Choose Psychiatry – Making training flexible

30 November 2022

In this podcast we hear from three trainees who each talk about one aspect of how the College encourages and supports flexibility in psychiatry training. We also go into how we'll be making training even more flexible over the next five years.

It was hosted by Dr Declan Hyland, Associate Dean for Choose Psychiatry (Careers), and we heard from Dr Rachel Kerrigan, Dr Jacqueline Haworth, and Dr Jehan Elturky.


Dr Declan Hyland (DH): Welcome, everybody. My name is Dr Declan Hyland, and I'm the incoming Associate Dean for the Royal College of Psychiatrists choose psychiatry. Thank you for joining me for this podcast today. I'm delighted today to tell you a little bit about the recruitment strategy that the college has recently produced for the next five years. And this has been a massive piece of work that my predecessor, dr Kate Lovett, led on in collaboration with lots of different faculties associated with the Royal College of Psychiatrists, and the English divisions and Devolved Nations. And there's been lots of people inputted into this piece of work. And the idea behind the recruitment strategy is really looking at what the college needs to do over the next five years, to not only recruit medical students and junior doctors into psychiatry, but also how we look after our trainees in psychiatry, both core trainees and higher trainees, and how we look after our specialty doctors as well and ensure that there are sufficient consultant posts as well. So it's really about recruitment and retention. And I'm delighted today to be joined by three trainees, or from the Mersey region where I'm based myself. And they're going to talk in turn a little bit about their own personal experience of being a trainee, and also talking a little bit about why they went into psychiatry, and then I'm going to ask them some questions about their own particular circumstances. So, we've got a trainee who's less than full time. And we've got a trainee who's done an out of program experience. And finally, a higher trainee who's going to talk a little bit more being less than full time, but predominantly about doing a special interest session, and also research session as well as part of a higher training. So I'm going to come on to our first trainee who is Jackie Haworth. So Jackie, would you like to say hello and introduce yourself?

Dr Jackie Haworth (JH): Thanks, Dr Hyland. Hi, everyone. So I'm Jackie Haworth, and one of the CT1s in the Mersey Care region, and started my training in February. Previously, I was an anaesthetic trainee and speciality doctor. And as dr Hyland mentioned, we're going to talk a little bit about less than full-time training, which I do currently for health and for childcare.

DH: Okay, so I guess, Jackie, you know, less than full-time training, maybe something that some of our listeners might not have even heard of before. So can you just explain a little bit about what less than full-time training means and the implications for your training pathway?

JH: Yeah, sure. So less than full-time training is essentially, you know, what the name suggests. It's a training program, it leads to a CCT in the same way as a full-time training award. But it gives you the opportunity to do it in like a longer period of time. So that means that you can work less days a week. So it really depends on what region that you work in, kind of what percentage of full-time is available. So we're really lucky in Mersey Care that we in sorry, in the Mersey and Health Education Northwest region, that we are able to train anywhere between kind of 50% and 80%. So that's really, really flexible. So since starting in February, I've actually changed my percentage, just because it's hard to find what percentage really works well for you and your circumstances. So previously, I did 60% In my previous role in anesthetics, which worked really, really well. But in psychiatry, I do feel that maybe it is better to work a slightly higher percentage, because obviously, we have lots of commitments, like our educational commitments, our Balint commitments, and it's just about getting the balance, right, between the clinical work and everything else.

DH: Okay, so and you said before, that you went less than full-time for both childcare reasons and health reasons. Do you feel then that going less than full-time has kind of benefited your health and actually made childcare a lot easier for you? Has that been a real advantage?

JH: Yeah, I mean, everybody's circumstances are different. And you know, that's not to say that, you know, it's not feasible to do it full-time. Some people can certainly manage it full-time. In my particular circumstance, I have a husband, who's an NHS consultant, working well beyond full-time, and it's just the two of us, so kind of one of us has to manage the kind of lion's share of what goes on. But for me, it has enabled me to stay in a training program. Obviously, it can be very frustrating because it takes a long time. And it can be hard when you do you know, naturally compare yourself to your peers. However, you know, it is then possible to stay in the training program. And it also allows you to do the training program in the way that you want to do it. So you're not constantly juggling things you do have time to do the little bit that you want to do. outside. So, for example, since February, I've been able to do some work on a poster. And I presented a regional poster already. And I was also involved in the local teaching program. So that was things that I was interested in, that perhaps I wouldn't have had the time to do has not been less than full-time.

DH: Okay, so I think that's really important, isn't it that, you know, less than full-time trainees not just for those trainees were thinking of starting a family or who have childcare commitments or, you know, primary care commitments. So it allows you to take on additional interest that you might not be able to do if you were working full-time. And one of the things that you mentioned, Jackie was around sort of comparing yourself to peers. I mean, you know, lots of trainees now, in psychiatry are opting to work less than full-time, have you had any negative any any sort of negative experiences with any trainees, because of the fact that you're less than full-time, as opposed to full-time?

JH: No, I would probably say the opposite. To be honest, if anything, I feel like sometimes my full-time colleagues are a little bit envious, especially when you've got a day off, and they haven't. And I think it is becoming more and more popular. So obviously, when I first became less than full-time, which is more than 10 years ago now. So it was quite a long time ago. it was a lot rarer than it is now with the introduction of category three, basically, any trainee is able to go less than full-time, if they wish, obviously, like it has to be able to be accommodated within the region. So it might not be possible straightaway. However, you know, more and more people are interested because it does give you that better work life balance. So even if you don't have a particular reason, you know, if you feel that you'd like to work less days a week, then you could consider less than full-time training,

DH: And has been less than full-time has it sort of hindered your progress in terms of sort of getting your membership exams? And, you know, you mentioned about sort of Balint groups and needing to get psychotherapy cases as a core trainee, which are sort of mandatory requirements, obviously, to complete core training has it hindered your progress in any of those respects?

JH: No, obviously, I'm still very early on in my training. And so I've not been doing my exams yet. In terms of the Balint groups, it can be difficult, if it's a day that's difficult for you to work. So for example, our regional training teaching program is on a Thursday, I don't normally work on a Thursday. So that has involved a little bit of negotiation to kind of be flexible, because you know, you need to have those training opportunities. But in terms of revision and time to prepare, you actually have a bit more, because obviously, if you do have commitments outside of work, or you do have health problems, you have an appointment to you know, attend or other commitments say, then you do lose that time. So that's where less than full-time training comes in. Because it means that you do have that time, even if you've got a busy life outside of work the most trainees

DH: And I think one of the things that training you might worry about is perhaps the attitude of clinical education supervisors, whether that, you know, that will be received in a sort of negative light is Have you had any anything like that at all or have supervisors generally been supportive?

JH: I think on the home people have been very supportive. I think compared to other specialities, like paediatrics, where less than full-time has been, you know, more established for a longer period. I don't think we're quite there yet. However, it certainly not been a problem. And in terms of adjusting my kind of full-time, percentage full-time equivalent, that hasn't been an issue at all. And you know, that was really proactively done. And it means that then, you know, as my circumstances change, not even just before or after training, but during the program, I'm confident that that can kind of accommodate that.

DH: And now, you mentioned before that in terms of less than full-time training, it can range from sort of, you know, 50% to 80%. So, you know, you can modify that, can you change them throughout your core training, you haven't got to stay as a 60% trainee, right, through your core training, is that correct? You can modify it as and when you want to.

JH: So, again, I really feel that it is region-dependent and speciality-dependent. Previously, and anaesthetics. You know, for a long time, we could only do 60%. But, you know, in this particular region, in psychiatry, it's been really, really flexible. I think if there was an emergency and you needed to drop your hours, suddenly, it can be accommodated in as little as 48 hours is my understanding. But on the whole, it's much easier if you can kind of tie it in with the rotation. But then other than that isn't really a problem.

DH: I suppose for any junior doctor or trainee, that sort of thinking less than We'll start training, would you have any sort of words of advice or any guidance on, on how to go about the process?

JH: I think the first thing, of course, is to do some research. There are disadvantages to less than full-time training, the most obvious one being that it does take longer to get to CCT. The other being of course, there's financial implications. So in the short term, you will be in a less pay. But also, it's going to have long term impact as well, because it'll take you longer to become a consultant. And you're going to be paying less into your pension each year, which we may not want to think about at the start of our training. But certainly towards the end, that is something that we're going to be thinking about more and more. So I think, do your research work out if it's well for you speak to kind of other less than full-time trainees. One word of advice, I would say, certainly from my previous experience, is if you can, try and do your initial period of training full-time, because when you do rotate to less than full-time trainee, it does take a little bit longer to settle into your placements. So psychiatry is a brand new speciality. And you are quite Junior, as a doctor saying straight out of foundation training, I think it would be beneficial to get your confidence up if you can do that initial part full-time. But obviously, everyone's circumstances are different. And that shouldn't put you off. And certainly, you know, should be well supported if you do decide to go less and full-time right from the beginning.

DH: Okay, that's great. Thank you, Jackie. That's fantastic. So I'm going to move on now to our second trainee, Rachel Kerrigan. So, Rachel you took and our program experience. So I think our listeners would be really keen to know, what is an outer program experience? And what did you do and why?

Dr Rachel Kerrigan (RK): Well, there's a few different types of out of program experiences, you could take a period out of program for research or out of program training, that's different to, you know, the competencies in the CCT. But for me, I took an out of program career break, which means I'm not doing any psychiatry for a few months. So I've taken a six month program, and I understand it can take up to 12 months, fairly, fairly easily. And I think there's some parallels to the category three have less than full-time training. So rather than having to apply for family reasons, or because of personal circumstances, now it's possible to apply for an out of program, experience, be it career break, or otherwise, without having to have a particular set of reasons. So for me, I had a few reasons I wanted to take some time out, it was so that I could have a civil partnership with my partner and enjoy spending time with friends and family. I also still had a dream of having a kind of gap year experience. And so I've spent the last six weeks in South America, improving my Spanish and being immersed in a culture that I otherwise wouldn't have experienced. And I also wanted to spend some time with elderly relatives abroad. So I had also considered where they go in less than full-time might work. And I could travel see them that way. But on the whole, taking six month period, out of program has been really perfect for me.

DH: And in terms of sort of the process of actually applying for out of program experience. Did you find that quite sort of easy to navigate? Or was it difficult to kind of understand the processes involved with that?

RK: No, it was really straightforward. So it started with a conversation with my educational supervisor. And we talked through the options, pros and cons of what I was thinking about. And then there were there was some paperwork application, but it was very, very straightforward. And the turnaround was pretty quick. So I knew within I think within about a week, I'd got my answer.

DH: And of course, you've had six months away from psychiatry. Now, I suppose the obvious question is, have you lost your interest for psychiatry, or are you still dying to get back now to your training?

RK: Well, dying to get back might be it might be a stretch, but no, I am. I'm looking forward to coming back. Pleased with my next rotation allocation, and actually the Health Education Northwest have been really proactive. And they've emailed me already about a return to training event that's happening in January. So I'll be restarting at the beginning of February. And I've also been in contact with my educational supervisor via email. So it's not going to be totally in the deep end, and kind of eased back in.

DH: And, I mean, I suppose it the other thing that I would sort of think about where if you're thinking of sort of going out a program, I mean, sounds like a bit of a positive experience, do you know of anyone that's kind of had a more difficult experience? Or not quite sort of being able to do what they wanted to do? Or is there generally, that flexibility there to kind of tailor the out of program experience to what you want to do and, and be able to achieve that without any difficulty?

RK: Oh, I don't know of anyone having a negative experience. And I in fact, I only know of one other person who's planning to take an out of program career break. Similarly, to my reasons, and I don't think they've had any issues in the application process. So not that I'm aware of.

DH: would you have any advice for any of the trainees or perhaps thinking about our program experience, or if any of our listeners have medical students or foundation doctors, any advice on, you know, how they might go about considering that program and experience for, you know, whatever reason.

RK: I'd say, firstly, plan your finances. So I sold my nice car, to fund this, and to have an old banger in place. And the other piece of advice would be to apply as early as you can, once you start thinking about it, have those discussions with your educational supervisor, talk with your family and friends. So you know, it is a big decision, six months out program, six months salary, not a decision to to take lightly. And the sooner the sooner you apply, the sooner you know, and the easier it is to plan.

DH: And it certainly your training pathway, Rachel, I mean, I'm not sure how far you on how far on you are with your exams, MRCPsych exams. But do you think that's going to be affected at all by you doing the Out of Program experience? Or is that not going to hinder your progress, do you think?

RK: Hopefully not. And I've, I had completed CT2 at the point that I paused for the career break. And in fact, I did the second exam paper B whilst I was on the career break. So I don't think it would, it should hinder anything, because that just leaves one exam. The CASC to do within a year. So hopefully, that's a workable timeframe. So I got at least two sittings.

DH: Okay, that's great. And I suppose the final question, I'd like to ask you in relation to out of program experiences? Was it worth it? Do you think it was the right thing for you to do? And do you have any regrets at all?

RK: Absolutely. I've no regrets it's been traveling in Colombia has been the experience of a lifetime. And I only wish that I had gotten there for longer. Yeah, no, no regrets.

DH: And I think you mentioned it was like the opportunity to take the gap year that you perhaps didn't take between foundation training and core training. Is that Is that right?

RK: Yeah. The unmentionable, the pandemic that hampered previous plans. So for me, it's been, it's been really wonderful to be able to do both for both training the specialty that I went to, and also fulfil those are the dreams.

DH: Okay, thank you, Rachel. I'm gonna move on to our final trainee, then Jehan. So Jehan, you're a Higher Trainee, unlike Rachel and Jackie, who are Core Trainees. So you're a bit further on with your training in psychiatry. Can you tell the listeners a little bit then about your experience as a Higher Trainee because I know you're less than full-time. But I guess the other thing I'm particularly interested in is in relation to the benefits associated with higher training terms of special interest sessions and research sessions. So can you tell us a little bit about your background?

Dr Jehan Elturky (JE): Yeah, sure. So I'm, I'm a dual trainee. So I'm doing training in general adult psychiatry and also medical psychotherapy. Which is a five-year training program, possibly more for me because I'm doing this full-time. So I get plenty of time to do research and special interest sessions. Because of the type of my training, because I'm doing medica psychotherapy, it's going to be my special interest session is always going to be medical psychotherapy. And this is what I'm doing. Doing psychotherapy sessions, and also participating in a kind of a weekly psychotherapy seminars, discussing papers on psychotherapy, which works really well for me. Because I have both both identities, being a psychiatrist and also a medical psychotherapist because I think this is the beauty of psychiatry is it's such an integrative type of medicine really, where there's a holistic approach of biopsychosocial approach, and I feel like in higher training, I have the privilege of just practicing both things that I like.

DH: So can I just ask them, Jehan, so with dual training, so you said it's five years, and you're doing general adult psychiatry and medical psychotherapy alongside that? So just so I'm clear, with regards to the five years do you do so many years of general adult psychiatry and community settings and inpatient settings? And then so many years of medical psychotherapy? Or is it that the medical psychotherapy is kind of mixed in on a yearly basis with a general adult placement?

JE: Well, it's a bit, it's a bit complicated. So in the two years of the training in general adult, in addition to a special interest session in medical psychotherapy, and then I moved to another three years of medical psychotherapy, but I spent, I spent the whole time in psychotherapy, there is no special interests session there.

DH: Okay. And why was it you chose to your training then, as opposed to just going into a single specialty? What, what kind of drove that decision for you?

JE: I think, again, because I'm someone who is fascinated with, with how psychiatry is approaching our patients' holistic approach and seeing them as bulging minds. It's, I'm someone who likes to look at buttons and work on them. And in the symptoms are patients who come to us with a psychiatric disorder there is there are usually some patterns, some problematic behaviour, some dynamics that just brings my attention, I feel like I want also to work in them. So although it's taking obviously much more time, but you know, five years are gonna pass by anyway. And for me, it feels good that when I finish five years, I'm going to be specialising in in everything that I want.

DH:  And I suppose, you know, regardless of whichever specialty we work in, in psychiatry, I guess that doctor patient interaction, and those relationships are important, aren't they, in terms of sort of maintaining therapeutic alliance, etc. And what you're doing is kind of giving yourself a little bit more expertise, you know, in that and developing, you know, increased knowledge of different modalities of psychotherapy that presumably you came across as a core trainee. And when you've done your core training, psychotherapy cases, and you're Balint group, etc. So did that spark an initial interest in psychotherapy for you?

JE: Yeah, definitely doing like doing psychotherapy, in core training has made me more aware of this is something that I really want to continue. And yes, just as you said, like psychiatry is all about really relationships. It's a relation, relational kind of practice, and there's always an emphasis and on doctor-patient relationship and alliance maybe more than other specialities.

DH: And do you see yourself at the end of five years going into a general adult consultant post or a medical psychotherapy post? Or is that something that you consider?

JE: Obviously I'm doing both because I can see myself doing both and then I kind of it's also it's interesting that I can change roles that I can do a bit of both it's just it's certainly not going to be boring for me.

DH: And in terms of your sort of decision to do dual training, had you spoken to other higher trainees that were doing dual training and you got sort of an indication as to from them as to whether it was a good thing to do and what were the positives of it, etc.

JE: Well, given that I started higher training coming from abroad, so I didn't have much exposure to trainees. However, I've done some research and have also asked around before choosing. Some of that trainees in the region I have contacted them and asked them about it and it it's just it's encouraging, it's a promising job that I felt you know, that I would like to try that and I feel like you know, I'm happy with my choice now.

DH: And from a supervisor perspective, have you found that sort of supervisors have been supportive? You know, because obviously your training is extended to five years, as you've said, and you're sort of doing posts in different environments if you like, have you found trainees, sorry, have you found trainers have been generally supportive of you throughout the dual training that you've completed?

JE: Yeah, really, like, almost my experience here. My supervisors had been appreciating my special interest and also my, like my, because it also comes with some kind of education and commitments in both specialities. So I found that yes it can be managed, I can be supported in both specialities which is helpful listening.

DH: I just wanted to briefly touch on a special interest session and research sessions. So as higher trainees, you're allowed half a day for your special interest session half a day for your research sessions. Is that correct?

JE: Yeah.

DH: Yeah. And is that time ringfence for you? Is that Is that something that you really have to fight for as a higher trainee? Or is it something that's kind of generally protected, you're not, you know, you don't have to worry about missing it, etc.

JE: I haven't been really worried in regards that I haven't really worked, for example, you know, like my consultants and my supervisor had been always encouraging for me to fulfil the research competencies, it's a bit difficult for me, because I'm doing a full day of special interest in medical psychotherapy. So it's a bit difficult for me to fit in research time, also, because I'm working less than full-time. So this is something that I'm working on to, to get the full-time but to be honest, like, it is time management, lots of other trainees who are doing like half a half-day session of special interest, you can easily get another half day for research and audits and I haven't really had so far problems about that. It's kind of a protected time, as long as it doesn't clash with, you know, major clinical and other education. commitments, obviously. Yeah, but it usually was arranged with the supervisees.

DH: Okay. All right. Well, thank you very much, Jehan, and thank you, Jackie, and Rachel as well, it's, it's been fascinating talking to all three of you today. And I guess you're all coming from fairly different backgrounds. I think it's given our listeners a really good insight into the possibilities available within both core training and psychiatry in higher training as well in terms of working less than full-time considering and out of program experience. And also thinking about dual training as well, in terms of higher training in psychiatry, so I just want to say a massive thank you to yourself, Jackie, Rachel, and Jehan for joining us today. And it's been interesting for me. So thank you very much.

JE: Thank you.

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