Despite this service need and the desire from some trainees to dual train in child & adolescent and forensic psychiatry, training opportunities have become extremely limited over the past 2 years. There are a number of reasons for this, the greatest being the introduction of Modernising Medical Careers (MMC). Although there continues to be the scope to provide dual training under the MMC framework, it is unclear how this will be facilitated. Access to dual training will continue to be at the deanery level but it seems likely that it will be increasingly linked to service provision. The lead-time of 5 years for higher dual training means that trusts and deaneries will require long-term vision. Alongside these changes, the College is continuing to consider how best to accommodate the increasing specialisation within psychiatry training. Options include increasing the number specific curricula (either via more CCTs or more sub-speciality endorsements) and it is possible that adolescent forensic psychiatry may become an individual speciality in the future. The move to competency-based training may facilitate this development, as it is likely to become easier for doctors to demonstrate achieved competencies across psychiatric specialties.

• Please see the AFPSIG Position Paper on Dual Training for more information

It is at present unclear to what extent dual training opportunities will exist within the new structure of MMC. Indeed, it appears that there are very few specific dual training schemes being offered at ST4 level at present, and none to my knowledge in child & adolescent and forensic psychiatry. It has been suggested that training in a second psychiatric specialty may occur after the first CCT has been achieved and I am aware of one trainee with a CCT in child and adolescent psychiatry who has been appointed on a forensic psychiatry training scheme at ST4 level. It is unclear at present whether this will be the solution to the lack of specific dual training schemes, and raises a number of issues, most crucially surrounding the funding of additional post-CCT training. Deaneries would have fulfilled their responsibility to provide training to CCT and may be reluctant to fund training beyond this. An alternative solution is that special interest sessions could be used to obtain competencies in a specialty other than that in which the trainee will obtain their CCT. This would require careful planning and cooperation between trusts and training programme directors and it is unlikely to be a sufficient alternative to full dual training.

It is clear that the combination of child & adolescent and forensic psychiatry remains crucial to the provision of adolescent forensic services and appropriate training must therefore exist to ensure that there are specialists in this area. However, traditional dual training appears to be under threat and adaptations need to be made to the new structure of postgraduate training to allow trainees to develop the necessary competencies across specialties. The rhetoric surrounding MMC promised greater flexibility of training and it is of paramount importance that this is developed in order for trainees to achieve the broad and diverse range of competencies that are required by these developing services. This will allow us to meet the needs of our patients and deliver the best possible care.

For more information please see the following article published in the Psychiatric Bulletin:

Oakley C, White OG & Bailey S (2009). Dual Training in Psychiatry: Which way now? Psychiatric Bulletin 33: 231-234.