Trainees experience of Training in Ireland Dr Eric Kelleher Chair, Trainee Committee College of Psychiatry of Ireland 27/09/ 2012
My Current Position
My Current Position
My own experience so far… • Qualified in 2004 • Internship x 1 year in medicine and surgery • Medical Senior house officer x 2 years • MRCP • Basic Specialist Training in Psychiatry x 3 years (DUPRTP) • General Adult Psychiatry x 1 ½ year • Specialty Training • Psychotherapy • Liaison Psychiatry • Child Psychiatry • MRCPsych • Clinical Research Fellow in Trinity College Dublin x 1 year • Currently PhD student & Clinical Research Fellow (TCD/SJH)…
My views on my Training Scheme Positive Negative • Supervision experience varied • Overall very positive • Mentorship would benefit • Excellent Consultants junior Trainees re choices early on • Variety in Specialties of • Varied opportunities for psychotherapy on location Interest • Research posts few nationally • Psychotherapy Supervision • Effects of EWTD on Training given recruitment issues • Research opportunities
2009
Training at Present • Basic Specialist Training today • 4 years Basic Specialist Training since 2011 • Foundation year followed by Annual review of Progress • 3 yrs. Basic Specialist Training in one of 11 national schemes • New College exam reflecting Training in Ireland • Certificate of Completion of Basic Specialist Training • Leads on to Higher Specialist Training (3-4 years)
BST Schemes 1. University of Limerick / Mid Western BST Scheme 2. South-East BST Scheme 3. Cork & Kerry BST Scheme 4. Sligo Leitrim BST Scheme 5. Galway University Hospitals/Western BST Scheme 6. Donegal BST Scheme 1. SJOG/SVUH/UCD BST Scheme 2. DUPRTP Scheme 3. Mater / UCD BST Scheme 4. RCSI BST Scheme 1. Cavan/Monaghan Training Scheme 2. Longford Westmeath BST Scheme 3. Laois / Offaly BST Scheme
Basic Specialist Training Positive Negative • Documentation • Formalised requirements • WPBA • Ensures Supervision • Consumes Supervision • WPBA draw attention to • Other supervisor difficult needs • Shows progress • Psychotherapy supervision variable • Audits on ward • Research opportunities vary • Supervision/ Teaching high standard • CAP experience • Journal Clubs • Case presentaions
Basic Specialist Training New Irish exam- Trainee’s perspective • Positive Independent national College accredits national training • Improve Training • Relevant to Irish Legislation • Concerns • Reciprocity Abroad • Irish exam & MRCPsych
Psychotherapy Training • Evidence from surveys suggests Trainees are not getting adequate experience or Training in psychotherapy 1,2,3 • New College Curriculum provides opportunity to review psychotherapy Training • Survey of 62 College Tutors on 13 schemes (Lee & Noonan, IJPM 2012) • Response rate 49/62 (79%) • 84% Psychotherapy training available • 67.3% tutors stated Trainees not making requirements 1 Rooney S, Kelly G, Psych Bull 1999 2 Byrne P, Meaghar D, Psych Bull 1997 3 O’Mahoney E, Corvin A, IJPM 2001
Psychotherapy Training • 80% tutors could provide training if protected time and resources available- Similar to UK • New Training Blueprint (BST) • Balint style groups must be provided • Minimum of one long case (24sessions) • Maintain supportive relationships/ refer suitable patients • Suggestions (Lee & Noonan, IJPM 2012) • 1 year placements • Protected time
Psychotherapy Training • CBT by BST Trainees (Kelleher E, Tone Y, Kearns C et al, 2012) • Competency of Psychiatry trainees in delivering CBT to selected patients over a two year period • Cognitive Therapy Scale (CTS-R) for rating quality of CBT. • Beck’s Anxiety Inventory (BAI) and Beck’s Depression Inventory (BDI). • Results: • 24 of 28 (72.7%) trainees took on 29 cases • Sample tapes from 6 trainees were rated by examiners using the CTS-R. The average result was 42.1/72 (range 33 to 50) establishing this subgroup in the “competent” range on the competency scale. • Outcome data 14 patients showed significant (P=<0.001) improvements • Psychiatry trainees can achieve “competency” and meaningful clinical improvement when delivering CBT for the first time even in 6/12 • Cost of training and supervision judged against these clinical gains.
BST Academic Training • E-modules • One day courses • In house teaching • Journal Clubs • Case presentations • Supervision • Presentation/ Research opportunities • College of Psychiatry 2 conferences a year • Opportunities to present (Oral/Poster) • Affiliate Conferences • Research Prizes (Addictions/ Forensic/ Psychotherapy) • Irish Journal of Psychological Medicine
Research Career • Between BST and HST • Clinical Research Fellowships • MD- complete in HST • PhD • BST Posts associated with Consultants assoc with Academia • Opportunities for research-> MD/PhD • Securing Funding difficult
Staffing of rotas/Recruitment EWTD: Impact on Training opportunities 198 NCHDS, 162 Cons 17 Sexton S, Kelleher E, Douglas L, Vaughan R, 2011
Staffing of rotas/Recruitment • Staffing difficulties • Especially in rural posts • Locum cover • Difficulty obtaining time off as no doctors to cover post • Emphasis on Service Provision rather than Training • Changes to Consultant Role (proposed Sept 2012) • Unilateral Salary Cuts • Changes to work practises • Impact on recruitment/ Retention/ Training in future
Applying for HST • Basic Specialist training (BST) to Higher Specialist Training is by competitive interview. • Prior to July 2012 will have completed at least 3 years training & MRCPsych • From July 2014, trainees will hold the Certificate of Completion of BST, based on CPI exam and progress at each annual review of progress. • • SRs are appointed by an interview panel convened by the COPI, which • Representatives medical schools, employers and psychiatric specialties. • Intake occurs at July each year. • New trainees are offered their initial post based on availability of posts. • Subsequent postings are based on training needs & Seniority
HST experience/ Curriculum • New curriculum in 2012 • Annual review of progress panels • Single CSCST: General Adult Psychiatry/ Psychiatry of Elderly/ Psychiatry of Learning Disability • Subspecialties (Adult)- Liaison/ Rehab/ Forensic/ Addictions • Dual CSCST: General Adult Psychiatry and Elderly/ General Adult Psychiatry and Learning Disability/ Psychiatry of old age and learning disability • 3 or 4 years duration • All Trainees offered 3 years clinical placement (Academic year can be recognised if applied for prospectively • Dual CSCST: 4 years
General Adult Psychiatry • 34 General Adult Posts • 9 Senior Lecturer posts (1 Forensic post)- 2 years • 13 Psychiatry of Old Age • 4 Rehabilitation posts • 5 Liaison Psychiatry Posts • 1 Forensic Psychiatry post • 4 Learning disability • 1 Substance misuse
Gen Adult HST experience • Own office space/ computer access • Satisfied with administrative support for clinical work but teaching not as well supported • Wide range of experience available on scheme • Core placements • Special interest sessions • Within research • Positive feedback regarding clinical teaching offered within posts- Consultant and MDT • Urban and rural experience • More community orientated
HST experience • Academic programme 10 meetings a year • Senior Registrar day release • Research • Supported in several universities • Opportunities for completing MD • Teaching • Associated with Universities • Special interest • Teaching qualification (M.Sc) • Management • Leading MDT, Formal Training
HST experience • Overwhelmingly positive re experience gained • Good experiences of supervision and development of interests • Issues: • Covering BST staff shortages • Unable to take 2 special interest sesssions/ week • Matching posts to interests
Child & Adolescent Training • 32 Senior Registrars in 10 schemes • 3 year Training Programme • CPsychI recommends at least one year in urban Dublin & one year in Rural environment • Experience: • Trainees reported they had supervision with their Trainers of high standard & support • Trainees felt case load adequate • Good exposure to treatment modalities including psychopharmacology, cbt, Family Tx, Group work & Early years but limited exposure to psychodynamic work • Good access to training programme with protected time for same
Child & Adolescent Training • Research experience varied in posts-> Research tutor appt would be beneficial to guide Trainees early in career • Varied access to inpatient experience, limited Day hospital exp • Improve opportunities for sub- specialty training • Forensic/ Substance misuse/ Liaison • On call opportunities can be limited across training centres • Most services have upper age limit of 16 y.o. • Development of adolescent posts • 3 year Academic programme well established & covers range pertinent to training • Overall Trainees expressed high levels of satisfaction with their Training experience
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