We welcome Oakley et al’s timely contribution to the debate around the future of psychiatric training. Reference Oakley, Jenkinson and Oyebode1 The issue of decreasing exposure to emergency assessments out of hours has been of concern to the Psychiatric Trainees’ Committee for several years. 2 Originally a fear prompted by the introduction of working time regulations, our unease is now focused on the impact of widespread service reconfigurations; in some areas these are resulting in rotas which dramatically restrict trainees’ exposure to emergency learning experiences.
Are presentations qualitatively different out of hours? Research in this regard is limited, but it is our unanimous opinion that outside of 9am to 5pm working hours and particularly at night, patients tend to present with more complex and challenging problems, often involving dual diagnoses, drug and alcohol intoxication and higher rates of self-harm and overdose. Services available are also more limited, making decisions about care more demanding.
We concede that out-of-hours rotas which involve trainees working off site, or not at all, may increase the trainee’s time spent with patients in day hours, providing continuity of care and the opportunity to attend teaching and academic programmes. However, daytime work is often centred on service provision and routine tasks, rather than acquiring essential emergency competencies required to be a successful and accountable higher trainee and consultant.
Decreasing trainees’ work out of hours may also serve to further devalue the image of psychiatry to other medical professionals - when seeking advice on a complex issue of risk, capacity or consent, for example, they expect to be able to speak to a medically qualified professional. As is well recognised, improving the image of psychiatry as a specialty is key to reducing professional stigma and promoting recruitment.
In this same edition of The Psychiatrist, Tadros et al describe a revolutionary and highly successful 24-hour, 7-days-a-week method of working. 2 We are of the opinion that the more services are designed with well-supported core trainees working at the coalface, particularly out of hours, the more training standards will improve and the more our specialty will be valued within the multidisciplinary environment.
We also believe that having medically trained professionals on the frontline makes for safer services.
The Psychiatric Trainees’ Committee has established a working group to look into the provision of out-of-hours services across the UK, with a particular aim of understanding how training might be affected by reductions in out-of-hours experience. We will present the findings to the College and hope to work towards a shared understanding of the future of out-of-hours training.
Submitted on behalf of the Psychiatric Trainees’ Committee.