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The Royal College of Psychiatrists Improving the lives of people with mental illness

Core training


Background to core training

The first years of training in psychiatry are spent in a wide variety of posts to ensure a robust and strong foundation from which to build your chosen specialist skills. Each post during this core training lasts for four or six months and trainees must obtain at least 12 months of experience in general psychiatry. They can also undertake posts in any of the other specialties of psychiatry.

During core training, universal and necessary skills are developed in, for example, assessment after deliberate self-harm and assessment of suicide risk. Trainees will have an identified educational supervisor (usually the consultant for the team in which they work) who will be responsible for supervising clinical activity and providing an hour of weekly one-to-one educational supervision.

Assuming satisfactory progress through formal exams and workplace-based assessments, this period of training lasts for three years.  Once a trainee has passed the three written exams and one clinical exam which make up the Membership exams of the Royal College of Psychiatrists they can become a full Member of the College and have earned the right to add MRCPsych after their name.  They are then able to progress to higher training in one of the six specialties: General Psychiatry, Child and Adolescent Psychiatry, Medical Psychotherapy, Learning Disability, Old Age Psychiatry or Forensic Psychiatry.

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Personal perspective one

Ever since I can remember at medical school I wanted to be a psychiatrist. I feel quite lucky in that way and I know it’s not the same for everyone but now I am actually here and doing it, I want to urge everyone to do the same. I doubt there are many other specialties that are as varied or interesting (but I know I’m biased!)

At the moment I work as a specialty trainee year 2 (ST2) in liaison psychiatry at Frimley Park Hospital in Surrey. It’s a pretty busy district general hospital with a military wing (so plenty of strapping young men in uniform, always a bonus). A typical day involves me heading straight to our team office, where I normally have a coffee with my specialist registrar (SpR) and our liaison nurse, and we sort out which patients need reviewing on the wards and whether there are any new referrals. Referrals come in from all over the hospital, for any patients in whom the treating teams suspect a psychiatric disorder. We also cover acute psychiatric presentations during the day that present to Accident and Emergency (A&E).

I normally have a couple of patients coming to see me in clinic – today I’m going to see a lady with breast cancer and cerebral metastases who has become agitated and difficult to manage at home. It’s a tricky one, but my consultant is running a parallel clinic so we see her together afterwards, and make a management plan together.

There are also two patients on the ward that need urgent review – a middle-aged lady who has taken an overdose who is trying to leave the ward, and a teenage girl who has presented with an acute change in behaviour and either has delirium or an acute psychotic illness. I go and see these two patients together with my SpR.

Later I head off to A&E as there is an acutely psychotic patient there who has been brought to A&E by the police. She ends up needing a Mental Health Act assessment so there’s lots of ringing around sorting that out. Eventually she is detained under Section 2 and we find her a bed on our local in-patient unit.

I come back to the office for an hour’s supervision with my consultant where we do a case-based discussion on the lady I saw in clinic. I then head home at 5pm, hoping to get a little revision done for my upcoming exams and plan for a meeting the next day where, as Trust rep, I need to present the results of a recent accommodation inspection.

I think the thing I love the most about liaison psychiatry is the variety of psychiatric presentations that you see; there are often patients who have psychiatric symptoms as the result of, or complicating, a physical condition. I would encourage anyone who is interested in psychiatry and who enjoys clinical medicine to consider liaison psychiatry, or old age psychiatry, as both specialties require extensive use of medical knowledge and experience.


Josie Jenkinson

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Personal perspective two

I am currently a year two specialty trainee in psychiatry on the Leeds and Wakefield rotation in the Yorkshire School of Psychiatry.

My interest in this specialty started in my third year of medical school and was reinforced by the special study modules, elective and clinical placement in psychiatry during my undergraduate years. I was privileged to have been given the opportunity to see how psychiatry is practised abroad in Montreal (Canada) and Rennes (France) at such an early stage in my undergraduate training placements.

Many of my peers were surprised to learn I had chosen psychiatry as a specialty as they felt it was far removed from the realms of core specialities that we were taught in medical school. I, on the other hand, felt psychiatry is the specialty which touches all aspects of medicine and surgery on a daily basis.

I was successful in being selected on to the senior house officer (SHO) rotation immediately following my pre-registration house officer (PRHO) year. I recall finishing my night on call in the medical assessment unit prior to completing my PRHO year, when I felt very excited about the thought of embarking on the career I had looked forward to since medical school. I started my SHO rotation with a general adult psychiatry placement. Despite eagerly awaiting this moment, my first on-call in the acute inpatient unit was a daunting experience for me. I remember various thoughts going through my mind: ‘What am I going to do,’ ‘Who am I going to call,’ ‘Where am I supposed to go,’ ‘I hope A&E do not bleep me tonight’. Fortunately, as time progressed, I realised how psychiatry is one of the friendliest specialities and how helpful and tolerant colleagues, ward staff, switchboard and library staff are. Since day one I felt supported by my consultant and the rest of the multi-disciplinary team.

Having completed my first two years of my SHO rotation, I obtained a place on the new modernising medical careers ‘run through’ specialty training programme in the Yorkshire Deanery. I have enjoyed the past few years as an SHO/ST with varied placements in all the base hospitals in Leeds and Wakefield. This has enabled me to work and learn in the various sub-specialties and given me the opportunity to work under the expertise of different consultants. I feel Psychiatry has enabled me to develop my management and organisational skills through liaising with other agencies, while working in inpatient, community, and on call environments

During all my placements I have pursued my interest and enthusiasm for the psychological therapies. I have participated in the balint and experiential groups, together with completing a supervised cognitive behavioural therapy and psychodynamic long case. This experience has been invaluable and has helped expand my ability to think psychotherapeutically in managing my patients.

I particularly enjoyed my posting in child and adolescent mental health service as I was able to participate in the various modalities of therapy (art, family and drama) together with using a biological role in the management of young people with mental illnesses.

The rotation has also incorporated an MSc programme in Psychiatry at the University of Leeds, studying for this has helped immensely in my success at the MRCPsych examination.

I have a passion for teaching and learning. In addition to my clinical training, I was appointed to the post of SHO tutor for University of Leeds. This role has involved teaching medical students on their psychiatry placements. I hope I am successful in igniting a passion in psychiatry in these students sufficient for them to consider pursuing a career in this great specialty.

Vikram Luthra, ST3, Leeds

 

Personal perspective three

I am just completing the fourth year of my senior house officer (SHO) training in the Yorkshire scheme. In general, however, SHO training (or core training) lasts approximately three years, made up of six month training posts, before progression to the specialist registrar (SpR) or higher training scheme.

When I first came into psychiatry,, I was surprised and somewhat dazzled at the sheer range of different subspecialities available. However, compulsory training requires a trainee to complete two general adult, one old age, and one learning disability or child and adolescent psychiatry posts. Once these are completed, a trainee is then encouraged to select particular specialities of their choice to work in. Options include addiction services, eating disorders, psychotherapy, forensics, crisis and liaison work.

This rotation through a wide number of different specialities has given breadth and depth to my knowledge and experience as well as the confidence to be able to choose my future career path. Particular highlights include my old age and liaison placements as, for me, the most rewarding part of working in psychiatry are the relationships that are built up with patients, their families and professionals from other disciplines. Day to day work, in addition to on call work, has provided me with the opportunity and skills to work in a wide variety of different environments, including busy acute mental health units, day hospitals, outpatient clinics, emergency department referrals and medical wards.

In addition to the everyday clinical work, I have been able to gain experience in cognitive behavioural therapy and psychodynamic psychotherapy. I have received support and supervision for a number of cases including phobia, depression and gender identity. Further educational opportunities include a twice weekly educational meeting, where a trainee is expected to participate in regular audit, journal clubs and case conferences.

In my locality all trainees take part in the masters programme at the university. One day a week is allocated to lectures, group work and eventually research. Teaching is given on psychiatric topics, communication skills and critical appraisal. It is an interesting course and also provides an opportunity to get to know other trainees from around the region. Currently, I have completed my diploma and have started putting together a research protocol looking at alcohol dependence in the elderly.

I have also been given opportunities to improve my teaching skills. As one of two SHO tutors, I spent one year teaching first and fourth year medical students from the University. This gave me the chance to teach in both small groups and formal lectures. It is a really positive and challenging experience, which has consolidated my knowledge and awakened an enthusiasm for teaching which I hope to continue in the future.

As my training progressed, my home situation changed and I had my daughter. The scheme provided the flexibility and support to enable a balance to be made between home and work life. For the last nine months I have been able to work three days a week in a job share and it has been great to be able to continue my training whilst seeing more of my daughter.

I have very much enjoyed my SHO training. Working in psychiatry has provided clinical experiences which have been varied, challenging and, at times, eye opening. Throughout my four years, I have always received a good level of support and supervision from my seniors, and my training to date has given me the confidence and skills to be able to progress into higher training. I am now looking forward to the next stage of my career as an ST4 in old age psychiatry!

Amanda Taffinder

 

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Personal perspective four

Like many of you reading this, I decided to study medicine as I wanted to make a difference to the lives of my patients. When I was at school, I had little idea of what a doctor actually does so I elected to do work experience in a hospital. I was placed in an old age psychiatry ward and was immediately struck by the vast difference that could be made to the quality of life for patients who were confused. I was also amazed to see these patients improve! I then got further experience with younger adults and found that an equal, if not greater, difference could be made. Now, as a junior psychiatrist, I am constantly challenged to assist my patients in making a difference. If you want an inspiring, stimulating and challenging career, then maybe you can make a difference as a psychiatrist too!

Core training in psychiatry involves rotating around various specialties thus I’m not sure there is ever a typical day. I currently have a growing caseload of adolescents. I manage young people with the whole range of psychiatric disorders from depression to psychosis and a range of developmental disorders. They come from varied social circumstances and this provides particular challenges. I liaise with GPs, paediatricians, our nursing team, social workers, teachers, families, the courts and adult psychiatry to name a few.  I also have legal skills in detaining patients under the relevant legislation. With this variety, no day is boring.

I am frequently told that a psychiatrist is ‘not a proper doctor’, but I have diagnosed encephalitis, hypothyroidism and fractures in my out-patients and often assist in managing chronic medical conditions in my in-patients. Currently, managing young people with eating disorders demands a high level of medical skill. Coupled with this, I see my patients getting better and do very rewarding work with the wider family. At present, I am involved in a major research project examining depression, genetics, brain imaging and treatment with ECT (electro-convulsive therapy).

All in all, could I have a better, more varied and exciting job?

Daniel Bennett

 

 

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