It takes two: trainees' perspectives on dual training

We have a very special podcast as part of our Choose Psychiatry campaign on dual training.

Dual training involves psychiatrists being fully experienced across two key disciplines. Joining us we have three dual trainees, Dr Ross Runciman, Dr Orima Kamalu and Dr Jennifer Parker, who are all involved in General Adult and Old Age Psychiatry.

In this podcast, we discuss the highs and lows of learning two different specialties, career development and staying motivated

To learn more about becoming a dual trainee please see our Dual Training page.

Transcript

Ella Marchant: Hello and welcome to the Royal College of Psychiatrists podcast with me Ella Marchant.

We have a very special podcast as part of our Choose Psychiatry campaign on dual training. Dual training involves psychiatrists being fully experienced across two key disciplines. This could be General Adult and Old Age Psychiatry, but could also be Forensic Psychiatry and Medical Psychotherapy or Child and Adolescent with Intellectual Disability. 

A challenging and rewarding path, dual training allows for a huge breadth of clinical experience and can provide more career opportunities for psychiatrists.

Joining us on the podcast we have three dual trainees, Dr Ross Runciman, Dr Orima Kamalu and Dr Jennifer Parker. Who are all involved in General Adult and Old Age Psychiatry. We will be discussing the highs and lows of learning two different specialties, career development and staying motivated.

So obviously, there is quite a lot to take on with being dual trained. So, what are the opportunities and pitfalls?

Jennifer Parker: I guess the really nice thing about dual training in old age and general adult is being able to think about people and care for people across the age spectrum. So, thinking about people, right from the time when they become adults, through their whole life without having to take a pause at any stage, which is really nice.

EM: Orima, could we hear from you on an honest opinion on what are the pitfalls if there are any of dual training.

Orima Kamalu: With regards to pitfalls I guess, and some of the things that count as real benefits when you're doing dual training. So, that ability to sort of work across all the ages, from early adulthood up into old age, probably also means that the breadth of what you cover in training is quite broad, because the two specialties are quite the opposite. They are distinct from each other, even though there's a lot of overlap. I think that just means that there's across the training, there is a lot more I think, to take in than if you were training in one specialty. And also it does mean that you're open to a lot more opportunities. 

I think it's really important to think about how you're going to sort of balance out your time and what you're going to focus on over the course of the training as well, just to be a bit more mindful about that. But I genuinely think the benefits outweigh any negatives.

EM: And Ross, what do you feel like have been the opportunities that you've been given through being dual trained that you wouldn't necessarily have had if you were in one discipline?

Ross Runciman: Absolutely, I think it's that vision of healthcare. So, I think there's two things I wanted to bring out. Firstly, thinking about integrated care systems, thinking about the future of how healthcare is vertically and horizontally integrated. Now, this may sound like a leap. But actually having that broader perspective enables you to look through someone's journey through healthcare services. Increasingly, you know, it's vital that we consider that patient centred care. So, that journey through and having that oversight of what it's like through the ages, enables you to think from a more patient perspective,  that's when I think, so that's the first thing. 

The second thing isn't so much as a direct advantage, or an enhancement. So, for example, I'm doing liaison endorsement at the moment, I'm doing it towards the end of my training, when I've had that dual training experience until now, in general, that old age means I can make more out of that liaison experience. So, I think it's enhancing, and it's as kind of mentioned by my colleagues, it's that broad perspective, and that reflects not just to the clinical, but when you think about the leadership, and indeed the future of healthcare.

EM: And Orima, to you as well, there is at the moment, a nationwide shortage of psychiatrists, especially addiction psychiatry. So, in terms of dual training, do you think this could help with workplace shortages?

OK: Oh, absolutely. And I think one of the benefits of dual training is that is definitely having that dual CCT. So, the ability to work, either as a general adult psychiatrist or in later life. And what that can mean, I think, for a lot of trainees, when they get to fully qualifying and working as a consultant, is that you're potentially a lot more flexible when it comes to trying to work in roles that may open up in you local services, or wherever you want to work. And it means that you're not quite as restricted when it comes to opportunities. And by the time of CCT, I think that was one of those attractive aspects of job training for myself is that it just means at the time I come to be a consultant, there's a lot more options and opportunities and ways of helping services than if I was sort of single trained.

EM: Jennifer, same question to you as well. There is a shortage of psychiatrists right now. Was that kind of on your mind when you decided to do dual training?

JP: I suppose it's always something to think about, which is, kind of thinking about will there be a job for me at the end of this training, and adding really to what Orima said. There's a greater wealth of opportunity that is opened up by being a dual trainee. Not least because you can sort of choose a job that focuses predominantly on later life or general adults, or indeed a job, which kind of blends the two together. So, there's kind of almost three channels that you can choose from there, as opposed to just one.

EM: And in terms of workload, Ross, do you feel like you can occasionally get swamped? Because you're doing dual training? Do you feel like it's manageable? Is this something that you speak about with people who are in one discipline?

RR: I think this works in different ways. I think about the liaison dimension at the moment that that's most relatable for me is there is more chance of being asked to do things because people know that you're trained. So, my working age colleagues and my older adult colleagues, perhaps nursing college will approach in equal numbers. That might have workload implications. But there's an interim stage here as well to say, actually, because I've got more time in training, I'm also having more time to develop those non clinical skills in managing the workload, managing my own time, there's a compensation there.

I also think there's an implication, say, if you're on call, you know, increasingly talking about systems under pressure, you're asked to do centralised rotas that might have older adults. General adults, as well as young people on that same rota. So, again, having that broad base manages that workload. So, absolutely. I'm not going to wash over and say it's straightforward. But you are equipping yourself with a broader skill set. Even if in the shorter term, there's a little bit more pressure.

EM: Orima, how do you feel about the workload of dual training?

OK: I was sort of taking the time to reflect on that a bit as Ross was speaking. And I think, and I completely agree with what he says. There is the risk that you can end up taking on a bit more than your single trained colleagues, because you have that breadth of experience and trainings, particularly when you're working in services that may sort of cross cover. Including community placements or liaison placements. But I think in fact, in reality, what I've seen is that I don't think we're significantly more stretched or have significantly more responsibility or workload than our single train colleagues. 

What it really comes down to is just being aware of the fact that you are going to be training across a big ball of a broad range of subjects. And just making sure that we're, that one balances out there. So, time and clinical workload appropriately to that, and was made a really good point there about the length of trading as well, because we get that extra year in jaw training. It really does help I think, in sort of planning your higher training in a bit less of an intensive way. And then thinking about the fact that you've got that extra time to take on other opportunities that may be non-clinical as well.  Really having that extra time to, yeah, to develop yourself clinically. I think that's so if anything, I think it really does balance out.

EM: What Orima was saying about developing clinically, is that something that resonates with you, Ross?

RR: Absolutely. As Irene was kindly relaying this, I was thinking about how selfish they are, I've seen colleagues on single CCT, who are approaching jobs, I've got the opportunity to learn from them. So, it's creating thinking and developing space. And it's also an opportunity to figure out what's most important to you. I guess, from my perspective, I never had to decide whether I really wanted to be a general adult or an old age psychiatrist. So, it forestalled that decision for me, and it gives me those options going forward. But that space to develop further is, measurable. And I'm really conscious of thinking about my 30 year consultant colleagues who reflect back and say, make sure you make the most of training. And I think that's one of the qualities of your training, it gives you just that to make the most of it.

EM: And what do you think they mean, when they say make the most of training? Do you think they mean like getting different experiences of patients or making friends? Like what do you think people mean when they say that?

RR: That's a good point. I mean, I think it means different things for different consultants. But what I would say is, I think it's about making use of that breadth. So, if you've got an interest in, say, perinatal, so that's my special interest session at the moment, then taking that opportunity to go and explore that service, or perhaps seeking breadth in addiction services, seeing if you can get some more experience in that. That's part of it. 

I think you're absolutely right, that finding time to develop friendships and also develop professional relationships as well. Network within your healthcare organisation, and that you're training in. So, both professionally and personally that space and time is really important and again, we're back to those themes of kind of breadth and also of diversity in that training, which really helps you, when you approach the jobs market.

EM: Definitely, it's great to have had a broad spectrum of experience and to have seen as much as possible before you settle down in a place because I'm guessing, once you do settle down in your first job, you're there for quite a long time?

RR: Potentially, I think that, again, we're back to that. If you have a broad base, then you're not necessarily committing just to general adult or just to old age, that's not to minimise those excellent specialties at all. But you actually have that broad portfolio from day one. I also wonder, perhaps what we didn't mention earlier, is about credentialing in the future there. So, again, I've mentioned liaison, but even if you don't have that opportunity, during your dual training, the prospect of a credential later on is really helped by a foundation of dual training before your CCT. So, again, it's that forward planning, I think that dual training gives you.

EM: Jennifer, is that something that resonates with you, this clinical development Orima was talking about because you're quite early on in your training.

JP: Yeah, I mean, I'm quite early in my higher training. And so at the moment, I've mostly been focusing on old age, but certainly it does feel as though I'm going to have the opportunity to be exposed to a really broad spectrum throughout the course of my training. Which is I suppose, broader than if I had chosen to do a single specialty. And that's, you know, there's also more time to do it. And that's a really kind of great opportunity, I think.

EM: And going back to you, Orima, how do you achieve work life balance? Do you think it's possible?

OK: Yeah, that's a really good question. I think something that, myself, my colleagues, and everybody who sort of works in medicine is always striving to try to find the answer to really. I think it absolutely is possible. And it really much depends on a lot of factors. So specifically to your training, and something that those have mentioned already, it's just really important, to take on as many of the opportunities as we're offered. But also know, and develop that skill in saying, knowing when to say no. Or filtering out those opportunities that might be really beneficial to your progress. 

Yeah, I think it's a constant sort of learning process. And, and yeah, I would be welcome to hear anybody else's thoughts on how to do that, because it's something I'm still learning to do. Myself really?

EM: Absolutely. Jennifer, can we hear from you from the same question, please?

JP: Yeah, I think Orima that you've made some really good points about how I suppose with more opportunities being offered, there's that kind of potential for becoming slightly more overwhelmed by saying yes to lots and lots of things. So I suppose it is a case of needing to be mindful of that. That's something that would kind of come up in any in any specialty, whether you're dual trainee, or not, there are often a lot of opportunities. And I do think it's possible to find a work life balance, whether you're a dual trainee or nurse.

EM: Ross, do you think that anyone training to be a psychiatrist, or who is currently psychiatrists would struggle with a work life balance? Or do you think it might be worse, if you're doing dual training?

RR: Yeah, I'm not sure it's worse doing dual training. I think that any doctor at the moment struggles with work life balance. There's a risk of falling into cliches here. But there are incredible pressures on the health service. And it can seem really paradoxical at the risk of sounding obvious, it seems really paradoxical to do that self care, enabling you to go and care for everybody else. And obviously, I would never suggest ever, that the doctor try and heal thyself without assistance, of course. But, that advice that we would give to our colleagues or patients is probably the advice we need to take ourselves to take that time out. So, what I'm trying to say is that doctors tend to be incredibly motivated people who think about themselves less or think about themselves last. So, we need to take the advice that we would give, but I don't think dual training has a particular opposition to that. I think paradoxically, again, that breadth that we talked about, may in fact, have a link. For example, in dual training, seeing that life course, kind of starts to remind you of what's important. Seeing someone say for example, with dementia at the end of life and wanting to know what was important to them and to see their memories and to see their family with them. That can be really refocusing. So if anything, I think for me, dual training is a greater reminder about the centrality of the work life balance and it's certainly not an option. It's core business.

EM: Absolutely, I definitely feel like work life balance is improving since the pandemic for lots of people, because organisations have realised actually, people can do stuff from home. Do you feel like the pandemic has calmed things down and and kind of made people take stock and have more work life balance? Or do you think it's, you know, obviously increased stress in a inpatient setting?

JP: Yeah, I think that's a really, it's a really difficult question. I suppose I think with more working from home and sort of the change in working it actually, in some ways I have found, maybe makes it slightly more difficult to balance, work life and find that work life balance. Because I think sometimes work can really bleed into home life in a way that it previously didn't. And I'm currently doing an inpatient job. And actually, some of the things, you know that some of the tasks I suppose, unroll from that inpatient job I have been doing from home. Maybe when I've been too unwell to go into work, but maybe not too unwell to work, like, for example, getting a cold and thinking: Well, I'm not, you know, really unwell - but maybe I shouldn't go into a ward like this. Whereas I think, historically, or pre COVID, we wouldn't have necessarily had that challenge or that opposition. So, I'm not sure if COVID has actually really helped it work life balance or hinders, difficult to say.

EM: Thank you, I realised that wasn't a very easy question to answer.

RR: So, I think about inpatient settings, I think there's a few little pitfalls. So, as Jennifer identified, there's an opportunity to look at your boundaries and an opportunity to say: If you're working from home, when do you shut that laptop down? And when you say: Right, I'm walking away now. So, I think in the inpatient setting, it's hard because it's been, it has been intensive, you know, it's been more intensive in many ways, than I've ever known it before. Due to the COVID. There's no point denying that. 

So, I think it's how you reframe that, because at the same time. Those times where we've had to spent time at home, for me, it's been a paradoxical reminder of what's more important. So, I think you've got to take the whole picture here, I think we've all got to be compassionate to ourselves and realise that we're still adjusting to this. There are no definitive answers. And whether we're your training or not, we are adjusting to how we negotiate this work life balance once again. It's new.

EM: Yeah, absolutely. There's never ever been a situation like that happen and fingers crossed, it doesn't happen again. Perfect. Okay. And just moving on to kind of how and when do you decide that you're going to be dual trained? Can you just decide at any time? Or is there like a specific time when you hand in an application? Like, how does it work? 

JP: Yeah, so, I'm quite familiar with this, as I'm in ST4. So, I've only just kind of started my hire training. In order to become a dual trainee, you apply at the point that you're applying for higher training. So, that comes after your foundation training and your core training in psychiatry, when you're applying to sub-specialise. And there are kind of a number of specific dual training posts which are advertised. It's not just old age, in general adult, which you can dual train in, there are a number of other opportunities as well, such as medical psychotherapy in general adult psychiatry combined. In order to dual train, you kind of choose that at the beginning of when you're kind of selecting your subspecialty. My understanding is that if you've kind of chosen a single specialty training, you can sort of reapply later to virtual training number, but it involves going back through the application process. But your, kind of, time and your single specialty is accounted for. So, I suppose it's coming up to the end of your core psychiatry training that you'd be making that decision of wanting to dual train.

EM: Thank you so much. So, you're fairly early on in your experience?

JP: Yeah, so I'm in my first year of higher training.

EM: Okay. And Ross, where are you?

RR: So, I'm in ST6, shall we say ST7 is a construct. I'm in the last year of a training. And I said on my liaison, working towards a liaison endorsement at the moment. I don't regret my choice whatsoever. I think in approaching this, there's listening to people's experiences perhaps on a higher podcast. But there's also a real opportunity just to talk to colleagues that have made that decision already. And I think that's what's really important. So, understanding what opportunities there are in the place that you're applying for, and listening to their, perspectives. Any thoughts they have, I think from from this perspective. I'm at the point where I'm looking for jobs.

I'm able because I've got a desire to stay locally, to look at jobs from both sides. I know I've mentioned this breadth before, but again, I'm presented with a lot more choice, unable to kind of identify what's important to me now for a job, and that those qualities may change in a couple of years, and I've got more choice. So, no regrets about choosing dual training. 

But I really think that you've got to take that word of mouth opinion from your immediate colleagues where you are. I think that dual training seems to have and maybe it's my own inclination, seems to have more thought given to the interactivity with the physical health of our patient. And I think that tends to come from our old age colleagues, and perhaps my own emphasis on liaison as well. But it's the way in which that then feeds back into the general adult psychiatry. So, I feel a bit more confident in making sure I'm getting that holistic approach to the patient. What I'm trying to say is that dual training specifically in old age, and general adults, amazingly enables me to do a slightly different approach to general adult psychiatry. 

There really is this symbiotic relationship between the different approaches, slightly different approaches taken by the two sub specialties. And I think that is a real opportunity.

EM: Thank you so much to our three speakers today Dr Ross Runciman, Dr Orima Kamalu and Dr Jennifer Parker for giving us their perspective on dual training. If you’re interested in pursuing dual training, please go to our website which is www.rcpsych.ac.uk, then select Training from the top menu, then Curricula and Guidance, and select Dual training.