovascular, in Prague, Czech Republic. 23-26 September 2013: Audience: All Trainees (appx 300) and faculty from Europe and UK. I covered the following subjects i) Lecture: Epidemiology of aneurysmal Subarachnoid Haemorrhage. 2) Attend meetings of the EANS Training Committee (Twice a year) as part of the course. I had to attend the meetings of the EANS Training committee at each course. These meetings decide the next Programme for the next Training Course. ACNS (ASIAN CONGRESS OF NEUROLOGICAL SOCIETIES) COURSES: 1) Teaching on ACNS Courses: As part of the faculty, I have taught on the following ACNS courses. A. Invited guest speaker to the ACNS/WFNS Live Surgery Seminar, Kolkata, India, 10-12 February 2018. Audience: Trainees from Asia and Faculty of the Asian Congress of Neurological Societies (ACNS) and World Federation of Neurological Societies (WFNS). I covered the following subjects: i) Lecture: MVD for Trigeminal Neuralgia and Hemifacial spasm.


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ii) Lecture: Neurosurgical training in UK and the concept of Boot Camps in Neurosurgery. B. Invited Guest Speaker to the ACNS (Asian Congress of Neurological Societies) World Congress, Surabaya, Indonesia, 9-12 March 2016. Audience: International Neurosurgical Trainees from Asia and International faculty from Asia, Europe and USA. I covered the following subjects i) Lecture: Simulation in Neurosurgery- Future of Training?. ii) Lecture: Retractorless Brain Surgery. C. Organised the 7th ACNS (Asian Congress of Neurological Societies) Lecture and Cadaver Course, Coventry, 16-19 May 2015. Audience: International Neurosurgical Trainees from Asia and Faculty from Asia, Europe and USA. I covered the following subject: i) Organised the ACNS Course ii) How I do it - Cervical Disc replacement. iii) Chaired – Interactive Seminar on Management of AVMs D. 5th ACNS Course Chitwan, Nepal 10-12 February 2015. Audience: International Neurosurgical Trainees from Asia and Faculty from Asia, Europe and USA. I covered the following subject: Lecture: Surgical management of Trigeminal Neuralgia and Hemifacial spasm. E. 1st ACNS course, Tyumen (Siberia) Russia, 3-4 October 2013. Audience: International Neurosurgical Trainees from Asia and Faculty from Asia, Europe and USA. I covered the following subject: Lecture: Surgical Management of Cervical spine injuries. OTHER INTERNATIONAL TEACHING ENGAGEMENTS: I have mentioned only important lectures but this is not an exhaustive list. A. I was invited Guest speaker to 18th Annual Conference of Neuro - Spinal Surgeons Association of India with Nagpur Neuro Society. Nagpur, India, 28-30 September 2018. Audience: Neuro-spinal surgeons from India and International Faculty of spinal surgeons. I covered following subjects. i) Lecture: Cranio-cervical junction Injuries ii) Lecture: Management of C2 fractures iii) Interactive session (with other International Faculty) - Teaching for the residents B. I was invited as Guest Faculty to the Coventry Spine Masters (World Spine) - University Hospitals, Coventry, UK 2017. This was an International Lecture and Cadaver course Organised by World Spine. Audience: International Faculty of World Spine and International Trainees. I covered the following subject. i) Lecture: Occipito-Cervical Trauma. C. I was invited as Guest Faculty to the CME at the International Conference of Neurological Society of India, Mumbai, India 12-14 December 2013. Audience: Neurosurgical Trainees and Consultant Neurosurgeons from all over India. I covered the following subject. i) Lecture on ‘Simulation in Neurosurgery’ D. Invited as an External Examiner for Exit exam in Neurosurgery by Bir Hospital in Kathmandu, Nepal. 15-18 March 2013.


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E. I was invited as a Guest Speaker to the National Meeting on ‘Trauma in Serving Personnel’ organised by the Army Base Hospital in New Delhi, India, 20-22 November 2010. Audience: Consultants (Neurosurgery, Orthopaedic, Intensivists) and trainees in the Indian Armed Forces. I covered the following subjects: i) Lecture: Management of Cervical spine trauma: INTERNATIONAL SIMLATION COURSES ORGANISED AT UHCW: Over the years I have organised several Simulation Courses for trainees as different stages of their training. These courses are as follows: Courses in 2011: 1. First Basic Neurosurgery Skills (Cadaver) Course, held on 21-23 February 2011 at the West Midlands Surgical Training Centre, UHCW, Coventry (aimed for ST1-ST4 Neurosurgery Trainees). This is aimed at ST1-ST3 trainees but also attracts FY2 (interested in neurosurgery career) and ST4-ST5. This covers all the basic surgical approaches to Cranium (including burr hole for EVD, Trauma flap, Bifrontal craniotomy, Parasagittal craniotomy, occipital craniotomy and posterior fossa craniotomy. It also covers Cervical (anterior and posterior approaches) and posterior lumbar Spine approaches (laminectomy and micro-discectomy on Cadavers. Courses in 2012: 1. Second Basic Neurosurgery Skills (Cadaver) Course, held on 20-21 February 2012 at the West Midlands Surgical Training Centre, UHCW, Coventry (aimed for ST1-ST4 Neurosurgery Trainees). This is aimed at ST1-ST3 trainees but also attracts FY2 (interested in neurosurgery career) and ST4-ST5. 2. First Beginners in Neurosurgery – Hands on course (Non-cadaver simulation), held on 24-25 May 2012 at the Clinical Science Building, UHCW, Coventry aimed at FY2, ST1 and ST2 trainees (interested in pursuing a career in Neurosurgery). This course has simulation for all the equipment the trainees would be expected to use in Neurosurgery including High Speed Drills, Operating microscope, Neuro-navigation, Neuro-endoscopy, shunts, plating used in replacing bone flaps, spinal instrumentation in models, surgical instruments used in Neurosurgery and suturing skills. The trainees get a chance to actually simulate neuro-navigation and III ventriculostomy on plastic head models. 3. Advanced Microsurgical Approaches to Cervical Spine ‘Hands on' Cadaver Course held on 2-3 July 2012 at the West Midlands Surgical Training Centre, UHCW, Coventry (aimed for ST6-ST8 Neurosurgery Trainees). This Cadaver simulation course covers all the advanced approaches in cervical spine including C1-C2 approaches, anterior cervical screw fixation, cervical disc replacement, posterior instrumentation in cervical spine, occipito-cervical instrumentation in Cadavers. 4. Advanced Microsurgical Approaches to cranium ‘Hands on’ Cadaver Course held on 4-5 July 2012 at the West Midlands Surgical Training Centre, UHCW, Coventry (aimed for ST6-ST8 Neurosurgery Trainees). This is aimed at senior neurosurgery trainees (ST5-ST8). This course teaches advanced cranial approaches like Orbito-zygomatic, supraorbital, transcallosal, retro-sigmoid, far lateral approaches as well as cranio-cervical approach. Trainers from across the UK have taught on different cadaver courses. Courses in 2013 5. Third Basic Neurosurgery Skills ‘Hands on’ Cadaver course held on 19-20 January 2013 at the West


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Midlands Surgical Training Centre, UHCW, Coventry, UK (aimed for ST1- ST4 Neurosurgery Trainees). This had the same curriculum as the first similar course. 6. Second Beginners in Neurosurgery – ‘Hands on’ Non-cadaver simulation Course, held on 1-2 July 2013 at the Clinical Science Building, UHCW, Coventry UK (aimed at FY2, ST1 and ST2 trainees). This had the same curriculum as the first similar course. 7. Second ‘Hands on’ Cadaver course on Advanced approaches to Cervical Spine held on 5-6 July 2013 at the West Midlands Surgical Training Centre, UHCW, Coventry, UK (aimed at ST5-ST8 Neurosurgery and Orthopaedic Trainees). This had the same curriculum as the first similar course. 8. Second ‘Hands on’ Cadaver course on Advanced approaches to Cranium held on 7-8 July 2013 at the West Midlands Surgical Training Centre, UHCW, Coventry, UK (aimed at ST5-ST8 Neurosurgery and Orthopaedic Trainees). This had the same curriculum as the first similar course. Courses in 2014 9. Fourth Basic Neurosurgery Skills ‘Hands on’ Cadaver course held on 28-29 June 2014 at the West Midlands Surgical Training Centre, UHCW, Coventry, UK (aimed for ST1- ST4 Neurosurgery Trainees). This had the same approaches as the first similar course. 10. Third Beginners in Neurosurgery – ‘Hands on’ Non-cadaver simulation Course, held on 30 June - 1 July 2014 at the Clinical Science Building, UHCW, Coventry, UK (aimed at FY2, ST1 and ST2 trainees). This had the same curriculum as the first similar course. Courses in 2015 11. Cadaveric dissection course as part of the 7th ACNS course held on 16-19 May 2015 at the west Midlands Surgical Training Centre. The Cadaver part of the course covered advanced Cranial approaches as follows i) Orbito - Zygomatic ii) Trans-Sylvian iii) Dolenc iv) Retrosigmoid Approach v) Mesial Temporal vi) Supraorbital vii) Infratentorial Supracerebellar viii) Transcondylar and Juglar foramen Courses in 2016 11. Fifth Basic Neurosurgery Skills ‘Hands on’ Cadaver course held on 16-18 April 2016 at the West Midlands Surgical Training Centre, UHCW, Coventry, UK (aimed for ST1- ST4 Neurosurgery Trainees). This had the same approaches as the first similar course but I added the simulation in positioning to the cadaveric dissection. RESEARCH EXPERIENCE Research experience in India: I obtained good research experience in general surgery during my term at LNJP Hospital and later in neurosurgery at G.B.Pant hospital. I submitted a thesis entitled "Cytological and Histological Changes Due to Urinary Calculi" to the University of Delhi, Delhi in March/April 1980 before the MS examination. I also submitted a Dissertation entitled "Intracranial Aneurysms, A Five Year Study" to the University of Delhi, Delhi in May 1987 as a prerequisite for the MCh in Neurosurgery. Research experience in UK: My research in UK involved a phase I/II clinical trial of Photodynamic therapy for recurrent pituitary adenomas that had recurred despite previous surgery and radiotherapy. It was based on the principle of selective uptake of photosensitiser substance by tumour tissue, its activation by light of appropriate wavelength, and selective destruction of tumour due to formation of singlet oxygen.


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This involved injecting a photosensitiser substance Photofrin II to the patients, selected for the trial, 24-48 hours prior to surgery. Pituitary tumour was removed through the trans-sphenoidal approach and the tumour bed was exposed to light of appropriate wavelength (diode laser with a wavelength of 630 nm). The patients were followed up at regular intervals for clinical examination along with endocrine as well as radiological assessment through MRI scans. Early results are encouraging. I was involved in giving the drug, in taking samples for analysis of photofrin levels, in the operation and helped the department of Medical physics in light delivery to the tumour bed. I followed the patients, as well as compiled and analysed the data. We sent a paper entitled "Phototdynamic Therapy for recurrent pituitary adenomas Clinical Phase I/II Trial" for publication to the British Journal of Neurosurgery. It has been accepted for publication in May 2000. Two other papers from the same study are also being sent to two other journals. Based on the results of this trial, a double blind study in under way, which involves comparing the effect of surgery alone Vs surgery and PDT in patients with recurrent pituitary adenomas. This might pave the way for development of PDT as a new modality of adjuvant therapy for such tumours replacing radiotherapy. PUBLICATIONS CHAPTERS PUBLISHED: 1. Amar Saxena: Management of Cervico-Medullary (Cranio-vertebral) junction Injuries. ‘Progress in Spinal Surgery’ 2018 published by Neuro Spinal Surgeons Association as part of the Spine 2018 Congress in September 2018 in Nagpur, India.

2. Ronan Dardis, Amar Saxena et al: Techniques of Cervical and Lumbar Arthroplasty'. Book chapter in Schmidek and Sweet: ‘Operative Neurosurgical Techniques 2-Volume Set, 6th Edition - Indications, Methods and Results’. Publishers also released a DVD on operative technique for Cervical disc replacement prepared by me.

3. Amar Saxena: The Epidemiology of aneurysmal Subarachnoid Haemmorhage. Book chapter Neurovascular EANS course published by EANS (European Association of Neurological Societies) September 2013. 4. Amar Saxena 'Simulation in Neurosurgery' in book 'Progress in Neurosciences' December 2013 published by Thieme Publications for Neurological Society of India. PAPERS/ARTICLES PUBLISHED: The following papers have been published 1. Research Article: A Saxena. ‘Cranio-Cervical Trauma: Epidemiology, Classification, Diagnosis And Management’ J Spine Neurosurg. October 2017, Volume 6, Issue 5, 1-15. 2. William Lo, Sanjoy Nagaraja, Amar Saxena. 'Delayed hemorrhage from an iatrogenic vertebral artery injury during anterior cervical discectomy and successful endovascular treatment - Report of a rare case and literature review’. World Neurosurgery, Volume 99, March 2017, 811.e11-811.e18. 3. Kuriakose Joshi George, Adam Rennie, Amar Saxena: Multiple cerebral aneurysms secondary to Cardiac myxoma. Birtish Journal of Neurosurgery, Volume 26, 2012, Issue – 3 4. Stuart Roberts, Digant J Kamdar, Hiten Mehta, Amar Saxena: Post-radiotherapy radionecrosis of the temporal bone resulting in delayed CSF otorrhoea: A case report Br J of Neurosurgery 27(1), August 2012 5. Dhamija B, Saxena A: Pneumocephalus- a cause of post spinal surgery confusion. J R Soc Med. 2011 Feb;104(2):81-83.


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6. P V Marks, P Belchetz, A Saxena, U Igbaseikumoku, S Thomson, M Nelson, M Stringer, J A Holroyd and S B Brown. Effect of photodynamic therapy on recurrent pituitary adenomas: clinical phase I/II trial –an early report, Br J Neurosurg (2000) 14(4): 317-325. 7. J Timothy, D Lafuente, A Chakrabarty, A Saxena and P V Marks. Meningioma recurrence at a different site masqerading as a subdural haematoma. J Neurosurgery (1999) 8. R Anthony, A Saxena, J Timothy and N I Phillips. Primary sphenoid sinus carcinoma presenting with blindness. Case report. Australian J of Otolaryngology (1999). 9. D J Price, A Saxena, and M Czonyka : The relationship of Vasogenic waves to ICP and Cerebral Perfusion Pressure in Head Injured Patients. Acta Neurochir (1998) [Suppl] 71: 297-299 10. A Saxena and B Prakash: Intracranial Aneurysms in India. Microsurgical approach. Acta Neurochir (1989) 101:18 - 22. 11. A Saxena, G. Tyagi and B. Prakash. Metastatic Cystic Adenocarcinoma of cerebellum (Short Communication) Neurology India (1989) 37, 388. 12. A Saxena, G. Tyagi and B Prakash. Temporal Lobe Glioma presenting as Catatonia (Short Communication) Neurology India (1989) 37, 185 - 192. EXTRACURRICULAR ACTIVITIES: My special interests are music, badminton, tennis and cricket. I was a lead singer in a choir group in Delhi and performed on national television and on stage. I compered programmes on the national television in Delhi in 1981. I play music on the keyboard. I play badminton and Tennis and love watching cricket and tennis. MEMBERSHIP OF LEARNED SOCIETIES Full Registration with the General Medical Council, UK (on GMC Specialist Register) Full Member of the Society of British Neurosurgeons Member of the British Medical association Fellow of the Royal College of Surgeons (England)

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