This Element describes the challenges faced by a trainee on-call for neurosurgery and how to prepare for the role.

On-call neurosurgery concerns practice related to urgent and emergency neurosurgical care including outside of 'normal' working hours. Being on-call involves many competing responsibilities and is regarded as one of the most demanding aspects of a neurosurgical career. The on-call work pattern has evolved over the past decade due to changes in demographics, technology and working practices, each of which have brought new and emerging challenges. These challenges aside, the on-call provides a unique and rewarding environment to make a meaningful difference to patients and to learn the science and art of neurosurgery. Success in on-call work requires not only good technical knowledge and application but also a wide variety of non-technical skills. These skills will help deal with some of the difficult situations neurosurgeons in training face when on-call to make the experience more manageable and educational.