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

Psychiatrists' support service
Information guide: On Starting Out

To contact the Psychiatrists' Support Service please telephone: 020 7245 0412  or e-mail:

This guide is intended for new UK trainee psychiatrists. The information should be used as a guide only and is not a substitute for professional advice. If you need further advice and support, please contact the Psychiatrists’ Support Service or one of the other organisations listed at the end of this guide.


Welcome to psychiatry from the Psychiatrists’ Support Service

Welcome to psychiatry, a specialty we hope you will find incredibly interesting and rewarding! Working in psychiatry can be challenging, and this leaflet includes tips on how to keep yourself healthy and happy, and keep your career on track.


Day-to-day life as a CT1–3


You should expect to attend an induction programme, which is likely to include mandatory courses specific to psychiatry, such as risk assessment, use of the Mental Health Act and training in rapid tranquillisation. It is important to note the differences in the policies and procedures at psychiatric hospitals compared with acute hospitals, particularly regarding the management of acute medical incidents.


Posts generally last for either 4 or 6 months. During your CT1 year, you can expect to have 6–12 months in general adult psychiatry, but it is also common to work in old age psychiatry in this period. During your CT2 and CT3 years you will typically work in more specialist posts, such as child and adolescent psychiatry, learning disability psychiatry, forensic psychiatry, liaison psychiatry, addiction psychiatry and psychotherapy, as well as gaining further general adult psychiatry experience. The process for allocation of training posts varies between deaneries. If you want to work in a specific post during your training, your training programme director is usually the best contact.


You should have weekly supervision from your educational or clinical supervisor. During this session, you will have an opportunity to discuss cases, as well as your career and opportunities for audit, research and teaching. You will also join a case-based discussion group (sometimes known as Balint group) to analyse the psychodynamic aspects of clinical cases.


Your on-calls may involve covering in-patient psychiatric units, providing psychiatric advice to medical wards, and conducting psychiatric assessments in the accident and emergency (A&E) department. For A&E department and medical ward cover, responsibilities are often divided between core trainees, liaison departments and crisis and home treatment teams; the local protocols should be explained at induction.

Providing out-of-hours cover to psychiatric wards is likely to incorporate the provision of both psychiatric and acute medical care for patients, and the medical registrar on call at the relevant acute hospital should be available to advise on medical issues. You may be asked to carry out assessments under the Mental Health Act; training on this should be provided at induction.

Psychiatric registrars and consultants are generally very approachable. It is important to discuss relevant issues with your seniors and these discussions are valuable teaching opportunities which can also be used as wworkplace-based assessments  (WPBAs).


Good organisational skills are essential to avoid being overwhelmed by multiple demands on your time. You will have to prioritise, delegate and manage your tasks. Remember to make time for teaching, research and audit, which all form an important part of your training. Administrative staff are a crucial component of overall psychiatric care and are often an important source of information.


The Royal College of Psychiatrists

It is mandatory for all psychiatry trainees to join the Royal College of Psychiatrists, as specified in the ‘Gold Guide’ (Modernising Medical Careers, 2010). You can register online. The College organises frequent educational events and conferences, including many specifically aimed at trainees. Details are publicised on the College website.

The Psychiatric Trainees’ Committee (PTC) comprises trainees elected from every College division, and has representatives on most College committees. Further details are available on the PTC webpages; you can contact the PTC by email at


All trainees are required to maintain a portfolio and a personal development plan, with input from educational supervisors. You can set up and manage your portfolio at the College’s Portfolio Online website.


The College’s membership (MRCPsych) examinations involve three written papers and one clinical exam. You will attend a local mandatory MRCPsych course as part of your training. Further exam guidance can be found in the Psychiatrists’ Support Service guide number 10, ‘On dealing with exams’, and on the  exams section of the website.


Workplace-based assessments include assessments performed as part of your normal day-to-day job, and incorporate evaluation of your clinical, communication and teaching skills as well as case and journal club presentations.


These reviews usually occur annually around June. At least three panel members will examine your portfolio to determine if you have attained the required competencies and have demonstrated them in an appropriate manner. Further information can be obtained from the ‘Gold Guide’.


Tips for looking after yourself


  • Be aware of your personal safety at work
  • Attend promptly to occupational health requirements
  • Participate in induction courses and mandatory training
  • Join the College as a pre-membership trainee (PMPT), which will give you access to Portfolio Online
  • Look into the ARCP process and the training requirements
  • Maintain patient confidentiality and keep good records; ensure appropriate entries are made in clinical records whenever you see, or have contact with, a patient
  • Obtain professional indemnity insurance by joining a medical defence organisation (some organisations are listed at the end of this guide)
  • Book study and annual leave well in advance to allow you to swap on-calls if necessary
  • Find out about annual National Health Service appraisal procedures in your trust.


  • Try to maintain a healthy work–life balance
  • Keep in touch with family and friends
  • Keep interests outside work alive and make time for hobbies
  • Exercise regularly and eat healthily
  • Register with a local general practice
  • If you become unwell, seek help and allow yourself time to recover
  • Flexible training is possible if you meet the criteria; your deanery can offer further advice.


What to do if things are not going so well

Psychiatry involves dealing with complex cases and hearing about difficult and emotional issues brought in by patients. You may experience personal difficulties yourself and, if things are not going well, please do ask for help from family or friends, or from your educational supervisor, training programme director or local College tutor. You may also consider seeking help from your deanery. Experiencing some difficulties at work is common and it is better to openly discuss issues with your supervisor rather than ignore or minimise them.


The Psychiatrists’ Support Service is a free, confidential support and advice service for members, trainee members and associates of the Royal College of Psychiatrists who find themselves in difficulty over issues such as:

  • bullying and harassment
  • training
  • exams
  • mental health
  • physical health
  • serious clinical incidents
  • internal and external reviews and inquiries
  • difficult working relationships
  • whistle-blowing
  • career pathway
  • GMC/NCAS assessments
  • exclusion

The Service has senior trainee and consultant doctor advisors who can offer confidential telephone advice and support. The dedicated telephone line is only open during office hours, Monday to Friday 09:00–17:00. Outside of these hours you can leave a message or call the BMA’s Doctors for Doctors line: 08459 200169.


Further sources of help and support

British Medical Association
BMA House
Tavistock Square
London WC1H 9JP
Tel: 020 7387 4499

Medical and Dental Defence Union of Scotland
Mackintosh House
120 Blythswood Street
Glasgow G2 4EA
Tel: 0845 270 2034

Medical Defence Union
230 Blackfriars Road
London SE1 8PJ
Tel: 08444 20 20 20

Medical Protection Society
33 Cavendish Square
London W1G 0PS
Tel: 020 7399 1300

Psychiatrists’ Support Service
Manager, Psychiatrists’ Support Service
Royal College of Psychiatrists
 21 Prescot Street,
London E1 8BB
Tel: 020 7245 0412



  • Modernising Medical Careers (2010) A Reference Guide for Postgraduate Specialty Training in the UK – The Gold Guide (Fourth Edition). MMC


© Royal College of Psychiatrists 2011


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If you require advice and support about a particular issue then please contact the Psychiatrists' Support Service at the Royal College of Psychiatrists on 0207 245 0412 or email

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