Psychiatry as a Career : Information for Medical Students
I particularly like visiting patients at home, and the
interactions with them and their carers can be
fun. I enjoy the mix of psychiatry and medicine
(and lots of other disciplines such as social
worker, driving instructor, lawyer, etc.) involved in my
job. The people in the team I work with are great,
and I get good support from my boss. I also get a
lot of freedom to do research (in bipolar
disorder) and special interest sessions (in brain
injury). Trainees in psychiatry have a lot of input into
our College, training schemes, etc...more than in
most other medical specialties.
Dr Rory O.Shea, SpR in
I missed out on psychiatry as a
medical student because I was on my honeymoon. It wasn't compulsory
and I wasn't examined on it. I began to realise what I had missed
when I started my general practice training, and after 3 years as a
GP I decided to apply for psychiatry training with a view to
returning to general practice later. My first consultant told me
that I had the common sense that was needed in psychiatry. To be
honest, I hadn't expected to enjoy it quite so much!
A career in psychiatry allows you to
get to know your patients and their families and to feel that you
can really make a difference to their lives as a member of their
healthcare team. The settings in which we practice are varied, and
perhaps because my roots were in general practice, I feel
especially at home in the community.
Some people think psychiatry is an
easy option. It isn't. I think it is one of the most challenging
careers in medicine. It is also intellectually stimulating and
personally satisfying. Many people choose a career in psychiatry
because they have experience of mental illness themselves, or in
their own family, or perhaps a family member has a learning
disability, and that's fine; personal experience increases one's
empathy for others, and this is an essential attribute for all
psychiatrists. My son has a learning disability and that's why I
specialised in psychiatry of learning disability having initially
trained in child and adolescent psychiatry and psychotherapy.
If psychiatry appeals to you, give
it a try. Ask some psychiatrists to talk to you about their
careers. Doctors who choose psychiatry for the right reasons rarely
So come and join us. Help us with
your intelligence to continue the advances in psychiatric
knowledge. Help us with your eloquence to combat the stigma that
surrounds mental illness. Help us with your innovative flair to
make use of the government's growing interest in mental health
services. And help us with your humanity to make relationships with
those in need.
|Professor Shelia Hollins, President
(2005-2008) Royal College of Psychiatrists
Psychiatry is one of the most varied, interesting and
rewarding specialties in medicine. Every day can be different and
every patient seen is unique. Psychiatrists work in a number of
different places including hospitals, people's own homes,
residential centres, old people's homes and even in prisons.
Psychiatry offers fast career progression and excellent job
opportunities. As a career, psychiatry attracts as many women as
men and it can be particularly appealing for those interested in
flexible (part-time) work.
What do psychiatrists do?
Psychiatrists are doctors who look after patients with mental
health problems, such as depression, anxiety, personality
disorders, learning disabilities and schizophrenia. Management of
these disorders involves a combination of measures, such as drugs,
psychological counselling, improving home environments and social
networks, and occasionally physical treatment such as
electroconvulsive therapy (ECT). Therefore, treatment of patients
with mental health problems depends on a wide range of
professionals, including clinical psychologists, social workers,
community) psychiatric nurses, and occupational therapists. The
psychiatrist needs to work together with these professionals as
part of a team.
There are few mental health disorders for which there is a
definitive diagnostic laboratory test, but most psychiatric
diagnoses are made on the basis of a full history and mental state
and physical examination. This is why good communication skills are
essential to be a good psychiatrist and why diagnosing patients is
a challenge for psychiatrists. Another distinctive aspect of
psychiatry is that patients sometimes have no insight into their
own illness. These patients sometimes need to be treated without
their consent. To safeguard the rights of patients, mental health
professionals need to follow precise procedures in the Mental
Health Act before they are allowed to admit and treat patients
against their will.
What is the day-to-day work
The workload and duties vary widely between jobs. The senior
house officers (SHOs) are usually responsible for the day-to-day
management of in-patients and community patients, review them
regularly, and present updates at the ward round or community
round. They also see both new and follow-up patients in out-patient
clinics. They attend multidisciplinary team meetings, where team
members representing different professions can discuss the problems
and needs of patients living in the community. SHOs are also
involved in occasionally administering ECT and assessing patients
presenting to accident and emergency.
Each trainee gets an hour of protected time per week for
consultant supervision where they discuss issues pertaining to
their professional development. They also get an opportunity to
attend teaching at the local MRCPsych course. The weekly attendance
at the local MRCPsych course is mandatory for all schemes and some
of these courses also double up as university postgraduate courses
leading to the attainment of a higher degree like the MSc or the
MMedSci. On-call duties are usually less hectic than in the acute
specialties and many rotas allow you to be on call from home. Some
hospitals have teams of nurses trained to deal with self-harm
assessments and patients who present in crisis. They help to reduce
the workload for the trainees and make the job more pleasant.
A number of doctors in training, especially overseas doctors,
find doing a clinical attachment especially useful before they
start working in psychiatry. This helps them familiarise themselves
with the unique UK mental health system and also helps them obtain
local referees. At present these placements are dependent on
trainees contacting individual trainers who might be willing to
take them on to provide them with this training opportunity. With
the current influx of overseas trainees it has, in fact, become
more difficult than before to secure a clinical attachment.
Flexible training is suitable for doctors who wish to train
less than full time but more than half time. Psychiatry is one of
the medical specialties with the highest number of flexible
trainees. Most doctors who choose to train flexibly do so because
of family responsibilities. Other reasons they may choose to train
flexibly include being a carer, physical or mental health reasons
or to pursue another career interest (e.g. professional sportsman).
With more women entering medicine and both men and women wanting
more flexible working patterns, flexible training is likely to be
in increasing demand. Flexible training in psychiatry allows you to
combine a fascinating and rewarding career with other commitments
Specialties in psychiatry
- Looks after people aged 16 - 65 with
a wide variety of mental health needs.
- Wide range of illnesses including
depression, mania, schizophrenia, anxiety disorders and people with
- The challenge includes not only
dealing with people with a wide variety of illnesses but also
working with a wide variety of health professionals including
community psychiatric nurses, social workers, psychologists and
- Exciting opportunities to work in an
assortment of settings including community bases, district general
hospitals, university hospitals or a combination of these.
Old age psychiatry
- Continuously evolving specialty
focused on mental health needs of those over the age of 65
- These include problems similar to
those in the general adult age group.
- A major part of the job involves
pharmacological, psychological and social aspects of dealing with
patients with cognitive impairment (mainly dementia but also
- Provides an almost unique interface
with geriatric medicine and the opportunity to apply both your
medical and your psychiatric training in the care of the
- Also has prospects of working with a
large assortment of professionals (including community psychiatric
nurses, social workers, psychologists, occupational therapists,
physiotherapists, geriatricians and neurologists) in a wide range
of settings (including community bases, district general hospitals
and/or university hospitals).
Child and adolescent
- Concerned with the intellectual,
emotional and behavioural problems of children from birth to
- A stimulating and fulfilling area of
psychiatry where positive treatments can affect a whole
- A variety of treatments are used
ranging from individual psychotherapy to behavioural and family
- Based in hospitals, child guidance
clinics, day units, special schools(boarding and day) for children
experiencing difficulties, or in community and remand homes.
- Interesting prospect of developing a
close working relationship with the child concerned and their
- Involves interaction between
psychiatry and the law, and cares for and treats offenders with
mental health problems.
- Special skills are needed in
assessing behavioural abnormalities, understanding and using
security as a means of control and treatment, writing reports for
courts and lawyers and giving evidence in courts of law.
- Based in general and special
hospitals, crisis intervention centres and prisons.
- Works with the courts in the
elucidation of medico-legal problems such as criminal
responsibility, fitness to plead and the management of offenders
with mental health needs.
Psychiatry of learning
- Concerned with the prevention,
diagnosis and treatment of the mental health problems which often
occur in people with learning disability.
- Expertise in related subjects such as
paediatrics, neurology, epilepsy, genetics, biochemistry and
psychology are required.
- Excellent opportunities to work in a
variety of settings including community bases, residential homes
and the person's home.
- Close working relationship with
family carers and a large range of professionals including
psychologists, nurses, speech and language therapists, occupational
therapists and counsellors.
- Required to assess and treatpeople
with, for example, psychoneuroses, personality and behavioural
disorders, and sexual and interpersonal problems.
- Need expertise in the application of
psychotherapeutic principles, including the psychodynamic use of
the doctor-patient relationship as part of the general management
of all patients with mental health and psychosomatic
- Based in hospitals, child and
adolescent units, child guidance clinics, student health centres,
and in doctors surgeries.
- Concerned with mental health needs of
patients in general hospitals.
- Prospects of developing expertise in
complex comorbidities (of physical and mental health).
- A chance to manage self-harm through
behavioural and problem solving therapies.
- Opportunity to understand and apply
various psychological theories and therapies in the management of
medically unexplained symptoms.
- Involves managing acute behavioural
disorders in patients on medical and surgical wards and in accident
and emergency departments, including the judicious use of the
Mental Health Act and common law in the general hospital.
Social and rehabilitation
- Concerned with promoting the recovery
of people with long-term serious and complex mental health
- Working supportively with families
and carers towards social inclusion is an essential skill.
- Multi-agency liaison across many
settings including the criminal justice system and
independent-sector providers is needed.
- Opportunity to work across diverse
settings within a network of support teams which requires expertise
in management, leadership, service development and clinical
- Application of a more pragmatic view
of the interaction of the social (and economic) environment with
mental health status which is central to the specialty; this
includes the impact of stigma and discrimination.
- Extremely gratifying role of ensuring
the mental and social wellbeing of patients with severe and
enduring mental illnesses.
- Involves treating adults and young
people with a range of drug, alcohol and other addictions. Many of
them also have other mental illnesses.
- Have skills in prescribing for
maintenance and treatment of withdrawal states, managing physical
illness and mental illness in addiction patients and in providing
- Requires ability to work with
professionals from a range of disciplines including courts,
prisons, probation and housing. Working with social services to
protect children from problems associated with drug use in their
- Concerned with the development of
services and advocacy for this under-served patient group.
- Concerns the exploration, through
research, of the basis for all mental illness, its clinical
manifestation and treatment.
- It involves the need to develop
research ideas, protocols for their study through testing
hypotheses, analysing and presenting results at conferences and
writing scientific papers.
- It relies upon presenting protocols
to grant-funding agencies, and working in collaboration with
- The clinical academic will spend a
lifetime engaged in developing new ideas, contributing to the
existing knowledge base upon which evidence-based practice depends,
as well as practising clinical psychiatry within their chosen
I'd never considered psychiatry until my undergraduate
attachment. This was the first time I saw people and their problems
being looked at in the round. Their stories were fascinating and
the psychiatrists I worked with were genuinely interested in not
just the symptoms and signs they could elicit, but trying to
understand the complexities of peoples' lives when affected by
mental illness. I've continued with that initial fascination, and
with increasing admiration for those whose resilience in the face
of adversity and sometimes long-term problems, puts most of us to
It's been a privilege to share in the intimate details
of peoples' lives and use a wide range of skills, including medical
and psychotherapeutic ones, to help people recover from all sorts
of problems. Working as part of a multidisciplinary team,
respecting colleagues' skills and, in turn, having my contributions
valued and sought out, both in community and in-patient settings,
has been a very positive aspect of my career.
Being a psychiatrist has meant being creative in
looking for solutions, not always sticking to well-tried formulae.
Mental health problems don't come neatly parcelled up; life can be
a messy business for us all. Working with patients and their
families over the longer term of many illnesses has given a
richness to my working life I don't imagine could easily have been
Dr Sally Pidd, Consultant Psychiatrist
Personally, I was intrigued by psychiatry as a
student, and, having completed a degree in public health at
university, chose to enter a training scheme after my PRHO year. I
enjoyed an interest in neurology and neuroscience and, having
conferred with a number of psychiatrists, felt I would enjoy the
continuity of care and patient interaction the specialty
Furthermore I thought the specialty had a bright
future, with the wealth of new information being relayed via
molecular biology, genetics and neuroimaging. Having been a trainee
for 18 months, I would say that all the above are still pertinent,
though the aspects I most enjoy are the human contact and the
opportunities afforded by the emphasis on training to learn and
develop what I consider to be a craft. More challenging aspects
include the perpetuating social determinants of our patient's
mental health that we cannot alter, and are at times expected to.
Those in psychiatry can have differing levels of intensity
associated with their work (flexible training schemes being an
example of this) and there are few medical specialties with such a
broad spectrum of individuals and opinions on the
Dr Sameer Jauhar, SHO in
Changes in psychiatry training
A number of major changes are taking place
in postgraduate medical education, which will affect training in
Postgraduate Medical Education and Training Board
The Postgraduate Medical Education and
Training Board is a newly formed body, independent of the
government, that is the competent authority for all postgraduate
medical education and training across the UK. PMETB took up its
responsibilities on 30 September 2005. It has responsibility for
the standards and quality assurance of all postgraduate education,
training and assessment in medicine and dentistry.
Modernising Medical Careers (MMC)
Modernising Medical Careers represents a
new structure in postgraduate medical education with an emphasis
on a more streamlined training pathway via a new competency-based
curriculum. MMC incorporates the implementation of the
foundation programme and the reform of specialty and general
practice training programmes.
After medical school
After graduation you will spend 2 years
working in a hospital as a ‘foundation programme trainee’.
Foundation programme training will extend the knowledge and skills
you have gained as a medical student and will help you become a
competent doctor, delivering the best quality of care to patients.
It will do this by providing you with a curriculum and learning
outcomes that you will need to meet through the 2 years’ training,
not only in acute clinical care but also the generic skills that
all doctors must now have. Most trusts and deaneries have created
foundation posts in psychiatry. The numbers around the country,
however, vary. The second foundation year (FY2) posts in psychiatry
do not at present count towards specialist training but this
remains under review.
The foundation programme is the start of
your postgraduate training and will help you understand the
important qualities that you will need to develop to be a
successful doctor in the NHS. After successfully completing year
one, you will be eligible for full registration with the GMC.
The second year of foundation programme
training will extend your knowledge and ability across the range of
generic and acute care skills but will also give you opportunities
to experience working within different specialties that you might
be considering as career options.
There is to be a national curriculum for
all doctors in foundation programme training and the curriculum
will be supported by nationally approved assessment tools and a
portfolio to guide the trainee and record achievements.
Once you have completed the foundation
programme you will be able to apply for specialty training. It is
not mandatory to have done any psychiatry training in your
foundation programme though you will need to demonstrate your
commitment to the specialty at the application stage. There are
several ways to gain experience in the mental health field and
enhance your CV which do not necessarily include the foundation
year training. There are numerous voluntary organisations such as
the Samaritans and Sane Line which provide experience and some
understanding of mental health issues. You can also contact local
consultant psychiatrists in your trust to see if they would be
willing for you to shadow them in order to gain first-hand
knowledge of the work.
Specialist training in psychiatry is 6
years, divided into 3 years of core training (CT1–3) and 3 years of
specialty training (ST4–6). Trainees are called ‘core trainees’ and
‘specialty registrars’ respectively. In the first 3 years there are
experiences available to build competencies in various aspects of
psychiatry, with specialisation starting in the 4th year. The
assessments during the training period are workplace-, knowledge-
and competency-based. The competencies are based on the GMC’s
document Good Medical Practice and the Royal College of
Psychiatrist’s guidance Good Psychiatric Practice. The
training and the MRCPsych course are modular. There are currently
six ‘certificates of completion of training’ (CCTs): general adult
psychiatry, child and adolescent psychiatry, forensic psychiatry,
old age psychiatry, psychotherapy and psychiatry of learning
The trainees’ section of the Royal College
of Psychiatrists’ website contains up-to-date information on PMETB
Entry criteria for specialist training in
One of the key principles in recruitment
and retention is to choose the right candidates who will be best
suited for psychiatry. In order to identify the best way of
selection it is important to understand the characteristics of a
good psychiatrist. The key competencies of a good psychiatrist
- medical expert
- health advocate
In addition, psychiatrists must be able to
tolerate ambiguity and uncertainty. Many of these attributes can
be developed with training, but some personal characteristics must
be present from the start. The structure for entry into psychiatry
therefore includes demonstration not only of interest in the
subject but also of an ability to communicate with patients and
their carers and skill in liaison with other professionals. This is
assessed via a combination of portfolio from FY2, CV-based
questions, a structured interview and assessment of teamwork and
Somewhere last year, up on the Pakistani - Afghan border, I
qualified for my bus pass. So I am about to leave medicine just as
you are committing yourself to it. Inevitably, everyone asks me the
same questions: 'Would you do it all again?' 'Would you be a
doctor?' And 'would you be a psychiatrist?' The answer to all
three, unequivocally, is 'Yes'!
I came into medicine by a round-about route. I was a history
entrant who ended up with a law degree. I was a newspaper reporter
for 5 years and then a teacher. I went back to school sciences and
back to university to become a doctor. I drifted through every
branch of medicine and came at last to psychiatry - and was
For a long time I thought this had been a process of
serendipity, but I can see now that there was a pattern. What I was
looking for was that unique combination of rigorous enquiry and
human warmth that psychiatry provides. Science is as important to
psychiatry as to any other branch of medicine. Some of the most
exciting advances in genetics are in psychopathology and its
treatment. But psychiatry is still about direct contact between
patient and doctor as human beings. And that is not always
comfortable. If you are hoping to keep your patients safely at the
end of a stethoscope, psychiatry may not be for you. In order to
get close enough to help people in distress, you may get close to
your own experiences and feelings too. You may need supports and
self-insight to carry you through - whether you are a junior
trainee or a long-established consultant. But the rewards at the
end of it will be enormous.
How I envy you the opportunity!
Dr Mike Shooter, Consultant in Child and Adolescent
Psychiatry and President of the Royal College of
New career pathway under Modernising Medical Careers
After you have
Academic and research careers
The training in academic psychiatry
is on par with that received by clinical psychiatrists and is under
the aegis of various specialist advisory committees within the
Royal College of Psychiatrists. Those training to be academic
psychiatrists by carrying out full-time research must have their
training programme approved in advance by the College.
Recommended entry requirements
The Royal College of Psychiatrists
currently urges core trainees to do 6 months in research
placements, if such options are available on the training scheme.
After the MRCPsych examination or equivalent, those who wish to
enter a clinical academic position: should have completed their
Basic Specialist Training should seek to have the funding secured
for a 1- to 4-year research programme (ideally 3-year research
programmes, which are most likely to be fellowships and which
should lead to MD or PhD). Most lecturers (at ST level) will
be expected to have either obtained their PhD/MD degree or be
registered for it. For appointment at senior lecturer level, they
should have demonstrated an ability to obtain independent grants
and conduct research with colleagues, and also have the ability to
supervise trainees. They should have obtained their CCT in the
specialty in which they are conducting research. Those planning to
take on teaching responsibilities should have teaching ability and
experience. The post-MRCPsych training therefore should have the
It should be approved by the
relevant committee within the College. It should have at least four
clinical sessions with the remainder as research sessions. The
training should include on-call commitments. The academic clinician
should have clinical responsibilities at the point of specialist
Modifications to the training
programme are possible in discussion with the programme director
and the relevant committee.
Consultants are appointed through
open competition. To be eligible for a consultant post in
psychiatry you must have obtained a CCT or equivalent, be fully
registered with the GMC and be on the Specialist Register.
Staff grade posts were originally
introduced to make up the shortfall of specialist doctors following
the limitations in the number of specialist registrar posts. This
grade is open to doctors who have not obtained a CCT and are
therefore not eligible for entry to the Specialist Register. Staff
grade doctors must be fully registered with the GMC.
An associate specialist is a senior
grade usually filled by doctors who have, for one reason or
another, chosen not to complete higher specialist training, or
having completed higher specialist training, have not taken up a
consultant appointment. They must have completed 10 years medical
work since registration but are not required to be on the
Over the past 10 years, the Royal
College of Psychiatrists has developed CPD as its key contribution
to promoting life-long learning. At its core, CPD requires
psychiatrists to maintain, develop and remedy any deficits in the
knowledge and skills relevant to their professional work.
Participation in CPD is central to maintaining standards within
clinical governance and will have a key role in revalidation.
Further information relating to CPD can be obtained from the
College website (www.rcpsych.ac.uk
The Royal College of Psychiatrists
The Royal College of Psychiatrists supports psychiatrists
throughout their careers with a wide variety of educational and
academic events and resources. The College enjoys an international
reputation and is proud to be known as a friendly, helpful
organisation dedicated to the advancement of the profession.
The Royal College of Psychiatrists promotes mental health
- Setting standards and promoting excellence in mental
- Improving understanding through research and education
- Leading, representing, training and supporting
- Working with patients, carers and their organisations.
The Royal College of Psychiatrists has been active in the
field of postgraduate education for 25 years, and the range of
activities it undertakes is enormous. For example, it offers advice
and information to the government, the Department of Health, the
National Health Service Executive, health commissions and trusts on
issues relating to psychiatry and education.
The College has a number of specialist departments, including:
Examinations, Communications, Policy, Professional
Standards, Publications and a dedicated Research Unit. A number of
committees meet at the College's headquarters in Belgrave Square,
London. The College also organises many events relating to the
profession, including seminars, workshops, conferences, charity
activities and media training.
It also publishes the three main academic journals relating to
psychiatry; the British Journal of Psychiatry,
Advances in Psychiatric Treatment and the Psychiatric
Bulletin; as well as a wide range of books and policy
documents. Primarily an administrative and educational
organisation, the College does not provide teaching on its
premises, or house any students.
There are a number of ways to become involved with the College
and these include joining as a psychiatric trainee, standing for
election for the Psychiatric Trainees' Committee
(PTC) and becoming an affiliate of the College.
Psychiatric Trainee Grade
The College is very keen to encourage future Members to be
actively involved in College activities and qualified doctors can
enrol as a psychiatric trainee (formerly known as an inceptor).
This grade is open to all those in psychiatric training until they
pass the MRCPsych examination. It offers excellent benefits
including the British Journal of Psychiatry, a
dedicated new trainees' meeting, access to vital exam and
training information, the Psychiatric Bulletin, and a
discount rate for Advances in Psychiatric Treatment (APT).
For more information regarding the psychiatric trainee grade,
please contact the Professional Standards Department at
Psychiatric Trainees' Committee
The Psychiatric Trainees' Committee (PTC) aims to represent
the interests of the trainees within the College and maintain and
improve the quality of postgraduate psychiatric training.
Membership of the PTC provides a range of valuable opportunities
for trainees, and fulfils an important function of the College. It
allows you to become involved in the work of the College at close
hand, influence training in psychiatry, meet fellow trainees from
around the country and even represent trainees at an international
Affiliateship is open to all psychiatrists in the staff grade
and other non-consultant career grade posts such as clinical
assistants and associate specialists. This grade enables
psychiatrists who were not in training grades or consultant posts
and who do not have the MRCPsych to have a closer affiliation with
the College. Further information regarding affiliates can be found
on the College website.
If you are interested in becoming a psychiatrist, we would be
happy to hear from you, and to give you any further information you
When I said at an interview for a psychiatry clinical lecturer
post‚ I had always wanted to do psychiatry, there was a general
chuckle. If that had been the case, why had I spent so much time
doing‚ other things, such as clinical medicine and research on AIDS
or cardiac peptides? The options open to me as a potential clinical
academic in psychiatry seemed obscure.
There are a significant number of people who seem to embark on
psychiatry later in their careers, but very few I think who regret
it. I suspect that our personalities need to be reasonably mature
to engage with, and make accurate clinical judgements on, the
impact of mental problems on other people. Psychiatrists I suspect
also need the courage of their convictions to overcome initial
obstacles to entering the specialty: the perception in some
quarters of it being a 'Cinderella specialty' or an 'easy option',
fear or stigma associated with the conditions from which patients
suffer, ideas that the study of psychiatry is 'fluffy' and not
scientifically based. If any potential psychiatrist thinks in these
terms now, I would strongly reassure them that: (1) psychiatry is
difficult, complex, hard work and intensely interesting; (2)
helping patients overcome their psychiatric illness, their fear
and distress, and that of others around them, is the most
satisfying task any doctor could hope for; (3) psychiatry research
is exciting and rigorous, includes a broad range of approaches and
interests and relies upon the very latest scientific techniques.
Indeed, the scientific questions identified by clinical psychiatry
are driving the development of many of these techniques.
In no other specialty can the doctor explore the inner
workings of the psyche and materially help those who suffer when
the psyche becomes disordered. Scientifically we are at the cutting
edge of understanding human nature and its problems, mental illness
and its treatment. Both in clinical practice and scientific
exploration, psychiatry offers us the privilege, afforded to
relatively few people, of a fascinating and fulfilling professional
Professor Peter Woodruff, Chair in Academic
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