Trainees experience of Training in Ireland Dr Eric Kelleher Chair, - - PowerPoint PPT Presentation

Trainees experience

• f 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

• Overall very positive
• Excellent Consultants
• Variety in Specialties of

Interest

• Psychotherapy Supervision
• Research opportunities

Negative

• Supervision experience varied
• Mentorship would benefit

junior Trainees re choices early on

• Varied opportunities for

psychotherapy on location

• Research posts few nationally
• Effects of EWTD on Training

given recruitment issues

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

• Formalised requirements
• Ensures Supervision
• WPBA draw attention to

needs

• Shows progress
• Audits on ward
• Supervision/ Teaching

high standard

• Journal Clubs
• Case presentaions

Negative

• Documentation
• WPBA
• Consumes Supervision
• Other supervisor difficult
• Psychotherapy supervision

variable

• Research opportunities

vary

• CAP experience

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 psychotherapy1,2,3

• 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

1Rooney S, Kelly G, Psych Bull 1999 2Byrne 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
• ver 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

17

Sexton S, Kelleher E, Douglas L, Vaughan R, 2011 198 NCHDS, 162 Cons

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

Summary

• Positive Training experiences reported by BST Trainees
• Supervision
• Training
• Clinical experience
• Opportunities for research
• Challenges
• Psychotherapy Training
• Training in the downturn
• Recruitment Rota/ Staffing
• HST schemes positive reports

Trainee Committee

• Involved in College

faculties / Groups

• Trainee’s perspective
• Liaise between

College & Trainees

• Positive experience

Staffing of rotas/Recruitment

Trainees experience

• f Training in Ireland

Dr Eric Kelleher Chair, Trainee Committee College of Psychiatry of Ireland 27/09/ 2012