Background to core training
The first years of training in
psychiatry are spent in a wide variety of posts to ensure a robust
and strong foundation from which to build your chosen specialist
skills. Each post during this core training lasts for four or six
months and trainees must obtain at least 12 months of experience in
general psychiatry. They can also undertake posts in any of the
other specialties of psychiatry.
During core training, universal and
necessary skills are developed in, for example, assessment after
deliberate self-harm and assessment of suicide risk. Trainees will
have an identified educational supervisor (usually the consultant
for the team in which they work) who will be responsible for
supervising clinical activity and providing an hour of weekly
one-to-one educational supervision.
Assuming satisfactory progress
through formal exams and workplace-based assessments, this period
of training lasts for three years. Once a trainee has passed
the three written exams and one clinical exam which make up the
Membership exams of the Royal College of Psychiatrists they can
become a full Member of the College and have earned the right to
add MRCPsych after their name. They are then able to progress
to higher training in one of the six specialties: General
Psychiatry, Child and Adolescent Psychiatry, Medical Psychotherapy,
Learning Disability, Old Age Psychiatry or Forensic Psychiatry.
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Personal perspective one
Ever since I can remember at
medical school I wanted to be a psychiatrist. I feel quite lucky in
that way and I know it’s not the same for everyone but now I am
actually here and doing it, I want to urge everyone to do the same.
I doubt there are many other specialties that are as varied or
interesting (but I know I’m biased!)
At the moment I work as a specialty
trainee year 2 (ST2) in liaison psychiatry at Frimley Park Hospital
in Surrey. It’s a pretty busy district general hospital with a
military wing (so plenty of strapping young men in uniform, always
a bonus). A typical day involves me heading straight to our team
office, where I normally have a coffee with my specialist registrar
(SpR) and our liaison nurse, and we sort out which patients need
reviewing on the wards and whether there are any new referrals.
Referrals come in from all over the hospital, for any patients in
whom the treating teams suspect a psychiatric disorder. We also
cover acute psychiatric presentations during the day that present
to Accident and Emergency (A&E).
I normally have a couple of
patients coming to see me in clinic – today I’m going to see a lady
with breast cancer and cerebral metastases who has become agitated
and difficult to manage at home. It’s a tricky one, but my
consultant is running a parallel clinic so we see her together
afterwards, and make a management plan together.
There are also two patients on the
ward that need urgent review – a middle-aged lady who has taken an
overdose who is trying to leave the ward, and a teenage girl who
has presented with an acute change in behaviour and either has
delirium or an acute psychotic illness. I go and see these two
patients together with my SpR.
Later I head off to A&E as
there is an acutely psychotic patient there who has been brought to
A&E by the police. She ends up needing a Mental Health Act
assessment so there’s lots of ringing around sorting that out.
Eventually she is detained under Section 2 and we find her a bed on
our local in-patient unit.
I come back to the office for an
hour’s supervision with my consultant where we do a case-based
discussion on the lady I saw in clinic. I then head home at 5pm,
hoping to get a little revision done for my upcoming exams and plan
for a meeting the next day where, as Trust rep, I need to present
the results of a recent accommodation inspection.
I think the thing I love the most
about liaison psychiatry is the variety of psychiatric
presentations that you see; there are often patients who have
psychiatric symptoms as the result of, or complicating, a physical
condition. I would encourage anyone who is interested in psychiatry
and who enjoys clinical medicine to consider liaison psychiatry, or
old age psychiatry, as both specialties require extensive use of
medical knowledge and experience.
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Personal perspective two
I am currently a year two
specialty trainee in psychiatry on the Leeds and Wakefield rotation
in the Yorkshire School of Psychiatry.
My interest in this specialty
started in my third year of medical school and was reinforced
by the special study modules, elective and clinical placement in
psychiatry during my undergraduate years. I was privileged to have
been given the opportunity to see how psychiatry is practised
abroad in Montreal (Canada) and Rennes (France) at such an early
stage in my undergraduate training placements.
Many of my peers were surprised to
learn I had chosen psychiatry as a specialty as they felt it was
far removed from the realms of core specialities that we were
taught in medical school. I, on the other hand, felt psychiatry is
the specialty which touches all aspects of medicine and surgery on
a daily basis.
I was successful in being selected
on to the senior house officer (SHO) rotation immediately
following my pre-registration house officer (PRHO) year. I recall
finishing my night on call in the medical assessment unit prior to
completing my PRHO year, when I felt very excited about the thought
of embarking on the career I had looked forward to since medical
school. I started my SHO rotation with a general adult psychiatry
placement. Despite eagerly awaiting this moment, my first on-call
in the acute inpatient unit was a daunting experience for me. I
remember various thoughts going through my mind: ‘What am I going
to do,’ ‘Who am I going to call,’ ‘Where am I supposed to go,’ ‘I
hope A&E do not bleep me tonight’. Fortunately, as time
progressed, I realised how psychiatry is one of the friendliest
specialities and how helpful and tolerant colleagues, ward staff,
switchboard and library staff are. Since day one I felt supported
by my consultant and the rest of the multi-disciplinary team.
Having completed my first two years
of my SHO rotation, I obtained a place on the new modernising
medical careers ‘run through’ specialty training programme in the
Yorkshire Deanery. I have enjoyed the past few years as an SHO/ST
with varied placements in all the base hospitals in Leeds and
Wakefield. This has enabled me to work and learn in the various
sub-specialties and given me the opportunity to work under the
expertise of different consultants. I feel Psychiatry has enabled
me to develop my management and organisational skills through
liaising with other agencies, while working in inpatient,
community, and on call environments
During all my placements I have
pursued my interest and enthusiasm for the psychological therapies.
I have participated in the balint and experiential groups, together
with completing a supervised cognitive behavioural therapy and
psychodynamic long case. This experience has been invaluable and
has helped expand my ability to think psychotherapeutically in
managing my patients.
I particularly enjoyed my posting
in child and adolescent mental health service as I was able to
participate in the various modalities of therapy (art, family and
drama) together with using a biological role in the management of
young people with mental illnesses.
The rotation has also incorporated
an MSc programme in Psychiatry at the University of Leeds, studying
for this has helped immensely in my success at the MRCPsych
I have a passion for teaching and
learning. In addition to my clinical training, I was appointed to
the post of SHO tutor for University of Leeds. This role has
involved teaching medical students on their psychiatry placements.
I hope I am successful in igniting a passion in psychiatry in these
students sufficient for them to consider pursuing a career in this
Vikram Luthra, ST3, Leeds
Personal perspective three
I am just completing the fourth
year of my senior house officer (SHO) training in the Yorkshire
scheme. In general, however, SHO training (or core training) lasts
approximately three years, made up of six month training
posts, before progression to the specialist registrar (SpR) or
higher training scheme.
When I first came into psychiatry,,
I was surprised and somewhat dazzled at the sheer range of
different subspecialities available. However, compulsory training
requires a trainee to complete two general adult, one old age, and
one learning disability or child and adolescent psychiatry posts.
Once these are completed, a trainee is then encouraged to select
particular specialities of their choice to work in. Options include
addiction services, eating disorders, psychotherapy, forensics,
crisis and liaison work.
This rotation through a wide number
of different specialities has given breadth and depth to my
knowledge and experience as well as the confidence to be able to
choose my future career path. Particular highlights include my old
age and liaison placements as, for me, the most rewarding part of
working in psychiatry are the relationships that are built up with
patients, their families and professionals from other disciplines.
Day to day work, in addition to on call work, has provided me with
the opportunity and skills to work in a wide variety of different
environments, including busy acute mental health units, day
hospitals, outpatient clinics, emergency department
referrals and medical wards.
In addition to the everyday
clinical work, I have been able to gain experience
in cognitive behavioural therapy and psychodynamic
psychotherapy. I have received support and supervision for a number
of cases including phobia, depression and gender identity. Further
educational opportunities include a twice weekly educational
meeting, where a trainee is expected to participate in regular
audit, journal clubs and case conferences.
In my locality all trainees take
part in the masters programme at the university. One day a week is
allocated to lectures, group work and eventually research. Teaching
is given on psychiatric topics, communication skills and critical
appraisal. It is an interesting course and also provides an
opportunity to get to know other trainees from around the region.
Currently, I have completed my diploma and have started putting
together a research protocol looking at alcohol dependence in the
I have also been given
opportunities to improve my teaching skills. As one of two SHO
tutors, I spent one year teaching first and fourth year
medical students from the University. This gave me the chance to
teach in both small groups and formal lectures. It is a really
positive and challenging experience, which has consolidated my
knowledge and awakened an enthusiasm for teaching which I hope to
continue in the future.
As my training progressed, my home
situation changed and I had my daughter. The scheme provided the
flexibility and support to enable a balance to be made between home
and work life. For the last nine months I have been able to work
three days a week in a job share and it has been great to be able
to continue my training whilst seeing more of my daughter.
I have very much enjoyed my SHO
training. Working in psychiatry has provided clinical experiences
which have been varied, challenging and, at times, eye opening.
Throughout my four years, I have always received a good level of
support and supervision from my seniors, and my training to date
has given me the confidence and skills to be able to progress into
higher training. I am now looking forward to the next stage of my
career as an ST4 in old age psychiatry!
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Personal perspective four
Like many of you reading this, I
decided to study medicine as I wanted to make a difference to the
lives of my patients. When I was at school, I had little idea
of what a doctor actually does so I elected to do work experience
in a hospital. I was placed in an old age psychiatry ward and
was immediately struck by the vast difference that could be made to
the quality of life for patients who were confused. I was also
amazed to see these patients improve! I then got further
experience with younger adults and found that an equal, if not
greater, difference could be made. Now, as a junior psychiatrist, I
am constantly challenged to assist my patients in making a
difference. If you want an inspiring, stimulating and challenging
career, then maybe you can make a difference as a psychiatrist
Core training in psychiatry
involves rotating around various specialties thus I’m not sure
there is ever a typical day. I currently have a growing
caseload of adolescents. I manage young people with the whole
range of psychiatric disorders from depression to psychosis and a
range of developmental disorders. They come from varied social
circumstances and this provides particular challenges. I liaise
with GPs, paediatricians, our nursing team, social workers,
teachers, families, the courts and adult psychiatry to name a
few. I also have legal skills in detaining patients under the
relevant legislation. With this variety, no day is boring.
I am frequently told that a
psychiatrist is ‘not a proper doctor’, but I have diagnosed
encephalitis, hypothyroidism and fractures in my out-patients and
often assist in managing chronic medical conditions in my
in-patients. Currently, managing young people with eating
disorders demands a high level of medical skill. Coupled with this,
I see my patients getting better and do very rewarding work with
the wider family. At present, I am involved in a major research
project examining depression, genetics, brain imaging and treatment
with ECT (electro-convulsive therapy).
All in all, could I have a better, more varied and exciting