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

Higher training


 

Background to higher training

During this part of training, three 12 month posts are generally undertaken. These posts will reflect the specialty chosen by the trainee, but will also offer the chance to incorporate experience in other specialties or to gain experience in specific areas. In addition, two or more sessions can be negotiated for the trainee to spend either as a "special interest" in a particular service or to work on a research project. Given that this part of training is relatively short (and passes very quickly!) these sessions are an excellent opportunity to broaden skills and knowledge. One of the most enjoyable parts of this level of psychiatric training is the flexibility allowed by these special interest/research sessions - an opportunity not always allowed in higher training schemes in other medical specialties.

The aim of this latter higher stage of training is to prepare the trainee for consultant level practice. This means that higher trainees are expected to participate in other activities such as medical education, supervision and appraisal of junior doctors, clinical governance, committee representation and service development. Trainees are also given gradually more autonomy in the management and treatment of patients, but educational supervision remains an important part of development and should continue on a weekly basis. It is common for the trainee at this level to act as second on call out of hours, which brings with it new responsibilities in line with the consultant role.

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Personal perspective one

Mark TarnI felt professionally stale after ten years in general practice. Paradoxically, the patients I found least satisfying to treat were those with mental illnesses, despite having had a strong interest in psychiatry at medical school. Slowly, it began to dawn on me, it wasn’t the patients but the system I was expected to treat them in that was bothering me, and there was simply not enough time. Also, I missed the academic side of medicine and working in medical teams; it’s possible as a GP to spend a day at work, have 40 consultations and go home having not spoken to another practice member.

I made the jump into psychiatry at 36 and was surprised to discover that many other senior house officers (SHOs) had come late to psychiatry and had a depth of clinical experience that enhanced their psychiatric skills. I finished my core training and moved to London to undertake higher training. My first year was spent as an specialist registrar (SpR) in liaison psychiatry at a large teaching hospital and it was fascinating to see similar patients I had treated in primary care, now managed with a better understanding of the psychological overlay to their presenting complaints.

I have now moved on to forensic psychiatry, which brings its own challenges. The mentally ill are stigmatised, whereas mentally disordered offenders are positively vilified in the public domain. Forensic psychiatry tests you in many ways, but lends itself to achieve some remarkable successes. I’m glad I changed and it really is never too late.


Mark Tarn

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Personal perspective two

I am a higher trainee in child and adolescent psychiatry based in Edinburgh. To be honest, what inspired me to psychiatry was pure curiosity and shameless glamour, after watching re-runs of “Frasier” on television! Actually what was beneath all that, I suppose, was the fascination to understand the mind and to discover what makes us who we are. Mental illness is highly misunderstood in society and this is, in my opinion, the main reason for the ugly stigma attached to it. As I began my psychiatric training I became increasingly aware of this unfair situation and I became more resolved to fighti for this cause. 

After enjoying my core training in various specialties, I chose to work with children, young people and their families as I found it immensely satisfying to be able to make a difference through early intervention by using psychological and, where appropriate, pharmacological treatments informed by developmental, biological and social issues. Every family is unique and treatments need to be tailored and sensitive to the young person’s needs. In my work, I frequently liaise with other agencies like schools, social work, and criminal justice services to develop the most holistic management plan for the young person and their families. Child and adolescent psychiatry is an evolving specialty and these are exciting times for research. Currently my research interest is in adolescent sexual offending. 

Waleed Ahmed

 

Personal perspective three

I came straight into psychiatry as quickly as I could after leaving medical school. At medical school, psychiatry seemed to be one of the few specialties where you really got to know and understand your patients. I also liked the mix of medicine, neurology, psychology and philosophy. I’ve now been training in psychiatry for four years and I am a year four specialty trainee (ST4) trainee in general adult psychiatry in Glasgow. I chose general adult as it is such a diverse specialty and I see a huge spectrum of mental health problems. I use skills that I have learnt from previous jobs in psychotherapy, addictions, child and adolescent psychiatry, old age psychiatry and forensic psychiatry. Every day really is different.

My current job is with the intensive home treatment team, assessing and treating patients in their home during an episode of illness. It is a really rewarding and fascinating job and the patients really appreciate being treated at home rather than coming into hospital. There are also plenty of opportunities in psychiatry to get involved in research and teaching and to develop any specialist interest you may have. I spend a day a week with a specialist team that treats patients who have developed a psychotic episode for the first time. My job is really varied and exciting and I couldn’t ever imagine doing anything else. 

Neil Masson

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Personal perspective four

Choosing psychiatry has never been more exciting than now! If you are able to thrive in situations of uncertainty, and like working with and taking the lead within teams, then this is the job for you! Having the time to really get to know your patients and looking at a patient in a truly holistic manner is one of the privileges of this specialty.
 
With regards to adult psychiatry, there have been several different developments taking place recently that offer the young consultant many different career pathways. As an adult psychiatrist, you will be able to decide if you want to be a community or inpatient consultant. The specialty has specialist teams working within emergency psychiatric care and early intervention services that are mainly based within a community setting. Adult psychiatry also has different subspecialties to choose from, including eating disorders, perinatal psychiatry, liaison psychiatry, neuropsychiatry, rehabilitation services and substance misuse services. There are also many management and leadership opportunities with adequate supervision. 
 
Psychiatry is a flexible specialty and has led the way for part-time trainees. It has good academic programmes and has also led the way in allowing adequate time for supervision. As a specialty, we have been well placed to meet the demands of recent changes to medical education and there are ample opportunities for research.
 
Working with this age group (16 - 65) gives you, the clinician, the chance to make a real difference by returning a productive member of society to work, returning a student to study or a mother to her family. Adult psychiatry is a challenging and rewarding choice with a good quality of life and anyone who chooses this dynamic specialty will have a bright future ahead of them.

Jon Van Niekerk
 
 

Personal perspective five

Ollie WhiteWhen I entered medical school I was primarily interested in general practice as the continuity of seeing patients over many months and years combined with the community aspect of the work really appealed. This interest continued as an undergraduate when I also became struck by how prominent various psychological difficulties were in patients’ presentation.
 
I really enjoyed my medical student placement in psychiatry and I soon realised that the specialty fulfilled many of my earlier aspirations. I find it interesting to care for relatively young patients (severe mental illnesses often start in early adulthood) and I like the fact that there is sufficient time to fully assess and understand each patient in order to explore and address many different aspects of their lives. I enjoy the significance placed on communication skills to elicit the history from the patient and their family rather than reliance on diagnostic tests, the importance of the patient-doctor relationship and the frequent liaison with other professionals. 

I have been training in psychiatry for almost six years, including spending some time working in Australia. I am specialising in child and adolescent forensic psychiatry, an uncommon combination that requires five years as a higher trainee. 

During my training I have also become involved with various training committees and I represent trainees at many Royal College and government meetings. This is an interesting contrast to my clinical training and is an example of one of many opportunities that is available.

A career in psychiatry will not be for everyone. However, for me, it is a fascinating specialty that treats patients with complex illness via a truly holistic approach.


Ollie White

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Personal perspective six

As a higher trainee in general adult psychiatry, I am exposed to a wide range of experiences in my working week. Many people feel that psychiatry is too removed from ‘real medicine’, but it isn’t. My current job is in liaison psychiatry which allows me to practice psychiatry in general hospital settings, so I have to keep my medical knowledge up-to-date and work closely with other medical professions, which is really exciting.

There are lots of opportunities to gain experience that is not clinical. Higher trainees are encouraged to become involved in teaching, both at undergraduate and postgraduate level and I am doing both this year. If you are interested in publishing, psychiatry is a great place to do so. The Psychiatric Bulletin published by the Royal College publishes a lot of articles written by trainees. Consultants are very supportive as well.

We have one day a week as a personal development day so that we can develop skills that will be helpful in our consultant careers. Some people use this to do a Masters degree or gain other postgraduate degrees. I am using mine to gain some experience in forensic psychiatry and go on prison visits once a week.

Higher training is a chance to develop the skills I will need as a consultant psychiatrist and it keeps me very busy. It is also interesting, exciting and fun. I highly recommend it!

Floriana Coccia

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Personal perspective seven

Like most doctors, the only psychiatric experience I had was an eight week placement in my fourth year of medical school. I have to say, I quite enjoyed it, but never thought of it as a career choice. It was only when I was fortunate enough to do psychiatry as my first post on a GPVTS rotation that I quite literally found my calling. It feels as if psychiatry chose me! I absolutely loved it, so much so that I ended up resigning from the GPVTS rotation, and then applied for a psychiatry rotational scheme. I have never looked back and am more than happy with my career path.

 

Psychiatry has given me the opportunity to work in a true multidisciplinary environment where I am faced with complex and unique problems. I have job satisfaction in playing a part in patients’ recovery and the depth of the relationship you build up with the patient. This is furthered by the wide range of clinical presentations and emerging treatments. I also have a sense of achievement that I have impacted on patients’ lives in an area which is usually neglected.

 

Psychiatry, as part of its training, offers you the opportunity to undertake research and also develop “special interests” in areas of psychiatry that you wish to broaden your knowledge in – I don’t know any other speciality that does this. I have had the opportunity to go to schools and speak to sixth-form students about psychiatry and also about trying to de-stigmatise mental illness. 

 

Above all psychiatry is a rewarding career that I feel I make a difference in – this may not be a big sweeping difference, but even small differences can have a great impact on patients’ lives.

 

Khadijah Hussain

ST4 in general adult psychiatry, London

 

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