Welcome to the first installment of this blog. This week I will start by giving a general overview of the training process for psychiatrists working in Ireland and how the systems have changed over the past two decades.
For each installment of the blog, I would welcome any queries, feedback, etc. in the comments section. And while this blog is designed to be a pragmatic and practical guide, I will insert occasional images from the history of Psychiatry to add a touch of erudition (and to break up the text!)
So here goes...
The main focus and aim of this guidebook is to formalize the informal and to capture some of the most important aspects of postgraduate training in Psychiatry and preparation for a long-term career in Psychiatry. This guidebook should prove to be useful for both CPsychI Trainees and for those on their own individual Continuous Professional Development-Support Scheme (CPD-SS). The guidebook will focus on the key areas of CV preparation, optimizing clinical experience, the junior doctor as teacher and the importance of research and audit, management experience and obtaining postgraduate qualifications along with the MRCPsych examinations.
Since my first day as a Psychiatry Trainee in St. Loman’s Hospital Dublin away back in July 1998, postgraduate training in Psychiatry in Ireland has been transformed radically. The primary driver in this change has been the gradual move away from the Royal College of Psychiatrists (RCPsych) in the U.K. and, ultimately, the formation of the College of Psychiatrists of Ireland (CPsychI) in 2009.
For each installment of the blog, I would welcome any queries, feedback, etc. in the comments section. And while this blog is designed to be a pragmatic and practical guide, I will insert occasional images from the history of Psychiatry to add a touch of erudition (and to break up the text!)
So here goes...
The main focus and aim of this guidebook is to formalize the informal and to capture some of the most important aspects of postgraduate training in Psychiatry and preparation for a long-term career in Psychiatry. This guidebook should prove to be useful for both CPsychI Trainees and for those on their own individual Continuous Professional Development-Support Scheme (CPD-SS). The guidebook will focus on the key areas of CV preparation, optimizing clinical experience, the junior doctor as teacher and the importance of research and audit, management experience and obtaining postgraduate qualifications along with the MRCPsych examinations.
Since my first day as a Psychiatry Trainee in St. Loman’s Hospital Dublin away back in July 1998, postgraduate training in Psychiatry in Ireland has been transformed radically. The primary driver in this change has been the gradual move away from the Royal College of Psychiatrists (RCPsych) in the U.K. and, ultimately, the formation of the College of Psychiatrists of Ireland (CPsychI) in 2009.
The laissez faire approach employed in
the past by the RCPsych and, to a varying level, by localized training schemes,
has now been replaced by a system of psychiatric training for CPsychI Trainees
that is highly structured and tightly monitored, involving a Foundation Year, 3
years of Basic Specialist Training (BST) and 3-4 years of Higher Specialist
Training (HST). The previously existing 13 training schemes throughout Ireland
have been reduced to 9 training schemes for BST and two training schemes for
HST, each managed by a CPsychI Vice-Dean or Vice-Deans and with a university
affiliation.
There are currently just
over 200 Trainees at BST level (approximately 60 of whom are in Foundation
Year) and approximately 100 at HST level. While we do not have figures for
twenty years ago, there has probably been a substantial reduction in the number
of formal Psychiatry Trainees since then, with a proportionate rise in the
number of NCHDs working on a CDP-SS basis. Health Service Executive (HSE)
restrictions on training posts in Psychiatry and other specialties has had a
significant impact and the number of HSE approved training posts is unlikely to
increase significantly in the coming years.
The main focus for Trainees
in their first 3-4 years in Psychiatry remains the completion of the membership
examinations, involving a combination of written and clinical examinations run
by the RCPsych and still completed by Irish Trainees, along with an ‘exit’
clinical examination run by the CPsychI that must be completed before Irish
Trainees can progress from BST to HST.
And now a break for some history...
And now a break for some history...
Emil Kraepelin (1856-1926), the German Psychiatrist who is widely regarded
as the father of modern Psychiatry
Parallel with the
examination process, the CPsychI has formulated an entirely new curriculum for
Foundation Year, BST and HST levels. Key learning outcomes (LOs) achieved
through stringent work place based assessments (WPBAs) have been introduced and
these are monitored closely by the CPsychI through an Annual Review of Progress
(ARP) process.
Along with CPsychI Trainees
at HST and BST levels, a large number (although data is not available) of
non-Consultant Hospital Doctors (NCHDs) working in Psychiatry now do so outside
of the formal CPsychI training scheme. These NCHDs manage their own Continuous
Professional Development (CPD) and are registered with the CPsychI as being on
a Continuous Professional Development Support Scheme (CPD-SS).
While the Medical Council
recognizes CPsychI Trainees as having Trainee Specialist Registration, NCHDs
working in Psychiatry who are not CPsychI Trainees (i.e. those working on a CPD-SS)
are registered with the Medical Council as being on the General Register and
they are required to devise their own Personal Development Plans and fulfil standard requirements for Continuing Professional Development (CPD) such as
internal and external CPD attendance and Clinical Audit.
NCHDs who complete their
examinations and CPsychI training in a psychiatric specialty are entitled to
enter the Specialist Divisions in Psychiatry, Old Age Psychiatry or Child and
Adolescent Psychiatry, whereas NCHDs who organize their own training through
PDPs are generally unable to join the Specialist Register.
The CPsychI training system
allows Trainees to plan an initial 4 years (i.e. Foundation Year and 3 BST
years) and, following completion of the MRCPsych examinations and the CPsychI
exit examination, another 3 years in HST.
While Consultant posts are
not linked to completion of HST, the path to a Consultant post is more
streamlined than in the past, when there was a ‘bottleneck’ effect for Trainees
who had completed their MRCPsych examinations and who had not yet entered into
HST (formerly referred to as Senior Registrar or SR) training. Once Trainees
had successfully overcome this first ‘bottleneck’, they entered SR training for
3-4 years.
And now some more history...
And now some more history...
Phillipe Pinel (1745-1826), pioneering French physician
who was famous for 'freeing the insane from their chains'.
While successful completion
of the MRCPsych and CPsychI exit examinations combined with satisfactory
completion of Foundation Year and BST training is now sufficient for entry to
HST, Trainees back in 1998 would likely have completed a substantial period
(2-3 years or more) in a research or lecturer post and ideally completed a
Doctorate in Medicine (MD) or PhD. There existed a facility to have one year of
such research or lecturer posts prospectively approved for SR training, thus
reducing the amount of time in the subsequent SR phase. A second bottleneck
occurred for the NCHDs who had completed SR training and were waiting to take
up a Consultant post.
Because of these two
bottlenecks in the training process, Trainees in Psychiatry were more likely to
opt to travel abroad in the past, either through choice or necessity, and
return to take up a Consultant post in Ireland once they had completed their SR
training abroad. In a separate but related issue, the pay-cuts in Consultant
salaries since the economic crisis of 2008 has made the traditional return of
Irish Trainees from abroad a far less attractive proposition for them.
In view of all these
significant changes, from RCPsych to CPsychI and the associated changes in the
curriculum, the assessment and examination procedures, along with changes in
the structure and planning of BST and HST training posts, the everyday teaching
and learning experience for both Trainees and supervising Consultants
(Trainers) has changed considerably over the past twenty years. For example, in
1998 a RCPsych training logbook was kept by each Trainee and there was a
notional one hour per week of supervision time with the Trainer. The logbooks
were rarely reviewed and so compliance was variable. Likewise, compliance with
the one hour of Trainer/Supervisor time was also variable, as was the level of formal
teaching, depending on the level of interest of individual
Consultants and services. A course of weekly didactic lectures in St. Patrick's
Hospital Dublin was available to Trainees from all over Ireland, but attendance
was patchy, as was the relevance of some of these lectures to the MRCPsych
curriculum and examinations. Formal visits and inspections of training schemes
by the RCPsych were rare and cursory. The initial and primary focus for
Trainees was the completion of the MRCPsych examinations as quickly as
possible.
Nowadays, along with the
focus on completing the MRCPsych examinations followed by the CPsychI exit
examination, a rigorous system of workplace based assessment must be adhered to
by CPsychI Trainees. Progress of Trainees from Foundation Year through the BST
and HST years is approved based on successful ARPs and Trainees can have their
progress accelerated, slowed or suspended based on the outcomes of these
reviews.
The move away from the
traditional and largely ad hoc ‘apprenticeship’ model of psychiatric training
to a more stringent and objective system means that there is much more
uniformity in how training is now delivered in comparison to twenty years ago.
The CPsychI curriculum is covered systematically over the seven years of
postgraduate training and monitored closely by the CPsychI through submission
of completed WPBAs that are discussed and signed off by the Trainee and
Trainer. The ARP process then determines whether or not (and at what pace) a
Trainee can progress through Foundation Year and the years of BST and HST.
Notwithstanding the many advantages of the new CPsychI system, in my time as a Consultant Trainer and Clinical Tutor I have noticed that blind adherence to this can lead to a piecemeal and disjointed approach to training. One of the aims of this blog is to give an overview of the key aspects of training with a longitudinal view over several years, thus hopefully helping trainees to develop a 'big picture' idea about their training and career and avoid some common pitfalls and blind alleys.
For the next installment in the coming days, I will be covering the CV - how to develop, write up and present your CV in the best possible light.
And finally, some more recent history...
Notwithstanding the many advantages of the new CPsychI system, in my time as a Consultant Trainer and Clinical Tutor I have noticed that blind adherence to this can lead to a piecemeal and disjointed approach to training. One of the aims of this blog is to give an overview of the key aspects of training with a longitudinal view over several years, thus hopefully helping trainees to develop a 'big picture' idea about their training and career and avoid some common pitfalls and blind alleys.
For the next installment in the coming days, I will be covering the CV - how to develop, write up and present your CV in the best possible light.
And finally, some more recent history...
John Cade (1912-1980), Australian Psychiatrist credited with discovering the psychotropic effects of lithium
