This blog started with two introductory posts and then moved on to cover the areas of CV development, clinical experience, research, teaching, management and postgraduate qualifications. Over the past few weeks I have had very helpful feedback from numerous colleagues, especially those working in Laois-Offaly and in the Midwest. Overall, the blog has had over 1,600 reads, in over ten countries and on four continents.
And now I am glad to add on two extra guest blogs. This week's guest blog is written by Dr. Diarmuid Boyle, who is coming to the end of his Basic Specialist Training with the UL Midwest Deanery. Diarmuid has written a really useful and comprehensive reflection on his experiences during his first 3-4 years in psychiatry, and he has also demonstrated very impressive writing skills, possibly drawing on his origins in north Kerry, a traditional hotbed of penmanship.
To complement Diarmuid's piece, I have dipped into a nice JAMA resource entitled 'Art and Images in Psychiatry' https://sites.jamanetwork.com/art-and-images-in-psychiatry/ Here you will find a fascinating collection of paintings by various artists, relating to different aspects of psychiatry.
Such is the quality of the collection that it is impossible to chose just a few samples. Instead, I have gone with the paintings of one artist only, Vincent van Gogh (1853-1890), who produced a series of masterpieces in his short and troubled life that highlight the triumph of his spirit and genius over the psychiatric problems that haunted him. You will note that all of the included paintings were completed within a year of his death.
So I would like to again commend Dr. Diarmuid Boyle on his guest piece and thank him sincerely for this very valuable contribution to the blog.
And here's Diarmuid...
My name is Dr Diarmuid
Boyle. I am in my 3rd year of the BST psychiatry training programme. I am due
to finish the BST in July 2020. I have been accepted onto the HST starting in
July. As I have managed to get through the BST with relatively few scars and no
criminal record, Professor O'Connell has asked me to share my thoughts on how
to make the best of the BST years.
I hail from Kerry and
originally graduated as an engineer many years ago from the University of Limerick.
The ESB kept me gainfully employed for most of the intervening years. After
getting my fill of running around power stations and working in energy trading
and project management it was time to find a new challenge. I graduated from
UCD School of Medicine in 2016. I did one year as an intern mostly in Tallaght
hospital and then started straight onto the psychiatry BST scheme.
Nearly 3 years in I have to
admit that they have been the most eventful and interesting 3 years of my life
so far. Before this my perspective on
life, people and society was blinkered by the soft padded walls of my safe and
relatively mundane middle class upbringing. In psychiatry every day brings a
revelation. Everyday a patient with a personality disorder (or insert any other
disorder here) walks into my office and metaphorically (and some days
literally) kicks a large gaping hole in my cloister walls. A little bit more light
comes shining in with all its shining colour and chaos. I won’t bore you with
the stories because if you are in this field you all have the same ones.
Suffice it to say in the last 3 years I have been hugged, kissed threatened and
assaulted,. I have had to wrestle a scissors from a patient actively and
violently stabbing herself in the neck. I have been involved in a murder
investigation. I have laughed and cried (multiple times). I have interviewed
paedophiles, celebrities, drug addicts, business women, house husbands, and of
course multiple Jesus’s. I have loved every minute of it. If you work in
psychiatry you will have the best stories for the pub by far (which of course
you will never be able to tell). I could not imagine myself doing anything
else. The life of a surgeon or cardiologist is positively humdrum in
comparison. For what it is worth here are my thoughts on the BST years.
Training Scheme
The training scheme is
organised by the College of Psychiatrists of Ireland. There are 3 mandatory
exams. Get them done early. The realisation that these were my last exams ever
was a real motivation to get them completed. A life without exams can seem an
unimaginable utopia to those weighed down by years forging through an
oppressive doctor training scheme. Trust me, the end is so close and it is wonderful.
Do this for you and your family. You can also do the CASC exam organised by the
Royal College of Psychiatrists. Getting this membership may make working abroad
if you are so inclined easier. I tried it once and failed. I may try again.
On Call
I will be glad to see the back of the dingy on-call rooms. Those rooms with
beds, room temperatures and noise levels deliberately set by hospital
management to keep you awake all night. I wonder if I will every unlearn the Pavlovian
response to pager and nokia ring tones that set my heart racing and my gastric
juices mining for ulcers within seconds of them going off. It doesn’t even have
to be my pager, any pager within an audible distance will do. This can make for
an uncomfortable day when you work in a hospital. Being on call however is
invaluable experience. Do not waste this opportunity. Your first few calls will
be difficult, stressful and thoroughly uncomfortable affairs. However this will
quickly change as you learn the ropes. This is where you will learn the skills
to confidently gather information, weigh it up and make a decision. These are
skills that you will need to be independent in by the end of your training. Be
thorough with your assessments. After all you have nowhere else to go. I cannot
stress enough the immense learning experience being on call is. Don’t waste it
drinking tea in the res.
Asylum at Saint-Remy, 1889
The Courtyard of the Hospital in Arles, 1889
The Hall of Asylum, 1889 - not from the JAMA resource
but included here because it just reminds me of being on call!
Specialties
I have been struck by the number of conversations I have had with
consultants expressing regrets about not having had experience in a particular
psychiatry specialty. Patients can so easily highlight your lack of expertise
in an area and leave you fumbling for the Maudsley guidelines or sifting
through your rolodex for a colleague to ring. Your BST years are really your
only chance to sample a wide variety of specialties. The experience gained in
each specialty will be with you for a lifetime as a consultant. Most people
don’t know what specialty they would like to work in as a consultant. Please
don’t be shy. It is important to push for experience in areas you think you
would like. By the time you are applying for the HST you will have decided what
specialty route you are taking. From the first day of your BST scheme you need
to be an effective advocate for your future career and try and get experience
in specialties that you want.
Research and Audits
I have one simple rule for research and audits. Never say no (within
reason obviously). You will be presented with numerous opportunities to do
research and audits. As a trainee it is important to take opportunities as
offered from colleagues. You can always decide to step aside from a project
later. Often these opportunities will not work out but maybe 1 in 5 will. Trainees
often complain about lack of research opportunities when in reality the issue
is that they do not recognise and take these opportunities when they are
presented to them. So be vigilant and don’t be too picky. You can find the cure
for schizophrenia next year. Now is the time to learn your trade by working
with colleagues who have experience in this area.
Learning outcome grid
The learning outcome grid can seem daunting when you first see it. How
can you possibly tick off every box in this 38 page behemoth of a document.
Just be diligent. You have literally years to finish it. Don’t stress, don’t
leave it till the last minute.
Consultants
Consultants come in all shapes and sizes. You will have to work for at least
6 and probably a lot more if you consider on call work, the inevitable locums
and the odd nervous breakdown. The rule is the consultant is always right. You
may disagree with them but always be aware that there is so much that you don’t
know. To quote Donald Rumsfeld, the “unknown, unknowns” are what you need to be
wary of while being a trainee. You need to foster a healthy sense of self-doubt
in your abilities. Consult your consultant even when you are nearly sure. You
will be surprised how often you get a different perspective and course of
action as a result. You are a trainee after all. You may be certain of a treatment
or plan but always remember there is so much that you don’t know and even more
dangerous so much you don’t know you don’t know. So for now the consultant is
always right.
Portrait of Dr. Gachet, 1890
Self-Portrait with Bandaged Ear and Japanese Print, 1889
Look after yourself
You will get stressed. You will feel overwhelmed. You will be treated
unfairly. You will be verbally abused. This will take its toll on you. Be able
to recognise when it does. If you think it won’t then most likely you need to
work on your self-awareness.
It is good to talk. Find a confidant, a colleague, a friend or a family
member. Practice self-care even if you think you don’t need it. I have very
deliberately prioritised 5 areas of my life that come before work. I only half-jokingly
call them my 5 pillars of happiness. I first try to ensure I am getting
exercise, have a good diet, am sleeping well, spending time with family and
friends and get some time for myself. After these comes work. You will be a
much better psychiatrist if you put psychiatry at least 6th on your
list of life priorities. Your job is mentally, physically and emotionally
draining. You need to look after yourself first.
In this blog post I tried not to regurgitate the same advice you have
heard many time before. This is not a step by step guide on the requirements
for fulfilling the BST training scheme. I have deliberately kept the advice a
little bit left of field. So hopefully it at least presents a different perspective.
Everyone will have their own. And unlike when it comes to dealing with
consultants we are all right in this case. I would like to finish with the
advice that resonated the most from reading Professor O’Connell’s blog;
“I would advise that you immerse yourself in clinical work from your
first day in Psychiatry and get busy. Avoidance of clinical work (for reasons
such as lack of confidence, fear or downright laziness) is far more time
consuming and stressful than getting stuck in (not to mention being the more
professional and ethical approach). You will find clinical work more
stimulating and rewarding if you are busy looking for new challenges and not
hiding in the wings hoping to avoid work and responsibility.”
This point is worth emphasizing. If you take this attitude to work with
you every day everything else will come easily.
Best of luck.
Best of luck.
The Starry Night, 1889
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