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

Psychiatrists' support service
Information guide: On transition from trainee to consultant

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


This information guide is intended for a trainee psychiatrist who will become a consultant. The information can 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 organisations listed at the end of this information guide.



It is not easy to make the transition from trainee to consultant. Although trainees find they are well prepared for clinical work, the greater volume of work and new managerial responsibilities are often challenging (Houghton et al, 2002). New consultants are expected to chair meetings, provide support and leadership to teams, deal with difficult colleagues, interview new staff, provide training and supervision, as well as preparing business plans and developing services.

Trainees are advised to obtain practical management experience and attend theoretical courses (Houghton et al, 2002). Invaluable experience can be gained by undertaking a locum or ‘acting’ consultant post, especially a locum post where you hope to obtain a substantive post. The National Health Service has a new consultant entry scheme for trainees who have completed training but have yet to find a substantive appointment (MacDonald, 2004).


Consultant post

Your first consultant job should be a job that you really want to have, with colleagues that you like, where you will enjoy working. It may be worth imagining what this ideal job would be like (Houghton, 2003) and then looking for a job to match your specification. Let senior colleagues know of your interests, in case a job is likely to become vacant soon.

Location is important, especially if you have domestic responsibilities, will have to move home or commute long distances. Isolation from family and friends when your work is far away from your home can add stress during the transition to being a consultant.


Advertised jobs

It is advisable to read the information about a post carefully. Before you go to the interview, arrange to meet prospective colleagues and senior management and visit the services. Even if you have worked there previously, the visit would be time well spent, as it could save you from making a costly mistake.


Catchment area

Consider the catchment area carefully, taking heed of the level of social deprivation and the type of work. It is advisable to look for less obvious duties and responsibilities, for example care of asylum seekers, prisoners or the close proximity to a port. All of these could affect the intensity and type of work that you might be expected to do.


Colleagues and department

It is worthwhile checking the history of the post including reasons for the vacancy. For a new post, consider the possibility that the post may contain parts of the service that other consultants do not want. Ask yourself such questions as:

  • How well does the service function?
  • Who will be your manager?
  • Will you enjoy working with the team?
  • Do you like and respect your prospective consultant colleagues and are they likely to be supportive towards you?


Job plan and specification

When appointed, you will have to work according to a job plan. There will be fixed sessions for clinical duties, administration, continuing professional development (CPD) and possibly research. Information should be provided on the expected case-load, catchment area, on-call duties, study leave arrangements, the employment contract and salary. Administrative support should be provided such as secretarial assistance, your own office, a computer and access to the email system.

Before applying for the post, it is advisable to discuss the employment contract and job plan with senior colleagues and to obtain advice from a professional adviser, for example from the British Medical Association. If you have concerns, you should try to resolve them before interview, as it will probably be too late afterwards. Explore the financial situation of the organisation. Is the service in debt, due for significant reorganisation or expecting cuts in services or staff?


Person specification

Check to see whether you have the relevant experience. Clues about the intensity of work are often in the person specification such as ‘must be able to work well under extreme pressure’. Are you excited about the job? Only apply if you really want the job.


Managing the transition

The administrative workload is much greater for a consultant, with swathes of emails, government and local documents to read and committee meetings to attend. Not only will you have to see the patients but also you will probably have to organise clinics, manage waiting lists, keep the service on track, supervise trainees and build working relationships with a wide range of staff, many of whom, if not all, will be new to you.

It is not unusual to worry and to wonder whether you will be able to cope. New consultants often feel isolated and may not know where to turn for advice and help. Before you begin your new job, it is a good idea to identify someone to whom you can turn for advice. This person could be a previous trainer or a mentor.

The Royal College of Psychiatrists recommends that all new consultants have access to a designated senior colleague – a mentor, who can provide advice, support and information, which is especially important in the early days of a new job. National Health Service trusts can provide a new consultant with a list of colleagues who have volunteered to be mentors. It is not compulsory to have a mentor, but having someone you can trust to talk to and who can offer sensible advice can help to reduce stress and uncertainty at this difficult time of taking up a new job. A mentor’s support can also help to broaden your skills effectively and quickly.

Organisational skills
Good organisational skills are needed to avoid being overwhelmed by multiple demands on your time. It is crucial to attend to fixed commitments so you will have to prioritise, delegate and manage your tasks. Key success factors include effective time management and the ability to plan ahead. Be prepared to say ‘no’ to taking on extra demands, especially at the beginning. If you are being swamped with work, review the pattern of your work and seek advice from your mentor.

Administrative support
Apart from being pleasant and calm, an ideal secretary (or personal assistant) will have good organisational skills, type accurately and be able to take minutes. They may know how the organisation functions and can identify decision-makers. If you are willing to listen to their advice, they will tactfully guide you through the transition. You can help by giving clear instructions if a task needs to be completed by a deadline so they can prioritise their own work.

Attending local management meetings will orientate you to service developments and local politics. You may have to

bid for resources, write business plans and be involved in making decisions about cuts in services.

Interpersonal skills
It is important to maintain integrity and probity. Some new consultants have problems managing the increased power that comes with their new role. Remember you are being observed in your interactions with others. Unless you have worked in the organisation before, most people will know who you are well before you know them. Avoid making inappropriate comments and bear in mind that colleagues may be related to one another. Address issues promptly rather than leaving them as you will not be moving on in the next few months as you did when training.


Tips for looking after yourself


  • Be aware of your personal safety in your new environment. Learn about local policies and procedures, attend promptly to occupational health requirements and take part in induction courses and essential training.
  • Discover how your performance will be measured, whether it will be for example by the number of admissions, length of stay of patients or the number of ward rounds you attended.
  • Maintain confidentiality and keep good records. It takes only a few minutes to dictate or make a file note of telephone contacts, interviews and meetings. Ensure appropriate entries are made in the clinical record each time that you see a patient.
  • Obtain professional insurance by becoming a member of a medical defence organisation. Ensure that your name is on the Specialist Register of the General Medical Council and that you are registered to implement relevant mental health legislation.
  • In the first few months, arrange to join a peer group, create your personal development plan and start collecting the evidence of attendance at CPD events, which you will need for your annual appraisal. Book study leave in advance and arrange cover for absences.


Family, friends and interests will help to keep a balance in your life. Plan your holidays well in advance so work commitments and on-call duties do not have to be rearranged at short notice. If you do have the misfortune to fall ill, seek help and allow yourself time to recover.


Sources of further help and support

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

Hospital Consultants and Specialists Association
1 Kingsclere Road, Overton, Basingstoke
Hants RG25 3JA
Tel: 01256 771777, Fax: 01256 770999

Medical Defence Union
230 Blackfriars Road, London SE1 89J
Tel: 020 7202 1500

Medical and Dental Defence Union of Scotland
Mackintosh House
120 Blythswood Street
Glasgow G2 4EA
Tel: 0141 221 5858

Medical Protection Society
33 Cavendish Square, London W1G 0PS
Tel: 020 7399 1300, Fax: 020 7399 1301

Psychiatrists’ Support Service
Royal College of Psychiatrists
 21 Prescot Street,

London E1 8BB

Tel: 020 7245 0412



  • HOUGHTON A., PETERS, T. & BOLTON, J. (2002) What do new consultants have to say? BMJ Career Focus, 325, S145a.
  • Houghton, A. (2003) Getting that all important job. BMJ Career Focus, 326, S143.
  • MacDonald, R. (2004) The New Consultant Entry Scheme. BMJ Career Focus, 328, 39.

© Royal College of Psychiatrists 2008


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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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