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
I 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
When 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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Page last updated on 16 May 2010 by E
Baker-Glenn