Psychiatry in Scotland – Trainee perspectives on access to higher training

Now hurtling towards the end CT3, our cohort is anxiously anticipating our Higher Training applications. This anxiety started to grow from mid CT1 when we realised from fantastic CTs before us that the numbers of applicants and posts available were not adding up. Over the last year, to us as representatives locally and on the PTC, it became clear that concerns about Higher Training availability are widely shared.

In August of 2023, the college published ‘A Core to Higher Training Attrition Report’ which felt like the first time the reasons for losing trainees were being recognised. The report used trainee focus groups to explore the reasons and factors influencing applying for higher training (or not). What was missing was qualitative data from across Scotland and it felt like this was something we could address.

What we did

In October to November of 2023, we surveyed core trainees and specialty doctors across Scotland by email. And they responded. We received 90 responses, with good representation from each region, and each level of training.

Here was born “Scotland’s Core Trainees and Specialty Doctors: a collective report on opinions and attitudes towards the current limits on Higher Training in Psychiatry”. 

Some key findings

• 83.3% feel that the current availability of Higher Training posts is affecting morale and motivation in psychiatry. 

• The vast majority (96%) do plan to enter higher training, and most wish to enter higher training directly from core training (63% yes, 11% maybe). 

• Currently 29% of core trainees are Less Than Full Time (LTFT), but 64% answered that they would plan to, or consider doing LTFT in higher training. 

• The majority (70% yes, 20% maybe) wished to do their higher training in their current region, and if unable to do so, 27% said they would consider leaving Scotland. Free-text data included a number of respondents explaining that if they had to uproot, they would prefer to do so to countries like Australia.

What else did trainees tell us?

At the end of the survey was a “Do you have any additional comments?” free text box. What surprised us, was that a third of responders wrote in this box. Not only that, but with no prompting, many felt strongly enough to include long, detailed and earnest feedback. We grouped several of these comments by theme in our report and would encourage you to read these in full if you have time; we feel it has been the clearest representation of the impact of Higher Training availability on trainees. 

Recurring free-text themes:

• Frustration that Higher Training numbers are not whole-time equivalent
• Finding the “bottleneck” stressful and demoralizing
• Concerns about the Higher Training process not being sufficient to delineate best candidates
• Not feeling valued by the wider system
• Not feeling able to move region due to family/housing/other reasons
• Some respondents also spoke about seriously considering leaving Scotland or the NHS (secondary to the difficulties continuing their training locally)

Our take home message

Our findings highlight that the difficulties in accessing Higher Training in Scotland are negatively impacting trainees’ motivation to stay within Psychiatry in Scotland. We are desperately aware of consultant vacancies, and long patient waiting lists existing, alongside a large number of core trainees wishing to train to fill those vacancies.

We also want to highlight that this feedback was national across Scotland. 40% of our responses were from North/East regions (a greater proportion of the total number of trainees in those regions). There was no difference in the nature of feedback between regions. Accessing Higher Training is a national rather than regional concern. 

What did we do with the trainees’ collective voice?

We wanted to raise awareness and let Scotland’s trainees know that their voice had been heard and recognised. The data and proposed recommendations were discussed at these events:

• The RCPsych in Scotland Scottish Workforce and Careers Committee on 15 November 2023
• The RCPsych Devolved Scottish Council meeting on 16 November 2023
• The Mental Health Specialty Training Board meeting on 1 December 2023

The work has kindly been endorsed by the Workforce and Careers Committee and Devolved Council in Scotland. We have now published the full report on the Royal College’s website, and this has also been circulated to trainees and trainers across Scotland. 

What next?

We included 8 recommendations in the report, which are, in brief:

1. A move to full time equivalent training numbers
2. A local review of why any unfilled higher training posts are unfilled 
3. Moving to a closer ratio of core to higher training numbers
4. Increasing the number of higher training numbers
5. Expanding dual training opportunities
6. A planned strategy to improve accessibility to higher training with clear communication with trainees about decision-making, and reviews of the impact over time
7. Consideration of how unfilled training numbers could be utilised without being lost
8. Further, and separate, examination of factors leading to low morale, training fatigue and burnout 

Turning to future projects, we feel that qualitative data on trainee opinions should be core in further decision making. As raised by the report, it would be useful to specifically explore trainee opinions about the process of applying for higher training, what specific dual training combinations/regions are desired, and what other factors are leading to trainee demoralization and burnout. 

Thank you for helping us raise awareness by reading this blog! As is central to our report, we want to hear and understand peoples’ views – please do get in contact if you would like to share your thoughts.

Blog authors

Ewan Mahony (CT3, South East) and Ailsa Bruce (CT3, South East)

Report authors

• Ailsa Bruce (CT3, South East)
• Ewan Mahony (CT3, South East)
• Arwa Elwad (CT3, East)
• Rachel Ball (CT2, North)
• Siobhan Connelly (ST6, West)