BASIC SPECIALIST
TRAINING
Training Handbook
ConTenTS
1. introduction 4
2. organisation of Training Schemes 5
3. The Tutor 7
4. The Supervising Consultant 8
5. Clinical Supervision 8
6. Training Placements 9
7. Educational Supervision, appraisal & assessment 13
8. assessment of Training Placements 14
9. The Teaching Programme 15
10. Postgraduate Facilities 16 11. academic Courses 17 12. audit/research 17 13. Psychotherapy Training 18 14. ECT Training 18 15. Case records 18 16. Safety 19 17. Employment Conditions 20 index 21 bibliography 22
appendix a: Form approval of Placements on basic Specialist Training Schemes 23
appendix b: 25 The Trainee Committee induction
Training Handbook
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1
. inTroduCTion
The College of Psychiatry of ireland (CPsychi) is responsible for all aspects of postgraduate training in Psychiatry in ireland. its aim is to provide the best possible training at both basic and Higher Specialist levels in Psychiatry. Satisfactory completion of Specialist Training confers eligibility for inclusion on the Specialist division of the Medical register.
To achieve its aims CPsychi has developed and organised training in a two stage format of basic Specialist Training followed by Higher Specialist Training.
basic Specialist Training (bST) takes approximately 3 years at the end of which time the Trainee will take an examination. Currently, basic Specialist Training is said to be completed when the Trainee has passed the membership examination of The royal College of Psychiatrists. new methods of assessment of clinical competencies will be introduced from 01 July 2011 which will also have to be completed satisfactorily before a Certificate of Completion of bST will be achieved but these are not a current requirement. a Logbook will also be introduced at the same time. This Handbook will be amended when these new requirements are introduced.
This Handbook shall inform all those involved in training as to how basic Specialist Training in Psychiatry should be organised and delivered in ireland and also outlines those standards which must be achieved if the training schemes through which this training is provided are to be approved by CPsychi.
a similar Handbook is available for Higher Specialist Training in Psychiatry. Following the successful completion of both these parts of training including the appropriate examination in Psychiatry (currently the MrCPsych) the doctor should have achieved the skills to be awarded a Certificate of Satisfactory Completion of Specialist Training (CSCST) in one of the specialties of Psychiatry recognised by the irish Medical Council viz Psychiatry, Psychiatry of old age, Child & adolescent Psychiatry or Psychiatry of Learning disability.
in providing this information CPsychi is stating specifically what is required for the doctor to be awarded a CSCST.
These requirements are not the same as those for sitting the Membership of The royal College of Psychiatrists. all Trainees must refer to The royal College of Psychiatrists website (www. rcpsych.ac.uk) to ensure that they meet the current criteria for sitting the MrCPsych examination.
2
. organiSaTion
2.1. SizE oF Training SCHEME
Currently there is wide diversity with some stand-alone schemes training as few as 9 Trainees while the largest co-ordinated training scheme has almost 80 Trainees. Very small schemes (i.e. less than 8 Trainees) are unlikely to be granted more than limited training accreditation (see Section 2.4 & 2.5). Training Centre Tutors (hereinafter referred to as “Tutors”) should not normally be responsible for more than 10 - 15 Trainees. Large training schemes will require several Tutors of whom one should be designated as Scheme Co-ordinator to oversee the efficient running of the scheme as a whole.
2.2. adMiniSTraTion oF Training SCHEME
Each training scheme should be administered by a Training Committee, normally chaired by the Scheme Co-ordinator, and including representatives from the Supervising Consultants, Trainees, local academic department, and general Management.
Each scheme should have a Trainees’ Committee which should meet regularly and keep records. This is important to ensure that the training programme is regularly reviewed and to enable the nomination of representatives to the Training Committee or other working groups. appropriate administrative support should be provided to enable and assist efficient functioning of the Committee, and enhance the management experience available to Trainees.
2.3. SELECTion oF baSiC SPECiaLiST TrainEES
The appointment of Trainees to a training scheme should always be through a properly constituted Senior House officer/registrar appointments Committee of which the Scheme Co-ordinator must be a member. Trainees may be committed to a career in Psychiatry or may be undertaking six months training in Psychiatry with a view to a career in general Practice or another specialty.
it may be helpful for Trainees to be appointed for an initial probationary period (probably of one year duration) so that those whose talents are not suited to a career in Psychiatry can be helped to find an alternative before too much time is lost. it is important that the initial job contract specifies this clearly and is approved by the Human resources (Hr) department. Subject to complying with the provisions of paragraph 6.1 the initial allocation of Trainees to training placements should be determined by mutual agreement between the Scheme Co-ordinator and the Training Centre Tutors in consultation with the Supervising Consultants taking account of the preferred choices of Trainees.
2.4. duraTion oF baSiC SPECiaLiST Training
basic Specialist Training in Psychiatry requires a minimum of 36 months in an approved training scheme. in general it is most satisfactory for a Trainee to be able to complete basic Specialist Training within one scheme. Smaller schemes which can only offer a limited range of training are normally approved by CPsychi for shorter periods (i.e. one year or 18 months) in which case Trainees will have to move to an alternative scheme to complete their basic Specialist Training.
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noTE: Trainees wishing to enter Higher Specialist Training, i.e. the Senior registrar grade, with the purpose of obtaining a Certificate of Satisfactory Completion of Specialist Training (CSCST) must satisfactorily complete a minimum of 36 months approved basic Specialist Training and have passed the MrCPsych Examination.
2.5. SPECiaLTy ExPEriEnCE
To receive full accreditation (i.e. for three years), a training scheme must include broad experience in general adult Psychiatry and experience in at least three of the following recognised psychiatric specialties:- Child and adolescent Psychiatry, Psychiatry of Learning disability, Psychiatry of old age, alcohol and drug addiction and Forensic Psychiatry. all Trainees must rotate through the specialties available.
2.6. dESignaTion and aCCrEdiTaTion oF Training PoSTS and PLaCEMEnTS
Each training scheme should maintain an up-to-date list of training posts with the standardized numbering system established by The Medical Council.in addition, CPsychi must educationally approve all training placements. Existing placements will be reviewed at regular CPsychi accreditation Visits (normally every 3 - 5 years).
Tutors seeking CPsychi accreditation of placements should write to the Head of Postgraduate Training, The College of Psychiatry of ireland, 5 Herbert Street, dublin 2.
nCHds with contracts of indefinite duration who are not in training posts cannot count experience gained in such posts for the requirement for completion of specialist training.
2.7. baSiC SPECiaLiST TrainEES MuST HaVE ExPEriEnCE in ParTiCiPaTing on a
FirST-on-CaLL duTy roTa, aT a MiniMuM oF an aVEragE raTE oF 1 in 10 oVEr a
THrEE yEar PEriod.
Trainees working part time or on flexible training must have equivalent experience. Psychiatric Trainees should not provide cross specialty cover for other medical specialties.
Where daytime on-call rotas are necessary, participation must not prevent Trainees attending training, except in occasional exceptional circumstances i.e. emergencies.
2.8. FLExibLE (ParT-TiME) Training
Each training scheme must make provision for Trainees who wish to train on a part-time basis. “Flexible” training requires the agreement of the HSE, CPsychi and the Scheme Co-ordinator. Flexible Trainees are required to undergo the same whole time equivalent length of training as full-time Trainees and may therefore spend a longer period in each attachment. Tutors and local personnel departments should familiarise themselves with the local arrangements for flexible training.
2.9. aCCrEdiTaTion oF Training SCHEMES
normally each training scheme will be visited every three to five years by an accreditation Team, appointed by CPsychi, consisting of a Convenor, a Supervising Consultant Psychiatrist and a Senior Trainee. The accreditation Team report, which includes mandatory requirements and recommendations, will be discussed and signed off by the accreditation Sub-Committee (CPsychi) and the Head of the College’s
Training Pillar before submission to the Council of CPsychi for approval. Continuing accreditation is subject to the mandatory requirements being addressed.
Where the quality of training is in doubt, an early revisit may be recommended. When serious deficiencies are identified, the continuation of training accreditation may be at risk either for one or more specific posts or the scheme as a whole. Where accreditation has been withdrawn from a post, re-accreditation will only be granted when CPsychi is satisfied that effective remedial action has been taken. When an entire training scheme loses accreditation, re-accreditation will require a further formal accreditation visit.
accreditation is normally granted for full basic Specialist Training. Small schemes offering a restricted range of training opportunities will normally only be granted accreditation for one to two years training (see also Section 2.5).
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.
THe TuTor
3.1 Every training scheme will have a Scheme Co-ordinator who is responsible for running the scheme. He/She will be supported by the Training Centre Tutors.
3.2 Tutors are normally nominated for appointment by local colleagues and must have the approval of CPsychi.
3.3 Tutors should have designated sessional time. a minimum of two sessions per week is usually required by a Tutor to carry out his/her duties.
3.4 all Tutors should hold permanent Consultant appointments and must be on the Specialist division of the Medical register and CPd compliant.
3.5 Tutors must be provided with adequate secretarial support to ensure the smooth running of the training scheme. in some cases, a Consultant’s secretary may be able to discharge this function but, in most cases, a full or part-time postgraduate education secretary will be required. it is essential for a Tutor to have access to e-mail and the internet.
3.6 Tutors should not usually be in post for more than five consecutive years.
3.7 Postgraduate training in Psychiatry is the responsibility of CPsychi. The Tutor is responsible for regular reviews of individual training, logbooks, counselling and general advice. The Scheme Co-ordinator is responsible for the co-ordination of accreditation Visits by CPsychi.
3.8 Tutors should be encouraged to participate actively in the national meetings of Tutors organised by CPsychi.
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4
. THe SuPerViSing ConSuLTanT
4.1. The Supervising Consultant is normally the Consultant for whom the Trainees do most of their work clinically and must be approved by CPsychi. normally the Supervising Consultant will provide both clinical and educational supervision (see below section 5 – clinical supervision).
4.2. Consultants who have been appointed at a properly constituted appointments Committee and who fulfil CPsychi’s minimum criteria for a Consultant appointment will normally be approved. Temporary/ Locum Consultants who are going to be in post for more than three months must apply on the prescribed form to CPsychi for approval as Supervising Consultants.
4.3. all Supervising Consultants must be on the Specialist division of the Medical register maintained by the irish Medical Council and CPd compliant. Posts on a team of a Consultant who is not registered on the Specialist division of the Medical register will not be approved for training by CPsychi.
4.4. Trainees should not normally rotate into placements without a recognised Supervising Consultant. Where this is unavoidable (for example when a Locum Consultant is in post who is not approved as a Supervising Consultant) temporary arrangements must be made for the Trainee to receive educational supervision from a CPsychi approved Supervising Consultant. Such arrangements should not exceed three months.
4.5. Consultant medical staffing must be adequate to permit satisfactory training. The supervision and instruction of Trainees makes considerable demands on the time of Supervising Consultants and the Tutor. it is particularly important that Consultant medical staff are available to provide appropriate clinical and educational supervision.
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. CLiniCaL SuPerViSion
Clinical supervision must be provided at a level appropriate to the needs of the individual Trainee. it must be provided by the Supervising Consultant who will normally provide close supervision of both inpatient and outpatient work and (unless other arrangements are made) supervision for emergency consultations including liaison work. additional supervision by a Senior registrar, where available, is also appropriate. Trainees must not be expected to conduct ward rounds or outpatient clinics alone.
6. Training PLaCeMenTS
6.1. The first twelve months of training should normally be in general adult Psychiatry, or a combination of six months of general adult Psychiatry and six months in Psychiatry of old age, but must not include liaison consultation in a general hospital.
6.2. Trainees intending to enter general Practice should work in general Psychiatry and/or Psychiatry of old age and their placements should be configured to take account of their particular training needs, with increased emphasis on community treatment and multi-disciplinary working.
6.3. all training placements must include direct clinical care of patients. Placements based on observation of the work of other professionals are not satisfactory.
6.4. all schemes should provide an overall balance of hospital and community experience.
6.5. Each placement must have a job description and timetable. Training placements should not include inappropriate duties (e.g. routine phlebotomy, filing of case notes, escorting patients, finding beds, etc.) and must provide a suitable balance between service commitment and training.
6.6. THE FoLLoWing guidELinES aPPLy To PLaCEMEnTS in THE VariouS SPECiaLTiES
i) general adult Psychiatry:
Training placements should include both hospital and community experience and will normally include the following:
• assessment and management of psychiatric emergencies. • assessment of new outpatients under supervision.
• day to day management of psychiatric inpatients, outpatients, day patients and long-stay patients. • Community Mental Health Team (CMHT) - participation in multi-disciplinary team meetings, home
visits, joint assessment with team members etc.
• Prescribing of medication and monitoring of side-effects.
• use of psychological treatments, including CbT and Family Therapy. • use of the Mental Health act (2001).
• administration of ECT (see section 14).
ii) general Psychiatry Sub-specialties:
a) Substance Misuse:
Trainees in general adult Psychiatry should receive appropriate experience in this area. Where a specific service exists for the treatment of alcohol and/or drug dependence it should be possible to offer a wholetime or part-time placement. For this to be regarded as a sub-specialty experience the Trainee must spend at least half their time in the service.
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Training placements should include:
• assessment, diagnosis and treatment of substance misuse. • Multidisciplinary Team work and service provision.
• Experience in dual diagnosis Clinics.
• Experience in inpatient treatment services for substance misuse. • Experience in outpatient treatment services for substance misuse.
b) Liaison Psychiatry:
a training placement in Liaison Psychiatry should include the following:
• assessment and management of patients presenting with deliberate self-harm.
• assessment, investigation and management of patients presenting with acute behavioural disturbance in a&E and general hospital wards.
• Managing psychiatrically ill patients on general hospital wards and working with general medical and nursing staff.
• gaining experience in the operation of mental health legislation as applied in the general hospital setting.
• develop an understanding of the relationships between physical and psychiatric disorders and in diagnosing the commoner forms of psychiatric disorder in the presence of physical illness.
• demonstrate familiarity with the appropriate use of anti-depressant, anti-anxiety and neuroleptic drugs for psychiatric disorders co-existing with physical illness.
• assessment and treatment of psychiatric disorders associated with pregnancy and the puerperium.
c) rehabilitation Psychiatry:
after six months placement the Trainee will be able to: • use the recovery orientated model of care.
• understand and use structured assessment tools.
• use therapeutic interventions for treatment resistant disorders.
• be familiar with psychological interventions including Cognitive behavior Therapy and Family Therapy.
• be familiar with social interventions including placement and supported residential programs. • understand the historical background to the development of rehabilitation services including the
closure of large psychiatric hospitals and the development of community services including assertive outreach services.
iii) Psychiatry of old age:
This should include both hospital and community experience including:
• assessment and management of functional mental illnesses in elderly people.
• assessment and management of dementia associated with behavioural and/or psychiatric symptoms.
• assessment and management of psychiatric emergencies in elderly people.
• assessment and management of elderly psychiatric inpatients (both acute and long stay). • Prescribing for the elderly.
• Liaison with other medical services and with the general community services for the elderly. • Supervised domiciliary assessments and review.
• Management of day hospital patients (where available). • an appreciation of the role of carers of dementia sufferers.
• an understanding of the interplay between physical and mental illness in elderly people. • assessment of (mental) capacity and related issues.
• an understanding of the organisation and operation of Psychiatry of old age services and services for elderly people in general.
iv) Forensic Psychiatry:
a six month placement in Forensic Psychiatry affords the Trainee an opportunity to develop their skills in relation to mentally disordered offenders. The main focus will be on:
• assessment and management of risk in patients in the criminal justice system. • assessment of referrals from other secondary services.
• assessment of level of security.
• a grounding in universal principles of Mental Health Law.
• Familiarity with structured professional judgment and risk assessment instruments.
• Preparing reports for Mental Health Tribunals, Mental Health review boards and the district Court.
v) Psychiatry of Learning disability:
The main focus of this attachment is to gain experience assessing, managing and treating people with learning disabilities who have psychiatric or behavioural problems. Particular priorities of training include:
• Community and campus based services.
• Working as part of a learning disability and/or mental health multidisciplinary team. • Working with all levels of learning disabilities.
• assessment and management of associated autistic spectrum disorders. • assessment and management of associated epilepsy.
• Working with people with recognizable genetic syndromes (e.g. down’s Syndrome, Fragile x) or behavioural phenotypes.
vi) Child & adolescent Psychiatry:
The six month placement in Child & adolescent Psychiatry affords the Trainee an opportunity to develop a family psychiatry perspective as well as obtaining some exposure to the core multidisciplinary team approach of the Child guidance Clinic. The main focus will be on:
• Community based service.
• Membership of a multidisciplinary team using a multi-axial classification system.
• assessment and management of a child in the context of the family (i.e. jointly interviewing child and parent).
• Family interviewing.
• Evaluation of a Child/adolescent patient presenting at a&E (e.g. with self-administered drug overdoses).
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vii. Child & adolescent Mental Health of Learning disability:
on completion of a placement the successful Trainee will be able to:
• demonstrate the ability to complete a child and adolescent mental health assessment of a child or adolescent with learning disability.
• demonstrate the ability to assess and manage episodes of deliberate self-harm.
• demonstrate the ability to work effectively as a member of a child and adolescent mental health of intellectual disability team.
• demonstrate the ability to collaborate with a multidisciplinary team involved in the assessment of children with autism spectrum disorders.
• Show awareness of the role of inter-agency working in relation to children and adolescents with intellectual disability and mental health problems.
• demonstrate knowledge of appropriate treatment modalities including psychotherapies and psychopharmocotherapy.
• demonstrate knowledge of:
(i) Mental Health Legislation as it applies to children (ii) Child Care Legislation
• Show awareness of psychopathological pathways from childhood to adulthood.
viii. Psychotherapy: (see also section 13):
Psychotherapy learning takes place throughout the placements in a training scheme over a three year period and is delivered through a combination of formal teaching, clinical supervision and participation in reflective groups. on completion of the three years the Trainees will be able to:
• Establish supportive doctor-patient relationships and psychotherapeutic relationships. • recognise and discuss suitability for different therapeutic modalities.
• understand psychotherapeutic approaches in personality disorders, psychoses and severe and enduring psychiatric illness.
• know when to refer for formal therapy.
• apply psychotherapy to a variety of clinical presentations. The Trainee will:
• Have developed good communication and interview skills. • Have an understanding of the psychodynamics of team work.
• Have been involved in an Experiential reflective group (e.g. balint group) minimum 30 sessions. • Have theoretical knowledge of a number of modalities.
• Have supervised Clinical Experience: a total of four cases in at least two modalities.
This should consist of three short-term cases of between 8 and 16 sessions and one long-term case of at least 24 sessions.
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. eduCaTionaL SuPerViSion,
aPPraiSaL and aSSeSSMenT
7.1. Educational Supervision must be provided by the Supervising Consultant on a regular basis for one hour per week and this should form part of the Trainee’s timetable. This time should be regarded as belonging to the Trainee (and not to the Supervising Consultant) and should be used for educational rather than clinical purposes. Educational purposes should encompass both clinical skills and theoretical learning. it may, for example, include discussion of interviewing skills, elementary counselling and psychotherapeutic interventions, principles of drug prescribing, use of the Mental Health act, multi-disciplinary working, presentation, audit and research techniques. The use of video recording may be particularly useful in teaching interviewing therapeutic or presentational skills. Career advice, time and stress management are other worthwhile topics.
7.2. Educational supervision must be provided by the Consultant designated as the Supervising Consultant and should not be delegated to other staff except when the Consultant is on leave.
7.3. no Consultant should be responsible for the educational supervision of more than two SHos. Educational supervision should normally take place with Trainees individually rather than in pairs or in groups, although group supervision may be provided in addition.
7.4. appraisal is the joint responsibility of the Training Centre Tutor, Supervising Consultant and Trainee. it involves an open discussion with the Trainee about his/her strengths and weaknesses, training needs and learning objectives. it informs a personal development plan. Much of this takes place within educational supervision and some at more structured reviews with the Supervising Consultant and sometimes the Tutor.
at the beginning of the training placement specific learning objectives should be identified appropriate to the Trainee’s experience and should be recorded in writing. From 1st July 2011 CPsychi will be introducing a Logbook which must be used by each Trainee.
7.5. assessment involves an objective process designed to confirm whether the Trainee has reached a satisfactory level of competence in attaining his/her learning objectives. at the mid point and at the end of each attachment, the Supervising Consultant must conduct and record a formal assessment of the Trainee.
Most training schemes use standardised forms for this purpose, covering the following points: • ability in history taking formulation, oral and case presentation.
• Therapeutic skills and judgement including ability and specific treatment techniques. • relationship with patients, relatives and colleagues (medical and non medical). • Theoretical knowledge of psychiatry.
• knowledge of and skill in general medicine (at a level appropriate to a general medical practitioner) to include basic life support training.
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• initiative, reliability, self reliance and awareness of limits of the Trainee’s experience. • administration and time-management ability.
• interpersonal and communication skills (including a good command of the English language).
7.6. Educational Supervision, appraisal and assessment must be undertaken. information relevant to future satisfactory progress in training, clinical competence, professional behaviour and setting of future training objectives must be made available to relevant Tutors, Supervising Consultants and others where relevant. due respect for confidentiality must pertain at all times.
7.7. Monitoring of progress should be done with reference to the CPsychi Logbook which should be in use by all Trainees. Trainees, Tutors and the Scheme Co-ordinator should work together to ensure that Trainees will be able to meet the various training requirements set out by the CPsychi curriculum during the course of their rotational training. Meetings between the Tutor and Trainees should take place at least every six months and should be recorded.
7.8. The CPsychi Logbook for basic Specialist Training will provide a suitable framework for recording and reviewing all aspects of a Trainee’s clinical and educational progress. Trainees should take responsibility for maintaining the record and ensuring it is available whenever required by their Supervising Consultant or Tutor. Trainees should take responsibility for ensuring the Logbook is regularly reviewed in weekly educational supervision and used for educational planning. Tutors may obtain guidance on the use of the Logbook in the Tutor’s induction pack provided by CPsychi. This includes material for dissemination to Supervising Consultants.
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. aSSeSSMenT oF Training PLaCeMenTS
8.1 at the end of each placement the Trainee should complete a confidential assessment of each training placement and this should be returned to the Tutor.
8.2 Where difficulties arise during a particular clinical placement, the Trainee should raise these in the first instance with the Supervising Consultant. The Training Centre Tutor may have a valuable role in helping to resolve such difficulties. as a result of regular discussions with individual Trainees, the Training Centre Tutor will be able to build up a picture of the quality of training in each placement. This information should be used for improving those aspects of the scheme which are found to be inadequate or unsatisfactory. Comments made by individual Trainees on particular Consultants should normally remain confidential between the Trainee and the Training Centre Tutor. if a series of adverse comments are received, the Training Centre Tutor should approach the Consultant concerned. Supervising Consultants should be aware that the allocation of Trainees to their teams is a privilege and not a right.
There must be a process in place in each training scheme to ensure that the standards for accreditation are maintained.
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. TeaCHing PrograMMe
9.1 induCTion PrograMME
all Trainees must participate in a structured induction programme at the time of taking up their duties. The form and content of induction programmes will vary according to local needs but should include the following elements as a minimum:
• Physical tour of facilities
• information on where CPr machines are located within the hospital and resuscitation policies / Emergency – response Team – role of Trainee
• Procedure for emergency referrals/admissions • rapid tranquillisation policy
• administration of ECT
• use of Mental Health Legislation (2001)
• Safety issues (fire prevention and safety, health, needle-stick injuries, etc.) • breakaway training
• Personnel issues (contract, on-call rota, etc.)
• defensible documentation (note-taking, record-keeping)
all training schemes should have an up-to-date induction Handbook for Trainees, which is given to them on arrival. Please see appendix b ‘induction Framework document’.
9.2 CLiniCaL TEaCHing
This is potentially the most important ingredient of training and requires regular contact between the Trainee, Consultant and other senior clinical staff.
Trainees should regularly present cases, both to their Consultant and in multidisciplinary meetings. all new cases seen in outpatients should be discussed with the Consultant during the clinic.
Trainees should participate in regular multi-disciplinary case meetings in both hospital and community settings and these should always have an educational component.
other clinical duties (for example emergency assessments, liaison assessments etc.) should be used as teaching opportunities wherever possible.
9.3 CaSE ConFErEnCES
Trainees should participate in regular case conferences at which they present cases for discussion. ideally, these meetings should be multi-disciplinary and focused on evidence-based practice. Case conferences should occur on a regular weekly basis throughout the academic year (i.e. approximately 30 per year).
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in the use of evidence-based psychiatry. Journal clubs should occur on a regular weekly basis throughout the academic year (i.e. approx. 30 per year).
a register should be kept of attendance at case conferences and journal clubs.
9.5 inTErViEWing SkiLLS
all Trainees must receive teaching in interviewing skills in the first year of training. The use of role play and/or video facilities is recommended.
9.6 ExaM rEHEarSaL
all Trainees should have an opportunity to rehearse for the MrCPsych examinations.
9.7 ManagEMEnT Training
all Trainees should have some experience of management training, either by participation in local management committees or by attending specific management training courses, e.g. time management, freedom of information, health and safety etc.
9.8 PaTiEnTS, CarErS and THEir rEPrESEnTaTiVES
Patients and carers’ groups could be usefully involved in the induction programme for Trainee Psychiatrists, and could participate in teaching sessions such as the in-house teaching programme.
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. PoSTgraduaTe FaCiLiTieS
10.1. Library
all Trainees must have access to a library which provides a comprehensive service under the direction of a qualified librarian. There must be an adequate stock of up-to-date books and journals and facilities for inter library loans, photocopying and on-line literature searching (including out of hours).
The library should include a minimum of ten psychiatric journals as well as access to general medical journals (e.g. bMJ, The Lancet).
approximately 50% of the library budget should be allocated to journals and 50% to books and information services.
adequate library facilities must be provided at each site where training is provided though the exact configuration will depend on local need. Satellite libraries should contain standard psychiatric texts and at least three psychiatric journals as well as photocopying facilities and telephone, fax and computer links with the nearest staffed library.
10.2. LECTurE & SEMinar rooMS
Each training centre must have one lecture room large enough to accommodate all the psychiatric medical staff, together with non-medical staff and doctors from other specialities, who may attend postgraduate meetings. The lecture room should be equipped with appropriate audio-visual equipment (e.g. slide projector, video recorder, facilities for PowerPoint presentations etc).
Seminar rooms may be less formal in character and should be able to accommodate 12-15 people. Where such rooms are used on a multi-disciplinary basis, Psychiatric Trainees must have sufficient access to allow adequate training. Video facilities should be available for interview skills training if required.
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. aCadeMiC CourSeS
11.1 all Trainees must participate in the CPsychi approved academic course comprising of a systematic course of lectures and/or seminars covering basic sciences and clinical subjects relating to basic Specialist Training.
Such courses, which may be online, are often provided by local academic departments and may form part of a university based MSc or MMedSci course. Tutors should ensure that they are kept informed about the attendance/participation of their Trainees at such courses and should regularly review the quality of teaching with Trainees.
11.2 Trainees attending the CPsychi approved academic courses must be released from clinical duties; they should not be prevented from attending courses or other fixed teaching commitments by clinical or on-call duties. only emergency situations should prevent Trainees attending educational activities. appropriate travelling expenses should be paid.
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. audiT/reSearCH
all Psychiatric Trainees are expected to complete at least one formal audit project.
Successful projects are usually modest in scope and reflect some area of the Trainee’s own interest. Tutors and academic departments may provide support for audit projects but these should remain primarily the responsibility of the individual Trainee.
Formal research projects will usually need the active collaboration of a senior colleague or the local academic department. all Trainees should be readily able to access advice about research projects and practical help in pursuing them. Each rotational training scheme should develop a close working relationship with the local academic department of Psychiatry, although this should not be seen as the only focus for audit and research activities; all training units should be regarded as “teaching hospitals”.
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13
. PSYCHoTHeraPY Training
Trainees should gain theoretical knowledge and supervised clinical experience of various different approaches in psychotherapy and should be familiar with all commonly used psychological treatment methods.
a senior clinician with appropriate training should be appointed as Psychotherapy Tutor to organise psychotherapy training in each training scheme.
Less specialised forms of training (e.g. interview skills training, balint-style case discussion groups) can be delivered by non-specialists. a range of specific approaches should be taught by clinicians with appropriate specialist training and experience.
Psychotherapy training must include both theoretical and practical (clinical) training and must be effectively supervised.
Following its introduction the use of the CPsychi Logbook will be recommended to ensure that each Trainee receives sufficient psychotherapy training during the rotational training scheme.
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. eCT Training
all Trainees are expected to become proficient in the prescribing, administering and monitoring of ECT. Training in the administration of ECT should form part of the induction programme. Trainees should not administer ECT to a patient for the first time without direct supervision from a Consultant. all Trainees should be familiar with local protocols for stimulus dosing. ECT must be provided in accordance with the Mental Health Commission rules and Code of Practice (see bibliography).
a Consultant responsible for ECT should be identified and should attend an approved course. This Consultant may be responsible for delivery of ECT in more than one training centre and should have one weekly clinical session designated for teaching and supervising the administration of ECT.
1
5. CaSe reCordS
all Trainees are expected to maintain case notes to an acceptable standard. Trainees should be aware of the implications of legislation relating to access to medical records and Freedom of information and should receive training in record-keeping and defensible documentation. This requires particular attention where multidisciplinary case notes are in use.
The standard of case notes will be reviewed as part of each accreditation Visit but should also be monitored locally as part of continuing audit activities. The physical examination and admission checking should be clearly identifiable.
all case notes must contain:
• reason for referral (or admission) • Previous psychiatric history/background • Mental state on admission
• Physical examination on admission
• an initial diagnosis/differential diagnosis and management plan • Progress notes
• all entries dated, signed and clearly identifying the signatory by name and designation • i.C.d.10 diagnosis should be recorded in all cases
[See iPTC booklet (“Psychiatric History Taking and the Mental State Examination, 2004)” prepared by Prof. P. Casey et al.] - www.irishpsychiatry.ie
16. SaFeTY
16.1 all training schemes must provide safe working conditions for Trainees in all facilities including those in general hospitals and in the community. Safety issues must be highlighted in the initial induction programme (see section 9.1) and the Trainees’ induction Handbook should incorporate a section on safety including information on accessing local policies and procedures.
16.2 assessment rooms used by Trainees for assessment of acutely disturbed patients (in inpatient units, assessment suites, emergency departments and community facilities) should be safe, including a door opening outwards with an unobstructed visualization panel, and should not contain objects that could be used as potential weapons or barricades. Trainees should be provided with personal alarms which are regularly tested and fully monitored. doctors, on-call at night, should be provided with mobile telephones if they are required to travel between sites.
16.3 Safety training (e.g. breakaway and Crisis Prevention intervention training) must be incorporated in the initial induction programme with a refresher course annually. attendance at such training should be recorded in the Logbook, when developed.
16.4 Each training scheme should have a mechanism for monitoring violent incidents involving Trainees; these records may be examined by visiting CPsychi accreditation teams.
16.5 Each training scheme should have a clear policy for the management of Trainees involved in untoward incidents, including immediate reporting of the incident and subsequent counselling and support, if needed. information about this should be incorporated in the induction Handbook.
16.6 Trainees should have training in fire prevention as part of their induction and be fully aware of their role in the event of fire.
Training Handbook
20
17. eMPLoYMenT CondiTionS
17.1 ConTraCTS:
all Trainees should be issued with appropriate contracts. a formal job description and timetable should be available for each training post and must be updated regularly.
17.2 STudy LEaVE:
Trainees should be made aware of their entitlement to study leave and the local arrangements for applying for this. Trainees’ clinical duties must not conflict with their ability to attend recognised training activities.
17.3 TraVEL ExPEnSES:
Trainees should be reimbursed necessary travel expenses in accordance with national rates and regulations.
17.4. oFFiCE aCCoMModaTion & SECrETariaL SuPPorT:
all Trainees must have access to an office where they can carry out administrative duties without unnecessary interruption. ideally such offices should be within the clinical workplace and may also serve as consulting rooms.
Trainees must have access to adequate secretarial support to allow them to discharge their duties effectively. This should be monitored in the light of local audit standards concerning the timeliness of clinical letters, discharge summaries, reports etc.
17.5. on-CaLL aCCoMModaTion:
on-call accommodation should be of a reasonable standard and must be kept clean and properly maintained.
17.6. duTy roTaS:
all Trainees are expected to take part in on-call duty rotas as part of their training (see section 2.7). They must be adequately supervised when on-call and should not be expected to perform duties beyond their competence. Cover from a senior member of staff (Senior registrar or Consultant) must be available at all times.
indeX
SubjeCT
appraisal 13
assessment 13
audit/research 17
breakaway training 15 & 19 Case Conferences 15
Case records 18
Child & adolescent Psychiatry 11
Child & adolescent Mental Health of Learning disability 12
Clinical Supervision 8
Clinical teaching 15
Tutors 7
Contracts 20
designation & accreditation of training posts & placements 6 & 23 duty rotas 20
ECT Training 18
Educational Supervision 13
Flexible Training 6
Forensic Psychiatry 11
general adult Psychiatry 9
induction Programme 15 & 25 interviewing Skills 16
Journal Clubs 15
Learning disability 11
Lecture & seminar rooms 17
Liaison Psychiatry 10 Library 16 Logbook 13 Management training 16 MrCPsych Examination 4 office accommodation 20 on-Call accommodation 20
Patients, Carers & representatives 16
Psychiatry of old age 10
Psychotherapy 12 & 18 rehabilitation 10 Safety 19 Secretarial Support 20 Specialty Experience 9 Study Leave 20 Substance Misuse 9
The Trainee Committee induction 25
Programme Framework for SHos/registrars Trainees – Selection & appointment 5
Training – duration 5
Training Placements 9
Training Scheme – administration 5
Training Scheme – Size 5
Training Schemes – accreditation 6
Training Handbook
22
bibLiograPHY:
Mental Health act, 2001
Psychiatric History Taking and the Mental State Examination (2004)
iPTC: Patricia r. Casey et al. - www.irishpsychiatry.ie
The College of Psychiatry of Ireland: National Higher Training Scheme in Psychiatry:
Training Handbook. January 2010
The Trainee Committee induction Programme Framework
Current information on the regulations for the MrCPsych Examination available on The royal College of Psychiatrists website: www.rcpsych.ac.uk
Mental Health Commission:
Code of Practice governing the use of Electro-Convulsive Therapy for Voluntary Patients (2008)
Safety of Trainees in Psychiatry (1997)
Council report Cr 78, The royal College of Psychiatrists: www.rcpsych.ac.uk
Psychiatric Services to Accident and Emergency Departments (1996) Council report Cr 43, The royal College of Psychiatrists: www.rcpsych.ac.uk
Training Handbook
23
aPPEndix a
EduCaTionaL aPProVaL oF PLaCEMEnTS on baSiC SPECiaLiST Training SCHEMES
aLL aPProPriaTE SECTionS oF THiS ForM MuST bE CoMPLETEd by THE TuTor rESPonSibLE For THE
SCHEME To WHiCH THiS nEW or rEViSEd PLaCEMEnT iS aTTaCHEd.
(Please return to Mr. John gloster, Postgraduate Training officer, The College of Psychiatry of ireland, 5 Herbert Street, dublin 2)
Please indicate, by ticking the appropriate box below, whether this form is intending to: 1. Seek educational approval of a new placement on the scheme
2. inform the College of a change to the Supervising Consultant in an existing placement
name of Scheme ………..………..………… name and work address of Tutor ………... ………...………..………. Specialty of placement ....……….…….……….………..…… Site of placement ...………..………... name of Supervising Consultant ……..………..………..… …
name of former Supervising Consultant (if applicable) .………. and nCHd Medical
Council Post numbers ……….. Please enclose the following:
a. Job description for the SHo (To include educational objectives and opportunities in this post)
b. Timetable for the SHo (This should show an hour of educational supervision, attendance at the College approved academic course, academic arrangements and on-call).
c. Timetable of the Supervising Consultant. (This should show an hour of educational supervision with the
SHo.)
d. an up-to-date brief CV of the Supervising Consultant, including all psychiatric experience and training. (This should include date of consultant appointment, qualifications, confirmation of entry on Specialist division of Medical register and registration for CPd).
Signature of Tutor i Co-ordinating Tutor...………... date ………..
PLEaSE noTE: incomplete applications, e.g., failure to submit the relevant documentation, will delay the approval
aPPendiX a
(downloadable from www.irishpsychiatry.ie)EDUCATIONAL APPROVAL OF PLACEMENTS ON BASIC SPECIALIST TRAINING SCHEMES
aLL aPProPriaTE SECTionS oF THiS ForM MuST bE CoMPLETEd by THE TuTor rESPonSibLE For THE SCHEME To WHiCH THiS nEW or rEViSEd PLaCEMEnT iS aTTaCHEd.
(Please return to Mr. John gloster, Postgraduate Training Manager, The College of Psychiatry of ireland, 5 Herbert Street, dublin 2)
Please indicate, by ticking the appropriate box below, whether this form is intending to: 1. Seek educational approval of a new placement on the scheme
2. Inform the College of a change to the Supervising Consultant in an existing placement
_________________________________________________________________________________________ name of Scheme ………..………..………… name and work address of Tutor ………... ………...………..………. Specialty of placement ....……….…….……….……….. Site of placement ...…...………..………... name of Supervising Consultant ……..………..………..… name of former Supervising Consultant (if applicable) .………. and nCHd Medical Council Post numbers ………..
Please enclose the following:
a. Job description for the SHo (To include educational objectives and opportunities in this post) b. Timetable for the SHo (This should show an hour of educational supervision, attendance
at the College approved academic course, academic arrangements and on-call).
c. Timetable of the Supervising Consultant. (This should show an hour of educational supervision with the SHo.)
d. an up-to-date brief CV of the Supervising Consultant, including all psychiatric experience and training.
(This should include date of consultant appointment, qualifications, confirmation of entry on Specialist division of Medical register and registration for CPd).
Signature of Tutor i Co-ordinating Tutor ...………... date ………..
PLEaSE noTE: incomplete applications and failure to submit the relevant documentation will delay the approval of posts.
Training Handbook
24
abbreViaTed ModeL SHo job deSCriPTion: naMe oF SHo
(no more than 2 sides a4)
1) name of Post
2) if existing post, nCHd Medical Council post number 3) Type of post and name of employing authority
4) a) name of Supervising Consultant (must be on specialist register and be registered for CPd) b) details of multidisciplinary team (grades of medical staff; availability of clinical psychologists,
CPn’s, PSW’s, oT’s, others, including secretary) 5) responsibilities and opportunities of SHo post:
a) Core clinical work:
Settings where work will be carried out;
•
numbers of beds, day places, clinics, etc;
•
Types of assessments and treatments (all clinical experience must be appropriate to SHo training;
•
details of on-call duty rota (number of tiers, arrangements for supervision by on-call Consultant);
•
b) Academic activities:
opportunities within scheme (e.g. case conferences, journal clubs, lectures);
•
attendance at The College of Psychiatry of ireland approved academic course
•
c) Supervision:
Explicit statement about minimum one hour/week timetabled personal supervision from Consultant,
•
additional to clinical supervision.
6) Timetables for SHo and Supervising Consultant (to show all regular commitments through the week). Must show supervision hour and sessions for attendance at The College of Psychiatry of ireland approved academic course.
7) Learning objectives
1. Please complete the proposed timetable for the Trainee This should show:
a. regular scheduled Consultant supervision of one hour.
b. attendance at The College of Psychiatry of ireland approved academic course c. Local postgraduate training arrangements
d. arrangements for on-call [minimum on-call commitment must be at an average rate of 1 in 10 over 3 years]
on-Call rota: ___________________
2. Please complete the timetable for the Supervising Consultant This should show regular scheduled Consultant supervision of one hour.
Monday Tuesday Wednesday Thursday Friday am
pm
Monday Tuesday Wednesday Thursday Friday am
aPPendiX b
THE TRAINEE COMMITTEE INDUCTION PROGRAMME FRAMEwORk
FOR SENIOR HOUSE OFFICERS / REGISTRARS
Part A: Hospital or Training Scheme Services 1. general introduction about hospital/scheme 2. Specialties available in the hospital/scheme 3. Consultants
4. Clinical director and Tutors 5. Teams (Consultant / MdT ) 6. geographical Catchment area 7. Specialties Services /Programme
• e.g. Eating disorder Clinic or alcohol Treatment Services 8. inpatient wards and information about the wards
9. day Hospital Services and Community based Programmes 10. outpatient department services
• e.g. Treatment programmes for oPd 11. nursing department
• Staff information • referral information
• Types of assessment and treatment services 12. Psychology department
• Staff information • referral information
• Types of assessment and treatment services 13. Social Work department
• Staff information • referral information
• Types of assessment and treatment services 14. occupational Therapy
• Staff information • referral information
• Types of assessment and treatment services 15. group Homes, Low, Medium and High Support Hostels 16. Sheltered workshop or Supported Employment programmes 17. rehabilitation programmes
18. Hospital Layout map and Tour of Hospital 19. other Services
Training Handbook
26
Part B: Registrar Clinical Information 1. induction day – day 1
2. Consultants and Multidisciplinary Teams 3. registrar’s Timetable and bleeps 4. annual and Study Leave
5. referrals for admission 6. admission Policy
• Voluntary admissions and involuntary admissions • Mental Health act 2001
• admission during 9am – 5pm hours and outside working hours • bed Manager and bed availability
7. nursing level observation and Special nursing Care Policy 8. SHo/registrar assessments
• e.g. Schema of history and examination of a psychiatric patient 9. Case note entries and Medical records
10. investigation
• Physical examination • routine blood test • ECg, x-ray, EEg • CT or Mri brain scan
11. Policy for Prescribing Psychotropic Medication • Prn Medications
• rapid Tranquilisation Policy / Flow Chart
• Prescribing policy for Elderly or Lesrning disability patients • Prescribing policy for oPd
12. Policies for Medical investigations and referrals to Medical Hospital
13. Patient daily activity Programme (Therapeutic Programmes for inpatients and outpatients) 14. discharge Policy
• inpatient and oPd discharge policy • discharge summaries • Follow up policy 15. on-Call duties 16. Security • Personal alarm • Panic buttons 17. Policies and Procedures
• Health and Safety Policy • ECT Policy and ECT rota
• Management of Challenging behaviour and Violent behaviour Policy • Seclusion Policy
• Medical Emergency Policy
• risk Management Policies and incident reporting Forms • Procedure in event of Suicide inpatient and outpatient • Confidentiality issues
• Freedom of information act procedures 18. useful Phone numbers
Part C: academic Programme
1. academic Tutor 2. Teaching Timetable
3. The College of Psychiatry of ireland Trainee induction Handbook / guidelines
4. The royal College of Psychiatrists Logbook and relevant royal College documents and Policies 5. Supervision Times
6. academic Course 7. Case Conferences 8. Journal Club
9. academic / guest Presentations 10. Membership Examinations Preparation
• Part 1 Examinations • Part 2 Examinations • Part 3 Examinations
• Post membership Programme 11. Psychotherapy Training
12. audits and research 13. appraisal
Part d: Physical Training
1. Crisis intervention training course 2. breakaway Techniques training course 3. basic Cardiac Life Support
The College of Psychiatry of Ireland, 5 Herbert Street, Dublin 2, Ireland
Tel: +353 1 661 8450 Fax: +353 1 662 9677 Email: [email protected]
