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Psychiatry recruited you, but will it retain you? Survey of trainees' opinions

  • Christina Barras (a1) and Jessica Harris (a1)
Abstract
Aims and method

To gather opinion from trainees across England about their current experiences and future career plans. This was done via an internet-based survey.

Results

Out of the 359 responses we received, 65.8% of trainees planned to stay in psychiatry until retirement. Trainees felt several issues were problematic, including the attitude of other specialties towards psychiatry, perceived substandard treatment of psychiatric patients by other specialties and implications of New Ways of Working.

Clinical implications

Despite there being many areas of training respondents were happy with, if attrition is to be minimised, issues such as how psychiatric trainees integrate with the other medical specialties and how the role of doctors in the specialty is perceived need to be addressed.

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Copyright
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.
Corresponding author
Christina Barras (christinabarras@doctors.org.uk)
Footnotes
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The authors contributed equally to this work.

Declaration of interest

None.

Footnotes
References
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1 Brockington, IF, Mumford, DB. Recruitment into psychiatry. Br J Psychiatry 2002; 180: 307–12.
2 NHS Information Centre. NHS Vacancies Survey: England, 31 March 2010. NHS Information Centre, 2010.
3 Lambert, TW, Turner, G, Fazel, S, Goldacre, MJ. Reasons why some UK graduates who initially choose psychiatry do not pursue it as a long-term career. Psychol Med 2006; 36: 679–84.
4 Goldacre, MJ, Turner, G, Fazel, S, Lambert, T. Career choices for psychiatry: national surveys of graduates of 1974–2000 from UK medical schools. Br J Psychiatry 2005; 186: 158–64.
5 Cox, J. Person-power. Reflections on the mental health National Service Framework for adults of working age. Psychiatr Bull 2000; 24: 201–2.
6 Storer, D. Recruiting and retaining psychiatrists. Br J Psychiatry 2002; 180: 296–7.
7 Wilson, R, Corby, CL, Atkins, M, Marston, G. Trainee views on active problems and issues in UK psychiatry. Collegiate Trainees' Committee survey of three UK training regions. Psychiatr Bull 2000; 24: 336–8.
8 Moloney, J, MacDonald, J. Psychiatric training in New Zealand. Aust NZ J Psychiatry 2000; 34: 146–53.
9 Royal College of Psychiatrists. Revised Action Plan on Recruitment and Retention of Psychiatrists. Royal College of Psychiatrists, 2004.
10 Postgraduate Medical Education and Training Board. National Training Surveys 2008–2009: Key Findings. General Medical Council, 2009.
11 Vize, C. New Ways of Working for Psychiatry. New Ways of Working, 2009 (http://www.newwaysofworking.org.uk/content/view/59/470/).
12 Shaw, JA, Lewis, JE, Katyal, S. Factors affecting recruitment into child and adolescent psychiatric training. Acad Psychiatry 2010; 34: 183–9.
13 Abrams, MT, Patchan, KM, Boat, TF. Research Training in Psychiatry Residency: Strategies for Reform. National Academies Press, 2003.
14 Lau, T, Shailesh, K, Robinson, E. New Zealand's psychiatrist work force: profile, recruitment and retention. Aust NZ J Psychiatry 2004; 38: 547–53.
15 Royal College of Obstetricians and Gynaecologists. A Career in Obstetrics and Gynaecology – Recruitment and Retention in the Specialty. RCOG Press, 2006.
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Psychiatry recruited you, but will it retain you? Survey of trainees' opinions

  • Christina Barras (a1) and Jessica Harris (a1)
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eLetters

Comments on 'Survey of Trainee's opinions on retention

Meave T. Fingleton, Locum Consultant Medical Psychotherapist
09 March 2012

Barras and Harris's survey on retention difficulties in Psychiatry, in provoking further discussion about the state of Psychiatric training, is an important piece of work. The systemic effects of the current economic crisis cannot be separated out from implications to services and in turn is felt by those working and training within the system.

Having myself, recently completed Higher training in Psychotherapy, and through my experience of facilitating trainee Case Based Discussion groups, many of the training comments picked up by Barras and Harris, felt all too familiar.

In terms of 'trainee concerns over the attitude of others towards psychiatry'. I very much agree with the thinking of the authors, that better integration of psychiatry with other specialities may increase understanding of both the contribution of psychiatry and challenge of mental health difficulties. Alongside this, I also think it is important to recognise that to 'bear with' the projected 'madness' of others; which may mean we are seen as 'unsettling' and 'to be kept a distance from' perhaps by devaluation; is an important function of psychiatrists. Trainees' function as containers, can be fostered, for example, in Case Based Discussion groups, enabling them to begin to understand and toleratesome of these processes, as they are played out in their day to day work.

In statements relating to working and patient care, comments traineesmade included; 'There is so much paperwork that people work mechanically and there is actually no sign of warmth in the service we provide.' And 'Ithink a culture of 'need to be seen to be doing things correctly' is undermining the real patients care'. The concept of a 'social defence', asdescribed by Menzies-Lyth in her study of poor medical nursing staff retention in Hospitals, is helpful in thinking about some of these difficulties. In Mental Hospitals, techniques that reduce contact with patients, such as; the care of an individual patient being split into tasks, or reduplication of checks to eliminate or share the responsibilityof decisions; are used by staff/managers because of a fear of being in contact both with patients' and their own 'mad violence' and fragmentation. Further to this, the additional pressures of restructuring may both, add to, and be part of the same process. Campling, in 'Intelligent Kindness', reminds us that 'there is certainly evidence that major structural change keeps senior managers and board members detached from the front line of healthcare.' In the face of this poor containment by the organisation, it is not surprising that morale is low amongst trainees.

The Medical Psychotherapy Faculty has recently been working towards an Education Strategy for the renewal and development of a more psychotherapeutic psychiatry, with the aim of bringing psychotherapy to the heart of psychiatry rather than at its periphery. I think that the model of meaning and mind that psychotherapy brings to the practice of psychiatry is crucial in enabling us to work with our disturbed patients, and as such it is crucial that it is embedded into training.

Barras M, Harris J. Psychiatry recruited you, but will it retain you?Survey of trainees' opinions. Psychiatrist 2012; 36:71-77

Menzies-Lyth, I. Containing Anxiety in Institutions. Two volumes. London: Free Association Books, 1988

Ballatt J. Campling P. Intelligent Kindness: Reforming the Culture ofHealthcare. Royal College of Psychiatrists, 2011

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Conflict of interest: None declared

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Exposure to Psychiatry in Foundation Years may Improve Recruitment and Retention.

Dineka Gray, CT3 trainee
16 February 2012

I would like to comment on the article entitled "Psychiatry recruitedyou, but will it retain you?" relating to a survey of trainees' opinions by Barras et al. I recognised one of the published comments submitted by a participating trainee as being my own. This comment was written merely weeks into my CT1year and related to the reaction of hospital consultants to my choosing psychiatry as a career (during my foundation two year). I would like to comment further on my experience as a foundation trainee in acute hospitalmedicine relating to psychiatry, and suggest how improvements could be made to the current system to improve recruitment and retention.

When I was a foundation year two trainee I was keen for the opportunity to undertake a four month rotation in psychiatry. Despite stating this preference I was not allocated to the specialty and instead Icompleted foundation year two jobs in in Accident and Emergency, Orthopaedics and Intensive Care. Although I was initially disappointed with this combination, it proved to be an extremely valuable learning opportunity which enabled me to realise and understand the vast overlap between psychiatry and acute hospital specialties. I observed trauma patients during my orthopaedic job who had sustained massive injuries from"failed" suicide attempts. I observed numerous psychiatric presentations in the Accident and Emergency department. Even Intensive Care provided me with chances to understand the consequences of psychiatric illness, ranging from irreversible hypoxic brain damage following hanging in a depressed patient to end stage liver failure in alcohol dependence.

Many medical students and foundation doctors who have enjoyed the acute hospital setting during their foundation years may be reluctant to consider a specialty such as psychiatry. This may be particularly true if they have not worked in a psychiatric specialty during these two years.

Perhaps a solution would be to encourage deaneries to provide three month foundation posts (instead of four months), so as more foundation doctors are exposed to psychiatry. It would also be worth considering whether these posts should be partly hospital based and have a particular emphasis on liaison psychiatry, so as foundation trainees can observe directly the important role of the psychiatrist in working collaborativelywith medical colleagues. Barras et al noted that 5.0% of trainees had stated they had considered leaving psychiatry because they wished they worked in a different specialty. At this time when retention rates are concerning, perhaps enabling foundation doctors to see for themselves the diversity of psychiatry and how it integrates with acute hospital medicine is key.

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Conflict of interest: None declared

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Is the grass greener on the other side?

Shalini Agrawal, ST5 Psychiatry
09 February 2012

I read with interest the article by Barras et al on perceptions of current trainees in psychiatry. It was somewhat disappointing to note the relatively low return of survey, specially from senior trainees. The senior trainees would have made significant career choices by now and firmly established in psychiatry therefore it would have been more interesting to know what their views were on future career pathways they are likely to take.It is also very disheartening to note the low morale as well as perceptionof trainees. One is reminded again of experience in A&E or trying to refera patient for medical problems and the resistance and indeed stigma one faces if you work in psychiatry.

I note that a significant number of respondents have stated they would continue to work in psychiatry albeit in another country. What I would have liked to know was of these how many have actually experienced or worked in another health system. I suspect it is more a case of the grass being greener on the other side. In spite of this survey, psychiatryin the UK is very much more developed as a speciality than many countries in the world. In fact in many countries the stigma against psychiatrists and their patients is immense. In some countries, patients with psychiatric presentations can end up being treated by neurologists or even internal medicine colleagues.

I think the solution is not in jumping ship when the going is rough but to weather the storm of New Ways of Working (NWW) and other changes. Also as professionals working in psychiatry we have a responsibility towards our patients and our profession and we must try to change things slowly but surely within the present system.

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Conflict of interest: None declared

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