Contents:
- Editorial
- Foundation posts in psychiatry
- Message from the New Associate Dean for Education
and Training Standards
- Recruitment campaign update
- Neel
Halder’s top 10 tips for successful publishing
- Mental health education in schools:
Setting up Special Studies Modules (SSMs)
- Passing the MRCPsych – The Insiders’
Guide
- Flexible Training
- Trainees’ day at the annual
meeting
1) Editorial
Jon van Niekerk, Chair of the PTC
As the first
decade of the 21st century draws to a close, we can start to
reflect on the passing of the “noughties”. Over the last decade,
postgraduate training in psychiatry has been through a sometimes
tumultuous and often bewildering process of change. Trainees have
had to cope with the modernisation of the NHS with the
implementation of the NHS Plan. At the same time we went through
Modernising Medical Careers (MMC), and the rapid introduction of
the computerised Medical Training Application Service (MTAS).
In addition to these changes we have had to contend with the
implementation of the European Working Time Directive (EWTD); PMETB
becoming the independent statutory body that regulates postgraduate
medical education and training in the UK; the change in immigration
laws for non-UK graduates; and the introduction of New Ways of
Working. On the ground we have experienced the introduction of
workplace based assessments, competency-based training and the rise
of the portfolio. We had run-through training and then uncoupled
training. We had PMPs and OSCEs and then the CASC. Even our names
changed, as we waved goodbye to the last SpRs and SHOs. Compared to
previous decades the pace and sheer number of changes has only been
matched by the resilience of trainees and their trainers trying to
keep up. This decade will surely be remembered in UK psychiatry
training as the “busiest of times”. As the UK recovers from
the recent economic Tsunami we need to ensure that training does
not suffer due to the financial climate.
I was delighted to be
elected as the new Chair of the Psychiatric Trainees’ Committee
(PTC) at our recent elections in Belfast. The PTC continues to
represent trainees' issues at the highest levels within the
College. The PTC has recently raised exam-related concerns,
including the frequency and timing of exams, and the importance of
out-of hours experience for trainees. The PTC
continues to work closely with the Dean on the College’s
Recruitment drive and I am pleased that we will be co-opting a
Foundation Trainee representative to ensure we attract high quality
trainees. The recent exam results have again shown a big
discrepancy between UK and non-UK graduates. The Dean has appointed
Dr Gill Pinner, Associate Dean, to support and help those trainees
who are struggling to progress trough training. In his
recent
Christmas Newsletter, the Dean also spoke of changes
to how workplace based assessments should be used to improve
training, and announced important changes are afoot to ensure
trainers know what standard is expected of trainees at the
CASC.
In this edition we will
look at the importance of creating the opportunity for newly
qualified doctors to have experience of the speciality early on and
Dr Stuart Carney reports on the work being done to expand
Foundation posts in Psychiatry. Meinou Simmons (Vice-Chair)
reports on a project to set up Special Studies Modules which
encourage medical students to produce mental health workshops for
secondary schools. We hear from Neel Halder (Trainee Editor of the
Psychiatrist) on how to get published as a trainee. We also get
some helpful exam preparation guidance from recent successful
candidates; and Lucy Watkin describes how to make the best of
flexible training. Jude Harrison (Student Associate) updates us on
the progress of the student societies and the recruitment drive and
the immediate past-Chair, Clare Oakley, invites us all to attend a
great line-up at the coming trainees’ day at the Royal College AGM
in Edinburgh.
The PTC will continue to address important
training issues on your behalf.
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2) Foundation posts in psychiatry
Dr Stuart Carney, Deputy National Director, UK Foundation
Programme Office
The Foundation
Programme Annual Report (2009) reveals that only 1% of F1 posts and
5% of F2 posts are in psychiatry. The Royal College of
Psychiatrists, the UK Foundation Programme Office and the
Conference of Postgraduate Medical Education Deans have set up a
Task and Finish Group to raise the profile of psychiatry in the
Foundation Programme, encourage the creation of more foundation
posts in psychiatry and share notable practice.
Despite the prominence of
mental illness in the Foundation Programme Curriculum, fewer than
one in five foundation doctors currently consolidate and develop
their skills in a psychiatry placement. Instead foundation schools
rely on the generic teaching programme to reinforce essential
clinical skills such as the assessment and management of patients
with depression, psychosis or those at risk of harm to self or
others. The two-year Foundation Programme also provides an
opportunity for foundation doctors to explore their career options.
Foundation posts in psychiatry, especially in F1 or in the first
four months of F2 (specialty recruitment opens in December for the
following August intake) enable foundation doctors to make a more
informed decision about a career in mental health. The shortage of
foundation posts may contribute to the relatively low competition
ratios for core psychiatry training.
The Task and Finish group
is working with foundation schools to try and increase the number
of training opportunities in psychiatry, which may be made easier
if there is further expansion in F1 posts in 2011 to take account
of the increased output from medical school. We are encouraging all
foundation schools to provide tasters weeks in psychiatry either in
F1 or F2 for foundation doctors who don’t have the opportunity to
experience psychiatry before national recruitment. Another
innovative approach for raising the profile of psychiatry is the
use of Balint Groups. For example, foundation doctors in the North
West of England have the opportunity to participate in a Balint
group under the guidance of a specialty registrar in
psychiatry.
Please contact the PTC at
ptc@rcpsych.ac.uk if you have any
suggestions about how we could raise the profile of psychiatry in
the Foundation Programme.
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3) Message from the New Associate Dean for Education and
Training Standards
Gill Pinner, Associate Dean for Education and Training
Standards
I would like
to introduce myself - I am a Consultant in Old Age Psychiatry and
DME of Nottinghamshire Health Care Trust. I have been involved in
teaching and training for many years and was appointed to this
newly created post in October 2009. The Dean created this new post
as a number of issues were causing concern, in particular, that the
current training system appeared to be failing trainees, especially
those who are non UK graduates. This has been a situation closely
monitored by the examinations department and is affecting both
written and clinical exams, but particularly highlighted with the
new CASC exam.
As you know the structure
of the Membership exam has been extensively overhauled resulting in
the clinical exam being the final component to be examined
formally. As knowledge has been extensively tested by written
papers, the CASC has a heavy emphasis on communication and
consultation skills. Some have been critical of this, but I
consider it is correct that, given the nature of psychiatry as a
speciality, competency should be clearly demonstrated in this area.
However, if English is not your first language, then this will
undoubtedly be harder to achieve. I do not think that language is
the only issue though; cultural issues will play a part too, as
well as the difficult personal circumstances that many overseas
doctors have to contend with when living in a new country. It is
also the case that many non UK medical schools provide little
teaching of interview and communication skills at undergraduate
level, so many trainees have not been exposed to the extensive
teaching that now happens routinely in most UK medical schools in
their formative years.
Until now, training for
trainees struggling with these issues has been rather passive and
reactive and, to some extent, seen as “their problem” rather than
“our problem”. My job will be to attempt to understand the issues
standing in the way of successful training outcomes for all
trainees, with particular focus on helping those with most need and
to make recommendations for action to be taken to remedy this
within training. It is a hard and complex task, but I sincerely
intend to make a difference! It is already clear to me that one of
my key missions will be to promote “excellent communication” as THE
core skill for psychiatry as a profession. This is something
that our GP colleagues have done over the years with great success
and we need to do the same and really value it. We will need to
re-establish and re-emphasise communication skills training for all
trainees and develop strategies that will particularly help non UK
graduates to achieve these skills – if this works, then exam
success will also follow!
I look forward to meeting
more trainees across the country and hope to come along to some of
your events to talk more about these issues. Specifically, I will
be organising a series of focus groups in the next couple of months
to map out the issues identified by trainees themselves, so I will
be happy to accept offers of volunteers!
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4) Recruitment campaign update
Jude Harrison, PTC Student Associate Representative, 5th Year
Student at Dundee University
2009 was the year
that saw serious attempts to remedy recruitment problems in
psychiatry. The College took the lead in organising a number of
events, including an undergraduate conference, a Student session at
the Annual Meeting and a summer school. Furthermore, it encouraged
the establishment of student psychiatry societies in medical
schools across the country. December was the first anniversary of
the Student Associate grade. There are now 1260 students and
foundation doctors signed up, many becoming actively involved with
the College through the newsletter and the student awards and
bursaries.
The first Annual Meeting
of psychiatry societies, sponsored by the Association of University
Teachers in Psychiatry, was held on 9 November 2009 at Guy’s
Hospital, London. The views of 14 university psychiatry societies
were represented at the meeting, mostly by delegates present in
person. It allowed us to share our ideas for successful events and
discuss way to collaborate further in future. I was pleased to see
that many of the most active members of the local psychiatry
societies this year had attended the summer school, the
undergraduate conference or the AGM, and returned to their medical
schools enthused about psychiatry, which is evidence of the success
of these events.
Up until now, the
recruitment campaign focused on medical students. The coming year
will see initiatives extended to include Foundation Doctors. A new
position has been made available for a Foundation Doctor on the
PTC; competition for the post has been stiff, with 19 applications
received before the deadline. Several of the applicants had been
involved with setting up psychiatry societies in their final year
at medical school.
In addition to organising
another season of undergraduate events, in the next few months the
College will undertake to register the established psychiatry
societies, optimising communication with the interest groups.
Furthermore, the University Departments of Psychiatry will be asked
to oversee and assist the societies at a local level. This will
provide them with more organisational structure, allowing them to
expand their activities and become more prominent within medical
schools.
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5) Neel Halder’s top 10 tips for successful publishing
Neel Halder, Trainee Editor (The Psychiatrist)
I have worked for some time as trainee editor (and
occasionally editor) of the Psychiatrist (formally the Psychiatric
Bulletin- feel free to blame me if you don’t like the redesign).
During that time I have picked up some invaluable tips “from the
inside” about how editorial boards and peer reviewers decide on
articles getting into journals. The following easy guide represents
my personal views on how to improve your chances of publishing.
Publishing should remain
the aim of all trainees. It is rewarding, and greatly improves your
chances of getting the job of your choice. It also fulfils several
important training competencies for the portfolio.
Before you start
1. Formulate a question
that you want answered. Write it down. Ask, “Is this something that
I and others will find interesting? Will it add anything to the
body of scientific evidence?” An accompanying letter to the editor
answering these questions on one side of A4 will definitely
help.
2. Select your target
journal.
- Is it an academic
original research paper, and do you want the prestige of it
appearing in the most cited general psychiatry journal in UK (and
3rd in the world)? Then aim for the British Journal of
Psychiatry.
- Is it an article on
continuing professional development aimed primarily at consultants?
Aim for Advances in Psychiatric Treatment.
- Is it about psychiatric
practice, service provision or anything of direct relevance to the
“jobbing psychiatrist”? Then The Psychiatrist is your answer.
- Of course these are just
three of the Royal College Journals. There are scores of other
mental health related journals just in the UK alone. You may be
able to obtain a list from your local trust library.
3. Read the “instruction
to authors” and follow it to the letter! They are available usually
on the inside of the front or back cover, or from the journal’s
website.
4. Ethical issues. As a
guide, a clinical audit or service evaluation doesn’t need ethical
approval; every other study does. See: www.nres.npsa.nhs.uk
During the write-up
5. Follow the accepted
scientific guidelines (IMRAD, Harvard or Vancouver referencing
styles etc)
6. Many good ideas don’t
get written up due to time constraints. Setting yourself achievable
goals and deadlines is key. Write a quick and rough first draft and
then flesh it out from there; little and often.
7. Ask yourself, can your
work be described easibly by the 4W rule:
- Why did you look at it?
- What did you do?
- What did you find?
- What did it mean?
All these questions
should be easily identifiable in your write up.
8. Always get someone
else to proof read your manuscript. Make it specific what you want
from them, and set a deadline, otherwise it will never get done –
e.g. “Please look for typos and comment on the readability by
Monday”.
9. Never submit your
article to more than one journal concurrently.
After submitting your article
So, after much blood,
sweat and tears, you have finally submitted your precious
manuscript. The wait begins. Knowing what happens to your article
is invaluable in improving chances of publishing. This is where the
peer reviewing process kicks in. I have written about this in
detail in an article commissioned by the Advances in Psychiatric
Treatment, hopefully to be published soon.
Essentially reviewers are asked to comment on
points that include:
- Originality
- Readability
- Topicality
- Validity
- Likely appeal
- Generalisability
- Whether it fits into the submitted
journal
- References (whether they are relevant,
up-to-date and correctly cited)
10. Very few get accepted
first time round, so be prepared to re-submit, maybe even several
times over. It is worth persevering. Once it’s accepted for
publication, celebrate- you’ve earned it!
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6) Mental health education in schools: Setting up Special
Studies Modules (SSMs)
Meinou Simmons. PTC Vice-Chair
A new project for PTC in 2009-2010 has been the
establishment of a working group which is focusing on drawing up a
template for medical students to set up mental health education
workshops in secondary schools. The PTC working group is currently
working on creating an SSM template which can be taken by the PTC
to local medical schools. We are hoping this will enable medical
students to set up workshops responsive to the needs of their local
community schools. The advantage of linking up with psychiatry
departments is the guidance and experience of psychiatric trainees
and senior consultants will be used to ensure material is
appropriate and up to date.
We are hoping this
project will be of benefit to all parties involved. It will enable
psychiatric trainees to develop skills in supervising and
overseeing local projects; it would also link to the college
recruitment drive of encouraging high calibre medical students to
choose psychiatry, through being engaged in a stimulating and
enjoyable project. As secondary schools in the UK currently follow
a very limited curriculum in mental health education we are hoping
to engage young people in the issues around mental health at a time
when their minds are still open and enquiring. We hope this
situation will be supported through medical schools and academic
departments of psychiatry in the UK.
The PTC has taken on this
challenge following an impressive presentation at the last PTC
residential in Belfast by Dr Maggie Mc Gurgan and Dr Holly Greer,
senior psychiatry trainees in Belfast. These trainees are part of
an enthusiastic group of Northern Irish psychiatrists who have set
up a well established programme of mental health workshops in
schools.
The Northern Ireland
workshops were piloted and modified using pupil and teacher
feedback in 2008. The final 1 ½ hour workshop comprises an
introduction to the session, a role-play (covering stress, mental
health issues and coping mechanisms among teenagers), a multi-media
didactic presentation with information on good mental health,
mental illness and stigma, and interactive small group work with
poster making and presentations. These were run and manned by a
core group of specialty trainees.
In Spring 2010, four
senior trainees (Dr Peter Sloan, Dr Maggie Mc Gurgan, Dr Holly
Greer and Dr Roinin Mc Nally) teamed up with the Queens University
of Belfast Medical School to create an SSM for medical students.
These trainees will run this module, at least in the initial years,
and will provide training to medical students to develop and
deliver the workshops. They are also contributing to our working
group, and we are hoping to host an information sharing day to
benefit from their experiences in Autumn 2010.
We are hoping that SSMs
will be ready to implement for the beginning of the next academic
year. If you are interested in helping set up this project in your
local medical school, please get in touch with your local PTC reps.
This is an ambitious project, and not without difficulties in
rolling out nationally. Anticipated stumbling blocks will be
arranging suitable times with schools and getting the appropriate
CRB clearance in advance. However, we are confident that it is an
achievable goal, especially if we attempt to ensure the workshops
are well supervised and locally responsive. Watch this space for
updates!
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7) Passing the MRCPsych – The Insiders’ Guide
Alice Lomax, Matt Impey and David Middleton
This article is a short
version of a longer
article written by trainees who have passed the
new-format MRCPsych exams. It is hoped that it will help colleagues
who are preparing for this essential step in their own
training.
Preparation is essential
for both the written and oral exams. Start early (perhaps 4 months
before each exam) and stick to a revision plan. Reading a chapter
of a book per week is much easier than skim-reading at the last
minute. Once your reading is underway, try doing a few past
questions. A good place to start is the college website as these
questions actually do come up with surprising frequency. Other
sources of practice MCQs and EMIs include textbooks and both free
and subscription websites. This approach will help to give you a
feel for the most commonly examined topics and can direct further
revision. You might prefer to attend a revision course in person
where you will be given revision notes and can work through plenty
of exam questions. Decide which format suits you and whether money
spent on a course might be worth it if it helps you to avoid a
repeat sitting of an exam. Another useful approach for some is
revising in a small group, either face-to-face or via online
networks. This will allow you to share knowledge, questions and
textbooks and might also encourage you to revise topics which
others in your group know more about.
Whichever approach you
choose, it is essential to leave time for enjoyable and relaxing
activities. Exercise, healthy eating and regular breaks will all
improve your ability to concentrate on revision and make it more
efficient.
It is particularly
important to prepare well for the CASC exam. Too many people slip
up due to poor time-keeping or exam technique despite having
sufficient knowledge to pass. The best way to identify these flaws
is to practise in front of senior colleagues. Setting up a mock
CASC is a great way to recreate the CASC proper. Ask enthusiastic
consultants and registrars if they are willing to be examiners.
Again, you might want to consider attending a course, some of which
use College examiners to provide feedback.
The key to success is to
start your revision early and use your senior colleagues to test
your knowledge and performance.
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8) Flexible Training (Now known as LTFT)
Lucy Watkin, WIPSIG representative
Approximately
8% of trainees are training “less than full time” (LTFT) which
means in practical terms somewhere between 6 and 8 sessions a week.
Most are female and look after dependent children the remainder of
the time. Trainees have to be recruited in open competition and
cannot be asked about intentions to work part time at interview.
Then, LTFT has to be applied for from the deanery as there is a
separate flexible training budget. Firstly, one needs to ensure
eligibility via an eligibility form. This prioritises trainees into
Category 1 e.g. looking after small children or category 2 e.g.
training for the Olympics. The second Category is more
discretionary. Neither category entitles a trainee to immediate
LTFT training as they may have to wait for funding and a space to
become available. Once a post is earmarked for LTFT, the trainee
needs to ensure that it is approved educationally, financially and
logged with the flexible training office. In practical terms,
various signatures need to be obtained for the flexible training
approval form. From my own personal experience, I found this part
time-consuming and somewhat tedious. So, do allow for sufficient
time and energy.
A LTFT post could be
supernumerary, slot share, job share or reduced sessions in a full
time post. Supernumerary is most expensive to a Trust and slot
share the least expensive, but the most difficult to consistently
maintain. Neither mandatory training, nor the salary increment date
is pro-rata’d and this places a financial burden on Trusts. Many
Trusts have embraced the fact that on-calls are not essential
throughout psychiatry training so where possible on-calls may not
be available. This means that the salary would be pro-rata basic
only, which may make childcare costs only slightly less than the
income. For your own mental health it is best not to acknowledge
this and to remember that things will get better. Also, peace of
mind when at work is essential so paying for good quality childcare
is money well spent.
An excellent resource for
the details on LTFT which answers many questions is on the
London
Deanery website.
It will be interesting to
see how the increasing numbers of women in the medical work force
and the movement of men into the domestic arena affect the shape of
the work place demographics in the future. Will we all be
part-time?
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9) Trainees’ day at the annual meeting
Clare Oakley, Immediate Past Chair, PTC
The Trainees’
Day at this year’s annual meeting in Edinburgh will be Monday 21st
June 2010. It promises to be a lively and informative day of
relevance to all trainees and their trainers. The sessions will
focus on three key non-clinical areas: management, research and
teaching. Experts will provide invaluable practical advice about
how to gain the best experience in these important areas during
your training. The final session of the day will consider hot
topics such as the impact of public spending cuts on mental health
services and the fate of functionalised teams. I am delighted to
announce an exciting range of speakers including Professor Robin
Murray, Professor Nick Craddock and the President, Professor
Bhugra. The full
programme is available on the website.
There will also be the
opportunity to attend a trainees’ dinner in the evening. This event
was a huge success last year and further details will be published
in the next PTC newsletter. I look forward to seeing you all in
Edinburgh.
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Page last updated 18
January 2010 by E Baker-Glenn