Dual Training In Medical Psychotherapy And General Adult Psychiatry
JUMP TO CONTENTS:
Overview of Training
Structure of the Five Year Training Period
Details of the Mersey Deanery General Adult Training Scheme
Details of the Mersey Deanery Medical Psychotherapy Training Scheme
Provision of Academic Training and External Psychotherapy Training
Progression Through Training and Appraisal and Assessment
Experience in Providing Training to Others
Research, Audit and Management Experience
The Health Education North West (HENW) Mersey general adult psychiatry and medical psychotherapy training schemes are offering a dual specialist training in general adult psychiatry and psychotherapy from August 2013. The five year partially integrated specialist training (ST) combines the training provision in both sub-specialties to enable qualification on the Specialist Register of the General Medical Council with two Certificates of Completion of Specialist Training (CCT) recognised by the General Medical Council as a medical psychotherapist and as a general adult psychiatrist.
The training programme outlined in this document describes a structure for training in medical psychotherapy and general adult psychiatry through combined specialist training in both general adult psychiatry and psychotherapy with the aim of integrating these specialist trainings to equip the doctor to practice as a consultant psychiatrist in psychotherapy, and/or as a general adult psychiatrist. The training programme is guided by an awareness of the need for the future consultant psychiatrist in psychotherapy/general adult psychiatry to deliver and apply expert psychotherapeutic skills/psychotherapy in a range of psychiatric settings. This training offers a psychotherapeutic approach to the understanding of the development of the personality, which can form a bridge between both general psychiatry and psychotherapy for complex cases.
The importance of an awareness of a range of models of therapy will be incorporated in the training programme in line with the requirements for general psychotherapy training. Within the Mersey Deanery the major model of therapy will be psychodynamic therapy, with the subsidiary modalities being cognitive behavioural therapy and systemic therapy. The clinical focus will be on working with complex patients with personality disorder and there will be opportunities to gain experience in specific models of therapy for this patient group.
OVERVIEW OF TRAINING
The training is five years in length and the trainee is appointed to the two dual training sub-specialties at the time of application. The Training Programme Director (TPD) for the General Adult Psychiatry is Dr Kauser Tabani and Training Programme Director for Medical Psychotherapy is Dr Simon Graham. The two Programme Directors take joint responsibility for the running of the dual award scheme and will both assess progress as part of the Annual Record of Competence Progression (ARCP) each year. Each year there will be a six monthly review ahead of the ARCP to assess the trainee’s progress and fulfilment of their training plan.
The trainee will be allocated both a clinical supervisor (trainer) who is a medical psychotherapist and a clinical supervisor (trainer) who is a general adult psychiatrist. The clinical supervisor for the predominant speciality of that year, together with the trainee and in conjunction with the relevant Training Programme Director, will take a lead in writing the training plan for that year.
The aim of this dual training programme is to help the trainee to become a medical psychotherapist and psychiatrist, who embraces and integrates their medical and psychiatric identity. The general goals of professional attributes, risk, audit, teaching and supervision, clinical and service management,
organisational change and clinical governance will form the backbone of this training programme.
STRUCTURE OF THE FIVE-YEAR TRAINING PERIOD
Trainees will be appointed to a five-year long training programme. Through the partially integrated dual training, trainees will likely spend the initial 2 years doing general adult psychiatry and then 3 years in psychotherapy (or vice versa).
The ST general adult training placements will potentially be to any of the accredited general adult post across the three Trusts within HENW Mersey. The ST psychotherapy training placement for Mersey will be within Mersey Care Psychotherapy and Complexity Service. However, psychotherapy training placements can be organised with other Trusts as described below.
During the two years spent in general adult psychiatry trainees will be expected to use their special interest/research time to undertake psychotherapy cases and attend the joint Dual Training ST post-graduate programme at Gaskell House in Manchester on Thursday afternoons (see below).
During each of the five training years trainees will contribute to the General Adult out-of-hours on call rota. The frequency of on call varies between the different Trusts (e.g. Mersey Care rota is 1 in 17).
DETAILS OF THE MERSEY DEANERY GENERAL ADULT TRAINING SCHEME
Mental Health provision across the geographic footprint of Mersey Deanery is provided by 3 local NHS trusts: Mersey care NHS Trust, 5 Borough’s Partnership NHS Foundation Trust and Cheshire and Wirral NHS Foundation NHS Trust. During general adult training trainees will have the opportunity to undertake placements (usually one community and one inpatient placement) across the three Trusts within Mersey. Mersey has a large geographical footprint and offers a wide range of potential training placements.
Placements will provide valuable chances for trainees to function as a medical expert within a multidisciplinary framework, providing opportunities for: leadership in multidisciplinary working, consultation to colleagues, participation in teaching and training junior colleagues/medical students and on-call/urgent work within a shift system. There will be additional opportunities for attaining management, leadership, and educational skills.
General Adult posts within the Mersey Deanery are geared around helping trainees attain the necessary skills and competencies to comply with the General Adult Psychiatry Curriculum requirements, Intended Learning outcomes (ILO), as set out by the GMC. These include:
|Assessment, diagnosis, formulation and management (including risk management).||
ILO 1-4 and 14
|Review formulations and management plans, and making shared decisions with patients and carers.||ILO 1-4|
|Urgent, on call and Mental Health Act work.||ILO 4, 7 and 11|
|Multidisciplinary reviews (CPA, MAPPA, risk).||ILO 4, 7 and 9|
|Communication about patients and implementation of Trust polices through team meetings.||ILO 9, 10 and 13|
|Developing leadership skills through regular/adhoc advice to team members.||ILO 10 and 15|
|Liaison with colleagues (primary and secondary care) around patient safety, governance and Mental Health Act issues.||ILO 9 and 10|
|Educating, teaching and training trainees and medical students.||ILO 15|
|Meeting the requirements for revalidation.||ILO 17 and 18|
|Participation in academic programmes and organising junior trainee/medical student programmes.||ILO 15|
|Special Interest time (Psychotherapy).||ILO 5 and 16|
DETAILS OF THE MERSEY DEANERY MEDICAL PSYCHOTHERAPY TRAINING SCHEME
The majority of training will be based within the Mersey Care Psychotherapy, Consultation and Complexity Service, Mossley Hill Hospital, Liverpool. Clinical supervision will be provided on all cases by experienced, accredited medical and non-medical psychotherapists, with postgraduate training to UKCP, BPC or equivalent.
(1) Mersey Care Psychotherapy, Consultation and Complexity Service.
The central placement for the majority of the psychotherapy training will be at Mossley House in Liverpool, joining the team there which comprises 6.6 WTE psychotherapists from different professional backgrounds, offering the following range of therapeutic modalities:
Analytic Group Therapy
Cognitive Analytic Therapy (CAT)
Mentalization Based Treatment (MBT)
Cognitive Behavioural Psychotherapy (CBT)
Systemic and Family Therapy
EMDR (Eye Movement Desensitisation Reprogramming)
Dialectical Behaviour Therapy (DBT)
Day Therapeutic Community Service (The Rotunda Service)
The Consultant Psychiatrists in Psychotherapy based here are Dr Simon Graham (full time) and Dr Justine Croft (part time). This service provides conventional psychotherapy and also specific interventions for personality disorder to the patients referred from within the secondary care service of Mersey Care NHS Trust. As such the trainee will gain experience in both conventional psychotherapy and more complex personality disorder cases. The post holder will gain experience of screening referrals, undertaking assessments for therapy, observing and undertaking psychotherapy consultations and taking on a caseload of patients for therapy. There are opportunities to develop the necessary competencies and experience in Family Therapy and CBT within this placement. There are also opportunities for gaining experience in the provision of teaching and training (i.e. Balint style Case Discussion Groups, seminars, the supervision of others and lecturing) through the work delivered by this department. The Department also has established links with researchers based at the University of Liverpool.
(2) 5 Borough’s Partnership NHS Foundation Trust
Within 5 Borough’s Partnership NHS Foundation Trust, Dr Helen Sowden, Consultant Psychiatrist in Psychotherapy, can provide supervision in the Cognitive Behavioural Therapy (CBT) component of the training. There may also be the potential to set up other therapy training experiences within 5 Borough’s Trust
PROVISION OF ACADEMIC TEACHING AND OPTIONS FOR EXTERNAL PSYCHOTHERAPY TRAINING
Across four of their five years the post holder will participate in the weekly Dual Training ST academic programme run jointly with the North West Psychotherapy Training Scheme, held on Thursday afternoons at Gaskell House in Manchester. This consists of regular journal clubs, case presentations and management presentations. This link creates the opportunity for the trainee to form a peer group with the North West Deanery trainees. Additionally, a national peer group also exists for psychotherapy trainees.
New arrangements are in progress, which will allow those completing NHS ST Psychotherapy Training direct registration with the UKCP, as a medical psychotherapist.
Some trainees may wish to pursue further additional external psychotherapy training. There are local external formal training in psychotherapy, leading to UKCP registration, in CAT by North Cognitive Analytic Therapy (NCAT) and for Group Analysis by Group Analysis North (GAN), both based in Manchester. Both courses run in blocks, which makes attendance easier. Additionally, there is a two-year Foundations in Psychodynamic Psychotherapy (D58 Course) in Leeds, which does not lead to registration as a psychotherapist, with a third year for a Masters in Psychodynamic Psychotherapy. The D58 course will also likely be running from Manchester by Autumn 2014. If a trainee is accepted onto an external training much of this would be undertaken in their own time outside of the ST psychotherapy scheme. It is also likely that this might not be completed within the time frame of the dual ST programme (i.e. it might continue beyond five years). Additionally, there are other local courses in Psychodynamic Interpersonal Therapy and Cognitive Behavioural Therapy also based in Manchester, and Leeds University runs an MSc in Systemic Therapy.
The trainee will have access to the standard level of study leave budget to contribute towards the funding of external courses and conferences. Trainees are subject to the standard contract with access to statutory study leave as described in the contract of employment. The post holder will have one day per week research/special interest, to be spent within psychotherapy.
PROGRESSION THROUGH TRAINING AND APPRAISAL AND ASSESSMENT
The trainee will have weekly contact with their clinical supervisor of the specialty for that year (i.e. GA in first 2 years and Psychotherapy subsequent 3 years or vice versa), but also regular but less frequent contact with a clinical supervisor allocated from the second specialty. The clinical supervisor role is to support as a mentor and to challenge as a colleague, enabling the trainee to reflect openly and robustly about their capacities and development. This process will be largely informal. Furthermore, additional medical and non-medical psychotherapists will supervise the on going psychotherapy cases.
The more formal element of appraisal and assessment takes place in the annual assessment, ARCP (Annual Record of Competence Progression). The annual ARCP will be undertaken by the Mersey School of Psychiatry informed by both Training Programme Directors, who are in turn informed by both clinical supervisors.
To prepare for the ARCP a six monthly review of the training will be undertaken, informed by both the clinical supervisors in general adult psychiatry and psychotherapy. 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 and plan any appropriate additional support/teaching, and also to help the trainee to prepare the portfolio and ensure coverage of workplace based assessments for the ARCP.
For psychotherapy the trainee will be expected to carry out a minimum of 700 hours in their major modality of psychodynamic psychotherapy and 100 hours of clinical practice in both Cognitive Behavioural Therapy and Systemic Therapy (total 900 hours). The trainee is required to have a minimum of 60 hours of assessing patients for psychotherapy and other psychological interventions. Joint assessments will be undertaken with psychotherapists with experience of different modalities, and mental health colleagues and medical and psychiatric colleagues as appropriate. The Psychotherapy Training Programme Director will decide with the trainee and educational supervisors what clinical experience will contribute to the hours of experience required.
Formative assessment will be based on learning outcomes as defined in the ST psychotherapy and general adult psychiatry curricula of the Royal College of Psychiatrists ratified by the General Medical Council Postgraduate Education Board (2009). In keeping with the RCPsych’s Curricula the attainment of competencies will be measured on an on-going basis using the work place based assessments developed by the RCPsych (i.e. SAPE, SAPA, PACE, Mini Ace, CbD, DONCS etc). Additionally for psychotherapy, there will be formal submission of four assessments/case studies for formal marking by the medical psychotherapists. Trainees will need to ensure their training meets the RCPsych general adult and psychotherapy ST4-6 curricula, and record evidence of this via both the general adult and psychotherapy on line RCPsych training portfolios.
For most trainees their personal therapy will be a central part of their professional development. It will help trainees think about working with severe psychiatric disturbance, and in particular the emotional challenges of working across different settings with potentially very different ways of thinking about patients.
Trainees will be expected to engage in personal therapy during the five-year course of their training, as a form of experiential learning and to aid the understanding of the therapeutic relationship from both the perspectives of a therapist and patient. This will most likely be individual analytic therapy but group analytic therapy could also be considered. The trainee may begin in a once weekly therapy and increase the frequency as they develop through their training, but if a trainee is engaging in twice per week clinical work they should consider being in twice a week personal therapy.
It has been agreed that funding for one session of therapy per week (to a maximum of £2400), will be split equally between Mersey Deanery, the host Trust and trainee post holder. Trainees would be expected to take up personal therapy with an experienced UKCP/BPC qualified therapist equipped to address the relevant issues of personal and professional development as they may arise in the context of training. Personal therapists should be agreed with the psychotherapy training programme director.
EXPERIENCE IN PROVIDING TRAINING TO OTHERS
The trainee will be expected to gain experience of training others both in psychiatry and psychotherapy (i.e. Core Trainees in Psychiatry). In psychotherapy this will be through the provision of Balint style Case Discussion Group (CT1 trainees), as well as being involved in the delivery of psychotherapy seminars and therapy case supervision to CT2 and CT3 trainees.
Other opportunities for teaching are extensive and range from medical undergraduate teaching to lecturing on the local postgraduate MRCPsych course hosted by Liverpool University. Trainees would be encouraged to set up training events for others and so gain experience in curriculum design and implementation of a teaching programme. The trainee will develop and evaluate their own teaching materials, and will be expected to attend local “How to Teach” training courses.
RESEARCH, AUDIT AND MANAGEMENT EXPERIENCE
Research: The trainee will be expected to familiarise themselves with the literature and the methodological strengths and weaknesses in relation to research in their respective sub-specialties.
For psychotherapy the issues surrounding the evidence base and comparison between different models of psychotherapy should be familiar to trainees. The trainee should be aware of current outcome measures and their strengths and limitations and should be able to appraise the literature critically.
Through links with the University of Liverpool, especially the Postgraduate Department of Psychiatry, various research opportunities are available.
Audit: The trainee will be expected to have an understanding of the audit cycle and carry out an annual audit project in one or other of the two sub-specialties during their training in psychotherapy and general adult psychiatry. Within the psychotherapy service trainees are expected to take part in the departmental audit programme and with support undertake specific audit projects of their own.
Management: The trainee will attend 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. There are training opportunities in management for Specialist Trainees within each of the Trusts and the Mersey Deanery also provides a number of excellent introductory courses across many aspects of management. Beyond this, the post holder will be encouraged and supported to take on management tasks consistent with their level of training. The trainee will lead organisational tasks commensurate with their leadership development. Being a representative of training committees, organising local or national conferences and presenting at conferences will be an aspect of leadership development in the training.
Any interested trainees would be encouraged to contact Dr Simon Graham and Dr Tabani to discuss the training opportunities further.
Dr Simon Graham
Medical Psychotherapy Training Programme Director
Dr Kauser Tabani
General Adult Training Programme Director
The North Western Deanery offers a well established higher training scheme in Psychotherapy. There is the potential to complete a single CCT in Psychotherapy but nationally trainees are now encouraged to apply for dual training in Psychotherapy and General adult Psychiatry. The North West is an excellent place to live, and Manchester is a vibrant and interesting city with many cultural and sporting activities. One can have all the benefits of city life in addition to being able to get out into the countryside of North Wales, the Lake District, the North Yorkshire Moors and Derbyshire within one to two hours of the city centre.
There are currently 4 dual training psychotherapy posts in the region based in Gaskell House (Central Manchester), The Red House (Salford) and Albert Road (Preston). Trainees are usually based at one of the sites for the whole of the 5 year training but can access other training opportunities from other departments. At these sites, there are a range of therapies provided including Psychoanalytic psychotherapy, Group analytic therapy, Cognitive analytic therapy, Cognitive behavioural therapy, Dialectical behavioural therapy, Mentalization based therapy, Systemic/Family therapy, Transference focused therapy and a Therapeutic community day programme.
The North West offers a blended dual training programme in psychotherapy and general adult psychiatry over 5 years. For the first two years, 3 days will be spent in psychiatry and 2 days in psychotherapy. For a further two years, 3 days will be spent in psychotherapy and 2 days in psychiatry. In the final year the trainee will be based in psychotherapy full time. For the first two years of the programme, the educational supervisor will be a general psychiatrist with input from the linked consultant medical psychotherapist. For the remaining three years, the educational supervisor will be the consultant medical psychotherapist.
An in-house academic programme has been running on Thursday afternoons at Gaskell house since 2008 which is tailored to the needs of medical psychotherapists in training. This programme is currently being developed into a 4 year cycle to accommodate the needs of dual trainees who need to learn about psychotherapy and psychodynamic psychiatry. Specific training days in General adult psychiatry are also provided through the general adult programme.
The Scheme has close links with the University Department of Psychiatry in Manchester, which is one of the biggest in the country with many internationally renowned professors and academic staff. Psychiatry in Manchester is part of an academic health science centre (MASC), one of only two in the country which offers an excellent opportunity for trainees to engage in meaningful research. All trainees are encouraged to develop research interests with support from relevant academics or other consultant supervisors.
Trainees are required to do regular audit projects and it is expected that over time, these will be linked into meaningful management projects.
There are lots of opportunities for teaching and developing teaching skills including attendance at a teaching training programme linked to Edge Hill University. Trainees are expected to develop as skilled and enthusiastic teachers and culture carriers of psychotherapy and psychotherapeutic psychiatry.
The Certificate of Completion of Specialist Training (CCST)
The award of the CCST is granted by the Special Training Authority (STA). This will act on advice from the Royal College of Psychiatrists, who will accept evidence from the JCHPT and local Postgraduate Dean that a trainee’s performance has been acceptable for the award of CCST. This requires regular monitoring throughout the three years of training. For this purpose, an annual appraisal will be held by the Programme Director in conjunction with the Postgraduate Dean’s representative, the Regional Advisor, and if appropriate, a member of the local University Department.
Most trainees will opt to do a dual CCST. The candidate needs to apply in open competition for a National Trainee Number (NTN) for both general and specialty posts, sometimes at different appointment committees. The length of training for a dual CCST in Psychotherapy and General Adult Psychiatry is 5 years. The NTN is retained throughout the period of training. In rare instances, an applicant can apply for a single CCST in Psychotherapy if, for example, he/she has already completed a CCT in General Adult Psychiatry. In this instance a CCT can be awarded (assuming satisfactory progress) after three years with the expectation that a trainee will find a consultant post within six months of completion of the scheme.
As Training Programme Director, I would very much like to encourage you to think about applying to the Scheme if you are seriously considering a career in Medical psychotherapy. Please feel free to contact me to discuss this further.
Dr Mark Evans
Training Programme Director in Psychotherapy
North Western Deanery
Link to Medical Psychotherapy curriculum: