Otolaryngology

Elucidating the neurophysiology of vestibular migraine

Vestibular migraine (VM) is a common cause of episodic vertigo with prevalence of 2.7% in the adult population. It commonly affects females in their 30s and 40s, impairing their function both at work and at home. To-date the neurophysiology basis of VM remains unknown, detrimentally impacting upon the diagnosis and management of patients.

Recent work from our laboratory illustrates that VM patients have spatial disorientation, altered cortical interactions between visual and vestibular networks, and impaired executive control in the attentional network. These findings yield considerable promise to act as novel objective biomarkers and aid diagnostic certainty and monitoring of treatment.

This latter point is of critical importance, as there is no evidence based approach for the treatment of VM, although patients are routinely prescribed various prophylactic therapies such as propranolol, venlafaxine, flunarizine, and valproic acid.

The selected academic clinical fellow will initially refine and identify the most promising biomarker, which will form the foundations towards a fellowship/grant application to conduct a randomised control clinical trial to inform best practice with respect to the management of VM. This work will be conducted at the new Leicester Interdisciplinary Neuro-otology Centre (LINC) based at the University of Leicester and the Leicester Balance Centre within LRI.

Determining the clinically relevant anatomy to teach UG medical students

Human anatomy has been a core component of undergraduate medical education for many years, and while it continues to be a key theme, the depth of anatomy taught has seen a steady decline. The need for a solid foundation of anatomical knowledge, while more readily appreciated as essential for those pursuing surgical careers, is important for any practicing clinician. Clearly, which areas of anatomy are most relevant will vary depending on the postgraduate speciality. With ever increasing pressures on space within the UG curriculum, there is obvious priority to ensuring what is taught best enables students to meet the demands of the breadth of future clinical practice.

While the GMC do not currently stipulate specific outcomes for the level of anatomy within the UG medical curriculum, the future introduction of the UK Medical Licensing Assessment will likely lead to efforts to better establish ILOs for the basic sciences, as a whole. In 2016, in response to the lack of consensus and guidance on the appropriate level of anatomy, the Anatomical Society defined a core regional anatomy syllabus of 156 ILOs, which were to help curriculum planners determine the clinically relevant anatomy to teach UG medical students. The proposed ILOs were determined by a Delphi panel of experts, which included surgeons, radiologists and anatomists.

The first step of the project will involve a series of focus groups and surveys with a variety of early clinical trainees from medicine, surgery and primary care. The purpose of this will be to identify whether there are elements of the 156 identified ILOs that represent a base of anatomical knowledge common across a breadth of specialities (surgical and non-surgical). The second step will be to explore how well they perceive (by self-report) to have retained knowledge of those areas of anatomy (identified in the first step of the project).

The findings from this project will help to better define areas of anatomy that are seen as most important, relevant and common to a breadth of clinical specialities. Further work/projects could explore how this anatomy could be prioritised or given greater attention within the UG medical curriculum, or early postgraduate period and whether there are any interventions that can be applied to improve retention of knowledge in those areas.

Education

If you are interested in progressing an educational research project within the speciality please contact Professor Bob Norman who is based in the Leicester Medical School.