Core Trainee Welcome Guide

As a trainee in Wales, you are employed by the health board. The health board is responsible for the delivery of all elements of healthcare within its geographical area. There are seven health boards in Wales and they all report to The Minister for Health and Social Services in the Welsh Government, as health is a completely devolved area of policy.

You will likely remain within your own health board for the duration of Core Training. Some trainees may move between health boards for specific jobs, but this is usually within a similar geographical area to their regular area of work.

The health boards are:

• Betsi Cadwaldar University Health Board
• Hywel Dda University Health Board
• Powys Teaching Health Board
• Swansea Bay University Health Board
• Cwm Taf Morgannwg Health Board
• Cardiff and Vale University Health Board
• Aneurin Bevan University Health Board

There are also three NHS trusts in Wales. These operate across Wales, and you may find that you come into contact with these occasionally.

These are:

• Welsh Ambulance Services NHS Trust
• Velindre NHS Trust
• Public Health Wales

The activities of the College in Wales are led by the Chair who works alongside the devolved council, representing many different aspects of our membership. 

If you are interested in the activities of the faculty and becoming more involved, please get in touch.

The Royal College of Psychiatrists Wales is the professional medical body responsible for developing and supporting psychiatrists throughout their careers, and in setting and raising standards of psychiatry throughout Wales.

Our aim is to improve outcomes for people with mental disorders and learning disabilities, as well as improve the mental health of individuals, their families, and communities.

If you have any questions at all, please get in touch.

The Wales Psychiatric Training Committee (PTC) is one of the committees that forms a part of the Wales Executive Committee for the RCPsych. It also forms part of a wider UK PTC that meets nationally at the Royal College of Psychiatrists in London. Every year trainees in Wales elect three representatives to sit on the PTC and represent their interests to the RCPsych and the RCPsych in Wales.

Trainee Forums are run throughout the year by the PTC. These are used to gather feedback from trainees on training to Head of School, Dr Paul Emmerson and the Specialist Training Committee. 

Further information about the PTC is available.

As part of the College's routine activities in Wales, we engage with the Welsh Government and the Senedd (Welsh Parliament) on a range of issues.

We are always looking for trainees and members to help us champion our work and to suggest new changes to policy and legislation based on their experiences working in mental health services. If you can think of any policy, legislative change, or guidance that you think should be introduced then get in touch, we are always keen to support your work.

From time to time, you may also get emails from us asking for your views on consultations. The Welsh Government and the Senedd (Welsh Parliament) may reach out to us to get the Colleges perspective on new guidance or a legislative change. In turn, we take the time to understand the views of our members, by sending surveys, holding focus groups, and having conversations over email or phone.

If you do receive an email from us along these lines, we do read and take into account every single response, and we greatly value your experiences and thoughts. If you want to get more involved in the response for a consultation and make your mark just let us know. All our active consultations are listed on our website. 

In addition to policy work, the College is also able to support a portfolio of project work driven by our membership. We run newsletters, podcasts, webinars and hold conferences and events, too. If you have an idea for a project, scheme, or incentive that you would like help with getting off the ground then let us know, you may also be able to add it to your portfolio. 

Working in a health board in Wales you should have access to journals and academic resources. However, as a psychiatric trainee, the College can also offer you online journal access to articles that are not available through the NHS.

The College also hosts an impressive collection of academic literature and books that are not available online. These can be posted to you for free.

Finally, the College can complete literature reviews for you. Our dedicated library team are experts in scouring the digital collections and can provide summarised literature reviews on topics of your choice.

You can get in touch with the library directly by contacting Fiona Watson at infoservices@rcpsych.ac.uk or calling on 020 3701 2520

Throughout the year the College in Wales hosts a number of events that you can attend locally. These reflect our diverse range of faculties and often feature highly distinguished speakers.

These events often host poster competitions which can be entered by any of our trainees or members. We also offer discounted attendance to these events for trainees. You can claim CPD points for attending events and may be able to evidence your attendance in your portfolio. 

Our list of events is regularly available and updated.

HEIW is responsible for the education, development, and training of all healthcare workers in Wales. It replaced the Wales Deanery in October 2018, bringing together several different healthcare organisations.

The School of Psychiatry, within HEIW, is responsible for overseeing the training and professional development of psychiatrists in Wales.

The Interim Head of School is Dr Paul Emmerson, he’s supported by the Specialty Training Committee which brings together representatives from every Health Board. Dr Marque Fernando is the Training Programme Director for Core Psychiatry.

Head of School: Paul.Emmerson3@wales.nhs.uk

• Each Health Board has its own HEIW College Tutor and Training Programme Director who are involved in the day-to-day education of their trainees. Each Health Board runs its own education programmes, mainly through weekly postgraduate teaching.
• As a general rule, any day-to-day issues with training or education should be raised with your College Tutor, followed by the Training Programme director if the issue cannot be dealt with locally.
• The Specialist Training Committee meets three times a year, with a representative from the PTC attending each of these meetings. This is another way to feedback via trainee Reps any issues or problems that may arise.
• HEIW are responsible for running the Annual Review of Competency Progression (ARCP) and the Member of the Royal College of Psychiatrists (MRCPsych) course. Any questions about these resources can be directed to the Specialty Training Manager at HEIW.

Each year the ARCP Panel meet in order to review all trainees’ portfolios. You should set up your eportfolio account as soon as possible.

Over the past few years, the ARCP panel have met in the first week of June. The deadline for collating all necessary evidence into your portfolio is usually two weeks before the ARCP Panel meet.  By the end of core training, all areas of the curriculum should have been covered in sufficient detail for you to fill your portfolio. Your educational supervisor will be supervising this part of your training.

Each year the ARCP Panel meet in order to review all trainees’ portfolios. You should set up your eportfolio account as soon as possible.

Evidence for your portfolio can take several forms but listed below are the types of evidence required for ARCP (number required per year is shown in parentheses).

Types of evidence required for ARCP

• Case-Based Discussion (CbD): Discussion of a case and its management with a senior colleague. (4)
• Assessment of Clinical Expertise (ACE): A senior colleague observes you taking a full history and mental state examination (2 in CT1, 3 in CT2/3)
• Mini ACE: As above, but focused on a specific part of the patient interaction – i.e. mental state examination or management plan (4)

Multi-Source Feedback

• Mini Peer Assessment Tool (PAT): Mini PAT – Assessment of your behaviour by colleagues. (2)

Try and get a good range of feedback from across the multi-disciplinary team and not have too many from doctors – particularly those of the same grade as you. To get this released by your educational supervisor you need all assessing peers to have completed the form.

Alternatively, it can be released after it has expired. This is a month after starting it.

This is the most common reason to get a negative outcome at ARCP, so be sure to start the Mini PAT more than one month before the sign off date.

Other

• Reflective Piece – Reflection on a particular clinical or non-clinical event (no specific number required, but regularly throughout the year)
• Case-Based Discussion Group Assessment (CBDGA) – Usually obtained through attending regular Balint groups
• Case Presentation – Clinical presentation of an educational or interesting case – generally completed with at local postgraduate meeting (1)
• Journal Club Presentation – Again, generally completed with a local post-grad (1)
• Structured Assessment of Psychotherapy Expertise (SAPE) – Evidence of Psychotherapy – Will be expected by end of CT2

Next steps

When the form is complete, the evidence can be linked to a particular competency within the portfolio. This is so you can show that you have covered all areas of the curriculum in good depth. Try and keep the linking to within 3-4 competency areas per piece of evidence.

Once you have completed a few Workplace Based Assessments (WPBAs) you should aim to do a WBPA in an area that you haven’t covered elsewhere in your portfolio. These are then used by the ARCP panel as evidence in your portfolio. Competencies should be linked to Core Psychiatry Training (2016), the other areas are for higher training.

All workplace based assessments should be linked to a Case Log. You are expected to have a Case log of 50 by the end of CT3 – i.e. roughly 17 cases per year.

In general, anyone who has completed Foundation training will have been through a similar process previously. The Wales PTC would advise that it is important to be organised and try not to leave it all until the end of the Second placement.

The deadline is for the second half of the year is almost the end of May, leaving only four months (from February) to get everything completed. If you have any issues providing evidence for any reason, let your Educational Supervisor or College Tutor know as soon as possible.

The MRCPsych is the exam you will need to pass to become a member of the Royal College of Psychiatrists.

In Wales, the first sitting is paid for by the Welsh Government. Evidence of sitting the exam, In the form of an exam result, will need to be provided to claim reimbursement. An explanation of how to claim reimbursement is available.

There are two written exams:

• Paper A – Theoretical Basis of Psychiatry
• Paper B – Clinical Practice of Psychiatry

The PTC recommends talking to people who have recently passed the exam to find out more about sitting the exam. You can also find more information about the exam papers, such as topics that are covered, the current syllabus, as well as some sample questions. You may need to register for a free account before you can do this. This web page also provides details of how to apply for your examinations.

Ordinarily, you will need to have passed these two papers before you can complete the Clinical Assessment of Skills and Competencies (CASC), an OSCE based examination for psychiatry. Due to COVID-19, some exceptions have been made. Further guidance on completing CASC is available.

The PTC advise that you don’t leave all three of your exams until the end of core training, you can apply and take your exams at any point.

TrOn is a free online resource to aid your revision for the MRCPsych exams. It comprises of online modules which cover in great depth and breadth the topics that come up on the exam.

TrOn is a credible resource that can be recorded in your ARCP portfolio but is also incredibly flexible, allowing you to drop in and out of learning when it is convenient. The topics covered in TrOn are relating to Paper A MRCpsych exams.

Access the TrOn website. 

As part of your core training, all health boards in Wales offer you access to a study budget of £600. This is a fund which allows you to be reimbursed for travel and subsistence that you may incur as part of courses or exams attended. Try to claim this, a lot of trainees have not been claiming the full amount in recent years!

The way you request the study budget may vary from health board to health board. Most will ask you to access this via the Intrepid system. You should always keep your receipts for any courses or exams that you wish to be reimbursed for. If you need help identifying how to claim from the study budget, get in touch with the postgraduate department at the health board.

Trainees have access to 30 days study leave per year. Up to five of these can be for private study, usually taken shortly before one of the examinations. MRCPsych days are included in the total study leave total that trainees are allocated, but usually amount to 10-12 days, so there will be plenty left over.

Generally speaking leave has been allowed to be carried over between jobs if it has not been accessed due to COVID-19. Guidance on this can be found on the Health Education and Improvement Wales website.

General guidance around study leave for all trainees in Wales can be found on the Health in Wales website.

The ability to think in psychotherapeutic terms about patients is a key feature of the delivery of all psychiatric care.

As part of your core training, you will need to complete your psychotherapy competencies. This will be recorded in your portfolio as a Supervised Assessment of Psychotherapy Expertise (SAPE).

Training for psychotherapy refers to “cases”, these are examples you can give of when you have delivered psychotherapeutic treatment to patients. Over the course of core training, you will be required to complete at least two cases of different durations:

• Short therapy case: 12-20 sessions, as a minimum with one patient
• Long therapy case: over 20 sessions, as a minimum with one patient

A short case requires one SAPE associated with it, whilst a long case will have two SAPEs associated with it. The therapies must be of two different modalities.

The MRCPsych course offered by HEIW includes specific teaching sessions on psychotherapy modalities, usually with 2 sessions dedicated to Cognitive Behavioural Therapy (CBT) in CT1. HEIW should provide a course guide for more details.

It is the responsibility of trainees to identify patients that they can offer psychotherapeutic treatments to. The PTC suggests that Psychologists working within the Community Mental Health Team (CMHT) may be able to help trainees identify cases.

You may also need to evidence your competency to deliver these treatments with patients, you can use the taught sessions in the MRCPsych course to do so. 

It is ordinary practice that every week you should have a dedicated hour of supervision with your consultant.

This is an opportunity to talk through cases, ask questions and receive feedback. Supervision is very important so you should discuss this with your consultant as soon as possible after starting the job.

Regular meetings are usually preferable but if this isn’t possible you should book time in advance and make sure they are happening every week. You should write up reflections from your supervision meetings in your portfolio.

A Balint Group consists of a group of doctors meeting to discuss a case, usually one case per session. This is different from a traditional medical case presentation and focuses on the doctor-patient relationship. The initial idea was based on psychoanalysis, and the group is asked to reflect on the emotional impact an interaction had on both the patient and the doctor.

Balint Groups have been demonstrated to decrease burnout and is now a key part of Psychiatry training. Balint Groups will usually stay the same and will aim to meet on a regular basis, with the same supervisor.

The health board will normally organise Balint Groups and since COVID-19 some of these have been running virtually. If you find that Balint Groups are not running in your local area, get in touch with the PTC who may be able to resolve this. 

HEIW operate a support service for all trainee doctors in Wales, and it’s the first port of call for trainees who may be struggling. They are able to help trainees with advice, guidance and resources. They can also offer advice for trainees who fail and exam.

Find out more about the Professional Support Unit

We also provide a support service for psychiatrists of all grades to receive free, rapid, high quality support who may be experiencing personal or work-related difficulties. The service is totally confidential and delivered by trained Doctor Advisor College Members.

The service is available in normal office hours, Monday to Friday.

Phone: 020 7245 0412

Email: pss@rcpsych.ac.uk

Trainees are able to claim travel expenses through the SEL expenses system. This is for travel more than 10 miles beyond your base hospital. You must start claiming business mileage from the first month, as you can only back-claim for the previous three months.

Firstly, you need to create an account by emailing: nwssp.expensesse@wales.nhs.uk or by calling Payroll on 02920 903908. You will need to have your Health Board and Employee number to hand.

Once you have an account, you need to add your vehicle to the account, this will then be approved by SEL. Once that is approved, then you will be able to add claims – under “M&D Business Milage”. Almost always the reason given would be “Clinical Duties”.

Once you submit a claim it will be sent to your line manager, who is usually your Consultant.

Similarly if claiming for travel or study budget expenses, this should be claimed via the same system. 

All health boards operate an online leave booking system. This is via the Intrepid system.  

You should use your Wales email address and a unique PIN.

This system is linked to your rota, you will need to put a person who is covering you for the day that you request leave for. Annual must be applied for with at least six weeks’ notice. At CT1 you are entitled to 27 days per year, i.e. 13 per each days per 6 months placement, with one spare day.  After 5 years working for the NHS you will have access to 29 days annual leave a year. Any of the 8 bank holiday days that you work should be taken off as days “in leau”.  

We are all unwell from time to time. If you are unwell and unable to come into work, you should report this to the health board by no later than 9.30am on the first day of sickness. This allows for the health board to make alternative arrangements for your duties and if you have not already done so, will allow an admin to inform your teams of your absence.

You should normally contact every day including the day you are returning to work. You will be asked to complete a SSF1 form and to return it. A return to work interview may also be arranged.