What makes a great psychiatrist? Four core skills every trainee psychiatrist needs

Interested in specialising in psychiatry? Dr Ian Collings explores the key competencies that are vital for any medical student or trainee doctor transitioning into mental health.

Hello! My name is Ian and I'm a rehabilitation psychiatrist.

I’m incredibly passionate about education and development, and have a number of roles in Wales related to this – from improving trainee support through Health Education and Improvement Wales, to directing the Welsh Clinical Leadership Fellowship, a one year out of program qualification for doctors and other healthcare professionals to develop leadership skills.

I have always loved the responsibility of promoting psychiatry to medical students and trainee doctors. I think psychiatry provides the opportunity to have a wonderful, fulfilling medical career that can be truly humbling and uplifting at the same time. It is a great privilege to work with people at the most difficult times in their lives – a responsibility that psychiatrists should cherish and be the guardian of.

Practising any aspect of medicine is a lifelong learning process, one in which mistakes sometimes happen, and you can take a wrong turn. The important thing is to always reflect, move forward and grow when things don’t go to plan. After all, even doctors like myself don’t have everything figured out.

In addition, there are some skills that it’s helpful to focus on, to adapt to the psychiatric working environment. If I was to distil some of the most important ones a medical student or trainee doctor should try to develop to really shine, these would be my top four.

1. Great communication skills

Communication skills are of course the cornerstone of practising medicine, but I would say that they are even more crucial when you are a psychiatrist.

As psychiatrists, we spend a lot of time with patients listening to them in a non-judgemental way. We listen to try and understand their lives, their inner worlds and their thoughts, feelings and emotions. A thorough history is crucial when trying to diagnose our patients’ problems – and we may often have to try and support them when they have a range of communication difficulties, for example in those with physical brain disorders (such as dementia or brain damage) or intellectual disabilities.

This is why patience and understanding go hand in hand with being able to listen effectively. When communicating with patients, we also need to strive in doing it in a way that is clear, effective and understandable – avoiding jargon and using language that is familiar to them. Without this, we won’t be able to build a productive and supportive relationship with them.

2. The ability to manage uncertainty

Psychiatry is a specialty of clinical uncertainty. Humans are complex beings with unique patterns of experience and behaviour, and, for that reason, mental illness can often evolve, with diagnoses changing as more information comes to light.

In addition, patients diagnosed with the same illness will often require very different plans in place to support them. No two people suffering from schizophrenia – for example – will have the same cluster of symptoms. And people will respond differently to treatments; one may respond fully to a medication whereas someone else may not respond at all.

For me, this is one of the most fascinating things about being a psychiatrist – a feature which always ensures you are thinking on your feet. Our patients do not fit neatly into boxes and this can be challenging (and sometimes frustrating) for those who require more clear boundaries when practising medicine.

If you can embrace this aspect of psychiatry, you’ll be destined for a rewarding career filled with intellectual stimulation and enquiry.

3. Dealing with difficult emotions

The behaviour of our patients – and the stories they tell us – can sometimes be challenging, and this can impact the way we may communicate or empathise with them.

Take for example a patient who is aggressive or hostile to us. Of course, it is so important not to take this kind of response personally, as the patient may be angry about a range of issues unrelated to you. But this is often easier said than done – it can be completely human to become angry or frightened in these circumstances. The flight or fight response results in adrenaline coursing through our veins, and it’s not always easy to keep it in check.

Throughout my career, this has been the skill that I have had to work at the most. As a young psychiatric trainee doctor, I remember a time I became angry and raised my voice when faced with a particularly aggressive patient. The patient was a young man who had been referred to an outpatient clinic for psychotic symptoms – and after our first appointment he stormed out even more angry than when he entered. I kicked myself afterwards and spent the next few sessions trying to repair the doctor/patient relationship. I was fortunate he came back!

I eventually went on to develop an excellent relationship with him, diagnosing him with OCD – not psychosis – and effectively treating him. I think about that encounter even now as a consultant. The key is to try to become calmer as the patient gets angrier. It can often help to diffuse a situation ... but it does need a lot of practice!

4. A broad understanding of illness

I have often heard psychiatry referred to as ‘an art rather than a science’. Of course, that’s not totally true – but it is incredibly important not to just focus on the biological aspects of mental illness. One needs to look at our patients through the psychological and social lens as well.

Mental illness has complex and intertwined aetiologies. Whilst neurotransmitters and genetics play an important role in mental illness, so do the impact of life experiences and the sociocultural context of the individual. Similarly, our treatments in psychiatry aren’t just about prescribing medications. Whilst medications can play an important role, psychological and social treatments are just as important and always need to be considered side by side with medication.

This is why psychiatrists need to have a good understanding of the psychological and social aspects of illness and illness behaviour, and not just be biologically-minded.

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One of the interesting things about some of the skills above is that they haven’t just helped me to develop into a better doctor and psychiatrist – they have helped me in my other roles, as well as in life in general. Being able to effectively communicate, navigate in uncertain times and deal with people’s difficult emotions are key to being an effective leader, too.

If you are keen to develop and diversify your career, the skills you learn as a psychiatrist can really facilitate this – and will give you an advantage in all areas of your life, beyond the walls of your workplace.