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Changes in psychiatric education

  • K. Webb (a1)
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Royal College of Psychiatrists (2003) Executive Summary. Requirements for Psychotherapy Training as Part of Basic Specialist Training. London: Royal College of Psychiatrists. http://www.rcpsych.ac.uk/traindev/postgrad/ptBasic.pdf
Royal College of Psychiatrists (2005) The Dean's Medical Education Newsletter, April 2005. London: Royal College of Psychiatrists. http://www.rcpsych.ac.uk/traindev/postgrad/dean_05.pdf
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Changes in psychiatric education

  • K. Webb (a1)
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eLetters

PSYCHOTHERAPEUTIC SKILLS AND COLLEGE REQUIREMENTS

RAJASEKAR BASKER, Staff grade Psychiatrist
29 March 2006

PSYCHOTHERAPEUTIC SKILLS AND COLLEGE REQUIREMENTS:

We read with interest the recent publication by Dharmadhikari, (2006), commenting on difficulties encountered by psychiatric trainees in fulfilling the recommended requirements (The Royal College of Psychiatrists, 2003).

In order to determine the extent of the problem in Merseyside, we dida survey looking at the psychotherapy experience of trainees. Out of 73 trainees, only 31 (42%) were actually aware of the Royal College requirements. Five trainees (7%) had a long case and 41 (56%) had short cases. Of those who had cases allocated, 21 (29%) had 1 short case, 11 (15%) had 2 short cases, 9(1%) had 3 short cases or more. Only 14 trainees (19%) are expected to fulfill the requirements by the time they were to sit their MRCPsych part 2 examination. Of 11 trainees who were planning to sit their MRCPsych part 2 examination in March 2006, only 2 (18%) have fulfilled the college requirements. Of the 73 placements, 49 posts (67%) had supervision by a consultant psychotherapist. These included Balint group, which most trainees had to do in their first two placements. The remainders of the trainees were not receiving supervision by a psychotherapist at the time when the survey wasconducted. Our findings are consistent with that of Webb (2005) from Nottingham and Dharmadhikari (2006) from Leeds.

With the current 3 to 4 year training scheme it is difficult for trainees to fulfill the college requirements as would appear from available information from different parts of the country. The difficulty is due to the training scheme, geography, patients, service provision factors, and also the trainees themselves. It is hoped that with improved planning and the proposed changes in modernizing medical career and stringent RITA assessments will have the opportunity to fulfill the training requirements and develop the basic psychotherapeutic skills and knowledge essential for any competent psychiatrist.

We would like to propose that The Royal College of Psychiatrists makes it mandatory that before approving a training post at SHO or SpR level, or even the Consultant level, that approval will be granted only ifthe base hospital has a full time or part time consultant psychotherapist.This may apply a most needed pressure on some of the reluctant trusts and will certainly help to eliminate unequal opportunities currently present in psychotherapy in different parts of the country.

References:

1)ROYAL COLLEGE OF PSYCHIATRISTS (2003) Executive Summary. Requirements for Psychotherapy Training as Part of Basic Specialist Training. London: Royal College of Psychiatrists.

2)K. Webb (2005) Changes in Psychiatric Education. Psychiatric Bulletin 29: 470-471.

3) Anupam. R. Dharmadhikari, (2006) Basic Training in Psychotherapy.E-letter for

Webb. Psychiatric Bulletin.

Rajasekar Basker, Staffgrade Psychiatrist, Lord Street Resource Centre, St. Helens, Merseyside WA10 2SP

Rohan Van der Speck, SHO in Psychiatry, Brooker Centre, Halton General Hospital, Hospital way, Runcorn, Chesire WA7 2DA

Emad Salib, Consultant Psychiatrist, Stewart Assessment Unit, PeasleyCross, Marshalls Cross Road St. Helens, MerseysideWA9 3DA
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Conflict of interest: None Declared

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Basic training in Psychotherapy

Anupam R Dharmadhikari, Educational Staff Grade Psychiatrist
10 January 2006

I read with a lot of interest Dr Webb's views on integrating psychotherapy training into basic specialty training in psychiatry. I agree with Dr Webb that currently the situation is not very satisfactory.

As we all know, psychiatric services are becoming increasingly specialised with the continuing advents in biological and psychological approaches of treatment. The practice of psychiatry has also changed drastically over past decade or so. With the realisation of the importance of amultidisciplinary way of working and its subsequent implementation to improve standards of patient care, there is now a better mix of skilled professionals and availability of specific expertise. This, however, has narrowed down the role of each individual member of the team leaving him/her to focus only on the area of his/her competence. This may lead to some deskilling as we would be more than willing to ask our colleague to administer a treatment s/he knows better than us. Psychiatrists, having been trained in a medical model, run the risk of remaining oblivious to the psychosocial techniques unless they take specific steps during their basic specialty training to acquaint themselves with these vital skills.

It is a widely recognised fact that the psychotherapy services are still deficient/ underdeveloped in some parts of the country. Surveys haveshown that the psychotherapy training received by trainees is below the standards set by the College guidelines in 1993 (McCrindle et al 2001). Trainees also find it difficult to recruit patients and to keep them in a longer term therapeutic relationship (which is the basis of long-term psychodynamic psychotherapy) due to frequent job change and other commitments (Examinations, Audits, and Research etc).

Offering junior doctors a chance to use psychotherapy techniques using a brief and time limited approach (Brief Psychodynamic Psychotherapy, Cognitive Behavioural Therapy, and Motivational EnhancementTherapy etc) might be a way forward. This will help them to fulfill their training requirement as well as orient them to the fundamental principles of psychological aspects of treatment. I hope that the current situation improves with the proposed changes in training which will require trainees to demonstrate more competency based skills as part of their assessments.

McCRINDLE, D., WILDGOOSE, J. & TILLETT, R. (2001) Survey of psychotherapy training for psychiatric trainees in South-West England. Psychiatric Bulletin, 25, 140 -143

ROYAL COLLEGE OF PSYCHIATRISTS (1993) Guidelines for psychotherapy training as part of general professional training. Psychiatric Bulletin, 17, 695 -698
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Conflict of interest: None Declared

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