Health Education England (HEE) and RCPsych jointly manage two psychiatry run-through pilots, with GMC approval. The Child and Adolescence Psychiatry (CAP) pilot has been ongoing since 2018 and the Intellectual Disability (ID) pilot launched in 2022.
In August 2021, the first cohort of CAP trainees moved into ST4, enabling us to begin our programme evaluation.
What do the programmes involve?
Trainees in the run-through programme will be registered with a National Training Number (NTN) as an ST1 trainee.
Trainees in run-through programmes undertake core training alongside trainees in CT1-CT3. Programme outlines for ST1-ST3 are as follows:
Child and Adolescent
- Six posts of six months’ duration (as for CT1-CT3).
- In ST1, there will be two six-month whole time equivalent (WTE) placements in General Adult Psychiatry/Old Age Psychiatry etc – like CT1
- In ST2, there will be one six-month placement WTE in child and adolescent psychiatry, and one six-month WTE placement in a paediatric linked post (e.g. paediatric liaison or ambulatory paediatrics).
- In ST3, trainees will undertake the same placements outlined for those in CT3.
- In the ST2 year, even in the paediatrics-linked placement, ST2 trainees in the run-through pilot will undertake psychiatry on-call, will continue to have psychiatric supervision, and will attend all the educational and academic programmes (e.g. the MRC Psych course, psychotherapy courses and experience) as all the other Core Trainees.
- Six posts of six months’ duration (as for CT1-CT3).
- A guaranteed six month post in Learning Disability (Intellectual Disability) Psychiatry as part of the ST1-ST3 rotation.
- A fully funded place at the RCPsych annual Faculty of Intellectual Disability Meeting held in the Autumn.
- An annual training/networking day hosted at RCPsych by the Faculty of Intellectual Disability.
- Allocation of an ID ST mentor to support the trainee through their ST1-3 years.
All run-through trainees
- Trainees on the run-through pilot will have a psychiatry ARCP every year ST1-ST3 along with other psychiatry trainees.
- Trainees on the run-through pilot must attend their local MRCPsych course, all other psychiatry educational programmes, and psychotherapy training. They must provide the same evidence of academic activities and psychotherapy competencies as required in Core Psychiatry training and outlined in the Core Psychiatry Curriculum.
- All components of the MRCPsych examination (Papers A and B, and CASC) must be completed and passed to progress to ST4.
- Any extensions to training time for the Core Psychiatry programme will also be available to run-through pilot trainees. This is as per the provisions in the Gold Guide. If the trainee is unable to pass the MRCPsych examination despite the maximum allowable extension to training, they will be released from training as per the Gold Guide.
- Trainees in the run-through programme will directly progress to ST4 in their relevant specialty if they pass the MRCPsych examination. They will not need to participate in the national competitive interviews for entry to ST4-6 training. The specialty TPD, the Core TPD, and the School of Psychiatry in the area will ensure that the run-through trainee will have a post for ST4-6 training on the local rotation relevant to their run-through specialty.
- If the run-through pilot trainee does not wish to progress to ST4-6 in their relevant specialty, they must undertake national ST4-6 interviews to apply for the psychiatry specialty of their choice.
- Qualitative feedback about the pilot (through questionnaires sent to trainees and educators) and quantitative outcomes including ARCP outcomes, progression data and exam results will be collected by RCPsych. They will submit annual reports to the GMC and HEE.
Trainees in run-through programmes will be allocated a run-through mentor alongside their educational, clinical, and psychiatric supervisors.
RCPsych holds periodic induction meetings for trainees, and senior educators involved in the pilot.
Learning Outcomes from the Paediatric Linked post in ST2
- Ability to take detailed developmental history and assessment (including relevant physical examination) understanding normative development and pathological changes
- Identifying the mental health disorders/ comorbidities in CYPs presenting with physical illnesses/ disorders
- Developing an understanding of possible organic differential diagnoses to mental health presentations, gain understanding of relevant physical examination and investigations
- Risk assessments and management plans in Paeds ED & Paeds wards
- Assessing and exploring factors underlying medically unexplained symptoms
- Understanding physical health issues in cases of eating disorders
- Developing and demonstrating ability to work across disciplines and specialties
- Understand the process of providing the CAMHS consultation between Paeds and CAMHS systems
- Understand the use of CAP psychopharmacology in acute Paediatrics
Learning Outcomes from the CAP post in ST2
- Understanding of CAP work – specialist CAP and also Tier 4 (some CT-ST2 posts likely to be in CAP inpatient units)
- Common presentations in the main age groups in CAP (0-5; 5-12, 14-18)
- Developmental disorders – understanding especially ADHD, ASC, Tics
- Common presentations re mood disorders, anxiety disorders, eating disorders, somatoform disorders, impact of social issues – bullying, school issues, social media
- Understanding the ‘systemic perspective’ – not just the ‘family system’, but also Education, Local Authority, Paediatrics etc
- Safeguarding , especially vulnerable groups – e.g. Children Looked After, CYPs in Youth Justice
- Relevant CAP Psychopharmacology and physical health issues
- Assessment of risk and management of risks in CAP age group, systemic underpinning of risk management
- Relevant medico-legal frameworks and emergency work (including CAP out-of-hours if relevant)
- Psychological therapies in CAP – especially Systemic Therapy
- Gain an understanding of the structure and function of the intellectual disability multi-disciplinary team. Understand the role of the intellectual disability psychiatrist and other professionals within the team.
- Work collaboratively with other professionals in the multidisciplinary team and with other key professionals, e.g. social workers, to meet your patients’ care and support needs.
- Gain experience of working with wider care networks, including family and paid carers.
- Learn how screening and diagnosis of intellectual disability is carried out, for example (i) using a WAIS assessment to measure IQ and (ii) measuring adaptive functioning using a validated instrument.
- Develop skills in adapting your style of communication to meet the needs of the person with an intellectual disability, including across the range of cognitive ability and those with associated Autism. Demonstrate how to make reasonable adjustments when necessary.
- Assess mental illness in patients across the range of cognitive ability, including those with significant communication difficulties.
- Develop an understanding of the concept of challenging behaviour and how this is formulated and managed by professionals in the multidisciplinary team.
- Understand the presentation, assessment and management of neurodevelopmental disorders, including autism and ADHD.
- Understand the common physical health problems experienced by people with intellectual disability, how these may present differently - for example through behavioural change. Demonstrate an understanding of diagnostic overshadowing and how to avoid it.
- Understand the causes of physical health inequalities experienced by people with intellectual disabilities and how these can be addressed to improve health outcomes.
- Gain knowledge and understanding of relevant legislation, including issues related to mental capacity/incapacity and mental health law in people with intellectual disability.
- Understand how to assess capacity to consent in people with intellectual disability.
- Gain an understanding of key risk issues in people with intellectual disability.
- Complete an audit or quality improvement project relevant to intellectual disability psychiatry during your placement.
|CT1 – CT3||ST1 – ST3|
|6 x 6 months placements across 3 years WTE||6 x 6 months placements across 3 years WTE|
|Combination of GAP, OPMH, FP, AoT, Liaison, etc.||ST1 year – 2 x 6 month WTE placements (GAP/OPMH, etc.)|
|Will do either ID/CAP as “developmental post”|| ST2 year – will do 6 months WTE CAP and 6 months WTE Paediatric Linked post (Paeds liaison/ambulatory paeds)
ST3 year – similar to CT3
|On call – in Psychiatry||On call – in Psychiatry|
|Academic activities (MRCPsych Programme, Psychotherapy experience etc.)||Academic activities (MRCPsych Programme, Psychotherapy experience etc.)|
|ARCP – Psychiatry ARCPs||ARCP - Psychiatry ARCPs each year (including ST2)|
|MRCPsych gateway to ST4 (must complete all 3 components)||MRCPsych gateway to ST4 (must complete all 3 components)|
|National competitive ST4 interviews||No interviews to start ST4 in CAP|