General Adult

The West Training Scheme (Mersey).

General Psychiatry

Programme Director

Dr John Stevens

John.Stevens@merseycare.nhs.uk


PROGRAMME DETAILS

There are 26 trainees on the scheme and opportunities for a wide range of clinical experience, together with access to resources to develop teaching, research, audit, management and leadership.

The scheme offers trainees a three year programme with clinical posts to cover the clinical aspects of the curriculum. These placements are in a variety of settings, in teaching centres and district general hospitals, covering both urban and rural populations in Three Trusts across the Mersey Region.

The GA training scheme is part of the Mersey School of Psychiatry. The head of School is Dr Manoj Agarwal and the Training Programme Director is Dr Kauser Tabani

Training placements are allocated by the training programme director according to training needs, and posts rotate each year in August and in some cases, in February. Trainees’ preference is given consideration as part of the post allocation process.

The clinical experience is complemented by opportunities in other aspects of training provided locally within training placements and centrally by the School of Psychiatry and Health Education North West (HENW) Mersey.

The trainee will be expected to work in different clinical placements to achieve experience with in-patients and patients within community and in out-patient clinics.

In addition to generic in patient and community services, trainees have opportunities to gain an endorsement in rehabilitation, liaison or substance misuse, with several posts available in these sub specialties.

There is on call work for all posts sufficient for trainees to attain the recommendation the RCPsych guidance for minimum number of on call duties.

In addition to the clinical experience in their main placement, each trainee can undertake Special Interest sessions for one or two half days per week in order to gain a wider variety of experience or pursue particular individual interests. There is a wide range of choice of such placements, including services such as ADHD clinics, neuropsychiatry and psychotherapy.

MERSEY DEANERY PSYCHOTHERAPY TRAINING GUIDELINES FOR ST4 AND ST5 GENERAL PSYCHIATRY TRAINEES

Introduction

This guidance sets out the requirements for Psychiatric Speciality Trainees (ST) to further develop their psychological skills (as measured by SAPE) and the range of potential training options within each of the 3 Trusts within Mersey Deanery to achieve these.

RCPsych ST Psychotherapy Training Recommendations

Following the psychotherapy training requirements at Core Training (CT) level (attending Case Discussion group + 2 psychotherapy cases), the RCPsych General Adult curriculum (Competency Based Curriculum for Specialist Training in Psychiatry: Specialists in General Adult psychiatry, page 143) stipulates that ST trainees should continue to develop their psychological skills, this being assessed by undertaking an Assessment of Psychotherapy Expertise (SAPE) in each year ST4-6 year, therefor 3 in total. Within this document (page 148) more specific guidance is provided within a table for each level of ST training:

ST4 SAPE: use of a psychological treatment appropriate to general adult inpatients or out patients.

ST5 SAPE: use of a psychological treatment relevant to the management of a patient in thisspecialist area (e.g. EIP, AO, crisis, eating disorders, neuropsychiatry etc)

ST6 SAPE: use of a psychological treatment relevant to the management of a patient in thisspecialist area (e.g. EIP, AO, crisis, eating disorders, neuropsychiatry etc) (if not completed in ST5)

HENW Mersey Psychotherapy Case Requirements

Translating this RCPsych guidance to HENW Mersey, it was agreed in April 2015 at the Psychiatry School Board that, from August 2015 onwards both ST4 trainees and ST5 trainees would be asked to submit two further psychological intervention, one in each of their ST 4 and ST5 years (assessed by a SAPE + recorded in this ST psychotherapy logbook) and presented ahead of their final exit ARCP.

Trainees will therefore need to conduct two brief psychotherapeutic interventions. These cases could be relevant to general adult work (inpatient or outpatient) or a specialist area (Early Intervention, Assertive Outreach, CRHT, Eating Disorder, Rehab, Neuropsychiatry etc). One case will need to be 4-8 sessions long (minimum length will be 4 sessions) and the other case 8-16 sessions long (minimum length 8 sessions). For those trainees wishing to do psychological interventions of a longer duration this of course will be acceptable. For any systemic and group therapy to count the trainee must have been the primary or lead therapist in the treatment. When ST trainees are looking to identify both potential cases and supervision the local Psychotherapy Tutors, will offer support in identifying opportunities and providing links to these. For example some trainees may wish to undertake a formal psychotherapy case (within the psychotherapy service) and have this supervised by one of the psychotherapists but other trainees might prefer to ask for other psychologically skilled clinicians to supervise their cases within their core teams (e.g. CMHT psychologist).

Examples of Mersey Care Trust’s options for ST psychological interventions:

  • Psychotherapy cases within the psychotherapy service
  • Supervision of brief outpatient/inpatient psychological work
  • Placement with PD Consultation Team
  • Co-facilitation with Psychology Groups in CMHTs and on inpatient units
  • Placements with Eating Disorder + Early Intervention + Rehabilitation + PICU
  • Placement in brief PIT Self Harm Clininc

Examples of Five Boroughs NHS Foundation Trust’s options for ST psychological interventions:

  • Psychotherapy cases
  • Supervision of brief OPA/Inpatient work
  • Co-facilitation of groups
  • (Possible settings relevant to GA: EIP, Home Treatment, Assessment Teams, Eating Disorders, Forensic, Inpatient, PICU, Recovery Teams, IAPT)

Examples of Cheshire and Wirral Partnership NHS Foundation Trust’s options for ST psychological interventions

Supervision of brief outpatient/inpatient psychological work:

  • General Adult settings(acute care wards, community)
  • Specialist areas (Liaison OPC, Eating Disorders, EIT, Rehab etc)
  • Co-facilitation of Psychology Groups in CMHTs and on inpatient units

Through discussion with the RCPsych it has been clarified that time to undertake these psychotherapy cases should come from the trainee’s core placement time, rather than special interest time, in keeping with the philosophy of RCPscyh guidance document “Thinking Cradle to Grave, developing psychotherapeutic psychiatry”. Trainees should therefore consider ways in which they might undertake these psychological interventions from within their current work placements (e.g. providing a brief psychological intervention through out patient clinic or as an inpatient) where possible.

Supervision

Psychological work must be supervised regularly by someone with the relevant expertise and this person will complete a SAPE at the end point of the case and sign off the necessary documents in the appendix of this logbook. The supervisor will enter the SAPE into the trainee’s on line RCPsych training portfolio. It is possible for non-medical supervisors to access and complete SAPEs via the Portfolio on-line system. Non-medical supervisors will need support from trainees and local Psychotherapy tutors to become familiar with workplace based assessments in general and the Portfolio online system in particular.

Uploading documents ahead of ARCP

As well as completing a single SAPE at the end of each case (on the RCPsych Portfolio on-line system) trainees will use appendix 1 of this HENW Mersey ST Psychotherapy Logbook to record (scan + upload) the evidence of their completed cases into the Psychotherapy Section of their RCPsych Portfolios as a single PDF. Appendix 1 contains (a) Patient Attendance Register (ST4) (b) Summary Record of ST4 Psychotherapy Case.

In order to be successfully signed off at ARCP there must be both two completed SAPEs and a completed ST Psychological Intervention Logbook (with both patient attendance register and summary record included) uploaded into the Psychotherapy Section of RCPsych Portfolio on line system.

References

A Competency Based Curriculum for Specialist Training in Psychiatry: Specialists in General Adult psychiatry. Royal Collage Psychiatry Feb 2010 (Updated March 2012) 

RCPsych: SAPE

RCPsych: Thinking Cradle to Grave, developing psychotherapeutic psychiatry

Dr Simon Graham      Training Programme Director Psychotherapy          


The East Training Scheme (North Western).

NORTH WEST DEANERY TRAINING SCHEME IN GENERAL ADULT PSYCHIATRY

INTRODUCTION

The North West Deanery training Programme in General Adult (GA) Psychiatry is a large scheme with posts across Greater Manchester, Lancashire ,Cumbria and Cheshire. There are over 50 trainees on the scheme and opportunities for a wide range of clinical experience, together with access to resources to develop teaching, research, audit,  management and leadership.

The North West Deanery School of Psychiatry offers six single Specialist Training schemes including GA Psychiatry and two Dual Training Schemes.The two Dual training schemes are: Psychotherapy/ GA and Old Age/ GA.

OUTLINE OF SCHEME

The scheme offers trainees a three year programme with clinical posts to cover the clinical aspects of the curriculum. These placements are in a variety of settings, in teaching centres and district general hospitals, covering both urban and rural populations in six Trusts across the North West.

The GA training scheme is part of the School of Psychiatry of NW Deanery. The head of School is Professor Damien Longson and the Training Programme Director is Dr Amanda Poynton.

Training placements are allocated by the training programme director according to training needs, and posts rotate each year in August. Trainees’ preference will be taken into account as part of the post allocation process.

The clinical experience is complemented by opportunities in other aspects of training provided locally within training placements and centrally by the School of Psychiatry and the Deanery.

The scheme is supported administratively by staff from the NW Deanery and School of Psychiatry. The Scheme organisation is overseen by The training Programme Director and the Speciality Training subcommittee which includes trainers and trainee representatives.

CLINICAL EXPERIENCE

The trainee will be expected to work in different clinical placements to achieve experience with in-patients and patients within community and in out-patient clinics.

In addition to generic in patient and community services, there are opportunities to work in specialist community teams such as Early Intervention Teams and  Crisis Response  Home Treatment Teams and in other specialist settings such as Mother and Baby unit, Neuropsychiatry and Eating disorders service. Trainees have opportunities to gain an endorsement in rehabilitation, liaison or substance misuse, with several posts available in each of these sub specialities.

There is on call work for all posts sufficient for trainees to attain the recommendation the  RCPsych guidance for minimum number  of on call duties.

In addition to the clinical experience in their main placement, each trainee can undertake Special Interest sessions for one or two half days per week in order to gain a wider variety of experience or pursue particular individual interests. There is a wide range of choice of such placements, including services such as ADHD clinics, neuropsychiatry, psychotherapy and Specialist Affective Disorders service.

OTHER ASPECTS OF TRAINING

TRAINING DAY PROGRAMME AND STUDY LEAVE

There is a mandatory training programme consisting of ten study days per year organised for the GA trainees in the scheme. The organisation of these events is undertaken by a small committee of trainees who are elected by their peers to this role.The programme is regularly reviewed with the Training Programme Director. In recent years there has been an annual training day  for Trainees and Trainers.There are also  one or two training days  per year organised as part of the programme in conjunction with trainees in other specialist training schemes.

Trainees are able to apply for  appropriate local and national courses and conferences which can be funded from the annual study leave budget with approval from Training Programme Director..

TEACHING AND SUPERVISION OFFERED BY THE TRAINEE

Throughout training the trainee will be actively involved in teaching, training and supervision.  This will include the provision of clinical case supervision to junior psychiatrists (ST1-3) and lectures or development of course materials for various events such as the MRCPsych course. Similarly there are opportunities to be involved in medical student teaching, training and examining and for involvement in teaching and  training for other professional staff.

The trainee will develop and evaluate their own teaching materials, and will be expected to attend  relevant training  workshops and  courses.

The North West Deanery offers trainees the opportunity to undertake the level 1 PGCE from Edgehill University, usually in ST5 year, which trainees can extend if they wish to take  further  to levels 2 and 3.

MANAGEMENT AND LEADERSHIP

Trainees are encouraged  to attend  local service business or management meetings during their placements to compare the different ways teams work and to observe the different organisational contexts and their influences.

Trainees will be able to develop an understanding of  local governance processes in each Trust and show evidence of their involvement.

Trainees will be have the opportunity to attend management courses at points in their training which are relevant to their needs. This could include involvement in the Medical Leadership in Practice course (MLiP) arranged through NW Deanery.

AUDIT

Each trainee will be expected to have an understanding of the audit cycle and carry out yearly audit projects during their training in Adult psychiatry . Trainees are expected to attain the standards set  in the  RCPsych curriculum with reference to the competency for the year of training  .

RESEARCH

Opportunities are available in each placement for trainees to develop their understanding of aspects of research as laid out in the curriculum for Specialist training.

For interested trainees, there are opportunities to undertake research as the Training scheme has strong links with highly regarded local  University  academic departments and supervision would be available for trainees wishing to  achieve  a higher research degree.

It is also possible to undertake GA specialist training as an Academic Clinical Fellow. Any interested trainees should consult appropriate National and Deanery guidance about this option for training.

TRAINING PROGRAMME APPRAISAL AND ASSESSMENT

Every trainee will have regular contact with his/her Educational Supervisor to consider progress. The Educational Supervisor role includes offering support as a mentor and challenging as a colleague, enabling the trainee to reflect openly and robustly about their capacities and development. This process will be largely informal. Trainees will also be expected to conduct appropriate numbers of WPBAs with a range of assessors including Educational supervisor.

Trainees in North West Deanery School of Psychiatry use an electronic portfolio, METIS, to record all aspects of their training. This enables each trainee to have a record which can then be discussed regularly in supervision and presented for review .

A six monthly review of the Training Plan by Training Programme Director will be undertaken with each trainee and this will be informed by the Educational and clinical supervisors’ reports. The six monthly review provides an opportunity for the trainee to raise concerns relating to placements, for Educational Supervisors to highlight potential areas of good progress or areas of concern in relation to the trainee and plan any appropriate additional support/teaching and also to prepare the portfolio and workplace based assessments for the ARCP

The more formal element of appraisal and assessment takes place in the annual assessment, ARCP (Annual Record of Competence Progression). The ARCP will be undertaken by the North West School of Psychiatry informed by  programme director, who will meet with trainees prior to ARCP to review progress towards competencies.

LESS THAN FULL TIME WORK

There are opportunities for trainees who meet the appropriate criteria to work less than full time within the North West Deanery GA Psychiatry Specialist Scheme. Trainees working less than full time are usually placed in Reduced hours in Full time placements and can do appropriate on call on pro rata basis. Further information is available on Deanery Website:
http://www.nwpgmd.nhs.uk/content/less-full-time-training


FURTHER INFORMATION

 http://www.schoolofpsychiatry.net

 http://www.psychiatrynorthwest.co.uk


Training Programme Director (TPD)

Dr Simon Sandhu

simon.sandhu@nhs.net