Why you should consider taking Dual Training

This blog post by Dr Sidra Chaudhry is part of the 2023 Choose Psychiatry campaign.

I started with general adult psychiatry rotating from inpatient to community posts, which gave me a variety of clinical and non-clinical experience in assessing and managing mental health disorders in people of working age.

I decided to group my general adult training years together as two consecutive years (ST4 and ST5) to allow continuity and consistency in development of my knowledge and skills as a general adult psychiatry registrar.

This helped me

• understand services catering to working age patient populations in a much better way
• build on my confidence in managing acute and chronic presentations of mental illness and to
• acquaint myself with the challenges in delivering exemplary patient care at local and regional levels.

During my general adult psychiatry training years, I quickly realised that I enjoyed working in the community particularly doing clinics and crisis assessments.

Working with adult patients, there was a degree of increased freedom in prescribing psychotropic medication to manage patients’ distress alongside psychotherapeutic interventions as there were generally fewer physical health co-morbidities to be mindful of. 

From General Adult to Old Age Liaison

As an ST6 I have now started working in Older People’s Liaison Psychiatry services, which has been one of the most rewarding placements of mine so far. I was understandably nervous, having done an Old Age placement only in my core training years and then being away from purely Old Age jobs until ST6.

I find working in an acute physical health hospital very motivating as I feel part of a wider team and work collaboratively with my medical and surgical colleagues to formulate holistic patient-centred plans.

Working in Older People’s Liaison Psychiatry services also allows me to refresh my knowledge and build my confidence around managing mental illness in those with physical health co-morbidities. 

The perks and the pitfalls

Dual training makes it easier to understand and work with people who transition from adulthood into old age, a journey that you could be actively involved in as a clinician. Working across the age spectrum makes one more confident in covering out of hours or teams where care is needs-led rather than age-based. 

Along with the perks of dual training, come the generic pitfalls as well. Dual training in general prolongs your training by a couple of years depending on whether you’re working fulltime or less than fulltime.

The longer period of training naturally means, more on-calls, more ARCPs and more portfolio requirements as compared to colleagues pursuing a single specialty.  Having been dual trained, you might find yourself at the receiving end of numerous consultations, some even inappropriate for your current role! 

I had the chance to speak to colleagues, who are also dual specialty higher trainees, and this is what they had to say about their training choices and experience.

What other Dual Trainees say

Dr David Bishop, who is an ST7 in Sheffield Health and Social NHS Foundation Trust likes the greater flexibility in terms of future career choices, especially if one isn’t sure about what they want to specialise in!

He also feels that dual specialty training in general adult and old age psychiatry could be a way of “future proofing” clinicians for teams where working age and old age populations are combined under one service. He also finds the prospects of training for an extra year quite attractive as that means extra time to work on research and develop special interests.

In some deaneries, dual training is the only way to get a CCT in old age psychiatry with an endorsement. This is also a significant factor in making trainees consider dual specialty training.

Speaking of the cons, David felt that having only two years in each specialty could make it harder to fit in inpatient training blocks and spending most of the time doing six monthly rotations opposed to yearly rotations. Dr Lauren Fitzmaurice, an ST5 trainee at the Rotherham, Doncaster and South Humber NHS Foundation Trust feels dual training opens up opportunities to working in an ageless mental health service, which is a very talked about move for the future of mental health services.

She feels a  con is potentially the increased training time but that it just gives trainees more time for professional development which lends itself to higher training such as extra qualifications. 

Dr Seonaid Beaumont, currently an ST4 dual specialty trainee has worked as a specialty doctor in the Older People’s Liaison Psychiatry Service and feels it would allow for an increased number of employment opportunities as a consultant.

She equally enjoys some aspects of adult psychiatry and old age psychiatry, which she wouldn’t want to give up! In some mental health community services, patients remain with a CMHT even after the age of 64 years.

Having the knowledge and skills of managing patients across the age spectrum helps in these circumstances. The only con, she could think of was the financial repercussions of not being a consultant at the end of six years of training as opposed to those who did single specialty training. 

With ST4 Psychiatry training application results just around the corner for the February 2024 intake, I hope this provides some clarity around the choices you may want to make when accepting your offers.

Wishing you all the very best!