Assessing the landscape and charting paths: UK neurology trainees' opinions on neuroinflammation subspecialty.

Therapeutics of neuroinflammatory disorders including multiple sclerosis is one of the fastest growing areas in neurology. However, pressures on higher specialty training in neurology together with an expanding curriculum have led to challenges in adequately preparing trainees for a subspecialist career. In this study we set out to understand current perceptions and barriers to training in neuroinflammatory disorders among neurology trainees in the UK. A structured questionnaire was used to assess trainees' perspectives on training opportunities and career aspirations. Findings reveal significant gaps in training, including insufficient training opportunities, lack of mentorship, and concerns about managing complex treatment regimes. We used these findings to develop structured action points with aim of improving training and retention in this subspecialty. These include early exposure to subspecialty experiences, enhanced mentorship, and equal access to training opportunities regardless of geographical location. Our findings underscore the need for further curriculum development in neurology training, potentially combining early support with dedicated fellowships later in training, in order to ensure sustainability of neuroinflammation as a subspecialty and to meet the growing demand for expertise in MS and related conditions.
Competing Interests: Declaration of competing interest TA has received honoraria or consulting fees for participating in advisory boards related to trial steering committees and data and safety monitoring committees, speaker fees & research grants from Janssen, Merck, Novartis, Roche and Sanofi-Genzyme NR has received honoraria and/or support to attend educational meetings from: Biogen, Novartis, Sanofi, TG therapeutics, Genzyme and Bayer. His institution has also received support for research from Biogen, Genzyme, Sanofi and Novartis. KS has received honoraria/support from Biogen, Merck KGaA, and Novartis, Roche and Sanofi-Genzyme, speaking honoraria from, and/or served in an advisory role for, Biogen, EMD Serono, IGES UK, Merck KGaA, Novartis, Roche, and Sanofi-Genzyme and Teva; and remuneration for teaching activities from AcadeMe and Medscape. RD received honoraria for speaking and/or traveling from Biogen, Merck, Roche, Teva, Janssen, and Sanofi. She served on advisory board of Roche, Biogen, Janssen, Sandoz and Merck. All honoraria for speaking, travelling and advisory boards were paid into an institutional account and used to support research, open access publications, and training for group members. She has received grant support from Biogen, Merck, Celgene. SH has received unrestricted educational grants or speaking honoraria from Biogen, Merck Serono, Novartis, Roche and Sanofi Genzyme. In the last 3 years, JC has received support from the Health Technology Assessment (HTA) Programme (National Institute for Health Research, NIHR), the UK MS Society, the US National MS Society and the Rosetrees Trust. He is supported in part by the NIHR University College London Hospitals (UCLH) Biomedical Research Centre, London, UK. He has been a local principal investigator for a trial in MS funded by MS Canada. A local principal investigator for commercial trials funded by: Ionis and Roche; and has taken part in advisory boards/consultancy for Biogen, Janssen, Lucid, Merck, NervGen, Novartis and Roche. ET reports honoraria and support to attend educational meetings from Merck and Novartis, support to attend educational meetings from Biogen, and salary as a UK MS Register fellow from Biogen outside the submitted work KM reports honoraria for advisory boards/educational activities from Biogen, Roche, Merck, Teva, Novartis, Sanofi. ORP has received honoraria for advisory boards and/or educational activities from Biogen, Teva, Sanofi, Merck, Janssen, Novartis, and Roche HLF has received support from the Health Technology Assessment Programme (NIHR) and the UK MS Society. In the past 3 years, HLF has been a local principal investigator for trials in MS funded by Novartis, Roche and Biogen Idec and has taken part in advisory boards and consultancy for Merck, Teva, Biogen, and Novartis ADS received honoraria or consulting fees for participating in advisory boards and speaker fees from, Merck, Novartis, Roche NMD received honoraria or consulting fees for participating in advisory boards, speaker fees & educational support from Merck, Novartis, Roche, Biogen, Moderna and Sanofi-Genzyme
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