Starting out as a trainee psychiatrist

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

Induction

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 (different for England and Wales, Scotland, and Northern Ireland) 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. 

Training posts

Posts generally last for either four or six 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. During your CT2 and CT3 years, you will typically work in more specialist posts, such as child and adolescent psychiatry, liaison psychiatry, addiction psychiatry and medical psychotherapy, as well as gaining further general adult psychiatry experiences. 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 person to approach.

Supervision

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 a 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 for medical ward cover, responsibilities are often divided between resident doctors in core training, 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 both psychiatric and acute medical care for patients. The medical registrar on call at the relevant acute hospital should be available to provide advice on medical issues, and there will always be a senior psychiatric doctor available for advice too. You may be asked to carry out assessments under the Mental Health Act on informal patients (i.e., for section 5 (2)), however, most Mental Health Act Assessments are carried out by more senior doctors and it is important to consult with a senior if you are unsure what is in your remit relation to the Mental Health Act.

Psychiatric ST4-6s and consultants are generally very approachable. It is important to discuss relevant issues with your seniors. These discussions are valuable teaching opportunities which can also be used as workplace-based assessments (WPBAs).

Good organisational skills are essential to avoid being overwhelmed by multiple demands on your time.

You will have time 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.

All resident doctors in psychiatry must join the Royal College of Psychiatrists, as specified in the Gold Guide (8th edition).

You can register online. The College organises frequent educational events and conferences, including many specifically aimed at resident doctors. Details are publicised on the College website.

We encourage resident doctors in psychiatry to join the Psychiatric Resident Doctors’ Committee (PRDC – formerly Psychiatric Trainee's Committee [PTC]). The PRDC comprises resident doctors elected from every College division and has representatives on most College committees. Further details are available on the PRDC webpages; You can contact the PRDC by e-mail at prdcsupport@rcpsych.ac.uk.

All resident doctors 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.

Exams

The College’s membership (MRCPsych) examinations involve two 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 PSS guide Dealing with Exams (PDF) and on the Exam section of the College’s website.

WPBAs

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.

Annual review of competence progression (ARCP)

These reviews usually occur in either June or December each year. 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 found in the Gold Guide.

 

Professional

• 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 on the PSS website).
•  Book study and annual leave well in advance to allow you to swap on-calls if necessary.
•  Find out about annual NHS appraisal procedures in your trust. 
•  Think about whether seeking a mentor might be helpful to you. There is more information in the Colleges’ Mentoring Guide for Trainees (PDF).

Personal

•  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 (GP).
•  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. 

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, 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.

This PSS webpage lists further sources of help and support.

This webpage is available as a downloadable PDF help sheet (PDF).