The role of the speciality tutor in the training of junior doctors in psychiatry

The speciality tutor is recognised but not appointed by the College. He or she may be appointed by the University, the Regional Post graduate Education Committee, or by a local committee, for example, the local Division of Psychiatry. The appointment, however, must have the agreement of colleagues (Royal College of Psychiatrists, 1996). The speciality tutor should be distinguished from the clinical tutors in each district who have overall responsibility for senior house officer (pre-Calman SHO and registrar) training in psychiatry, and from the Programme Dir ector (pre-Calman, the Organiser of Higher Specialist Training) who is responsible for the training scheme for post-membership specialist registrars (previously senior registrars) intend ing to become consultants in the speciality concerned. The speciality tutor's remit is to be the regional "organiser of training in the speci ality". As the programme director is respon sible for the training of post-membership specialist registrars, then the main part of the work of the speciality tutor will be for premembership trainees. This remit is rather non-specific and is one of those tasks which might potentially be a full-time job, or might be merely nominal. The College document on College recognition of tutors (1996) indicates that it is desirable for the tutor to have a session per week and some financial remun eration for the work, but in reality most tutors are likely to be doing the work on top of their usual clinical, teaching and administrative work-load. Any suggestion made about the role of the speciality tutor must therefore be feasible for a busy clinician. Although the College publishes a list of tutors and speciality tutors across the country, many clinical tutors are uncertain not only about the role of the speciality tutor, but about whether or not they even exist in some Regions. Recent discussion at the Annual Conference of Clinical Tutors in Psychiatry revealed that some clinical tutors do not know who their Regional speciality tutors are. This suggests that there is wide spread uncertainty about the responsibilities of speciality tutors. It would be useful to have a framework to guide the work of the speciality tutor, so that both they and the clinical tutors can use their time and expertise most effectively. This is a proposed outline of how the work of the speciality tutor might be organised.

The speciality tutor is recognised but not appointed by the College.He or she may be appointed by the University, the Regional Post graduate Education Committee, or by a local committee, for example, the local Division of Psychiatry.The appointment, however, must have the agreement of colleagues (Royal College of Psychiatrists, 1996).
The speciality tutor should be distinguished from the clinical tutors in each district who have overall responsibility for senior house officer (pre-Calman SHO and registrar) training in psychiatry, and from the Programme Dir ector (pre-Calman, the Organiser of Higher Specialist Training) who is responsible for the training scheme for post-membership specialist registrars (previously senior registrars) intend ing to become consultants in the speciality concerned.
The speciality tutor's remit is to be the regional "organiser of training in the speci ality".As the programme director is respon sible for the training of post-membership specialist registrars, then the main part of the work of the speciality tutor will be for premembership trainees.This remit is rather non-specific and is one of those tasks which might potentially be a full-time job, or might be merely nominal.The College document on College recognition of tutors (1996) indicates that it is desirable for the tutor to have a session per week and some financial remun eration for the work, but in reality most tutors are likely to be doing the work on top of their usual clinical, teaching and administrative work-load.Any suggestion made about the role of the speciality tutor must therefore be feasible for a busy clinician.
Although the College publishes a list of tutors and speciality tutors across the country, many clinical tutors are uncertain not only about the role of the speciality tutor, but about whether or not they even exist in some Regions.Recent discussion at the Annual Conference of Clinical Tutors in Psychiatry revealed that some clinical tutors do not know who their Regional speciality tutors are.This suggests that there is wide spread uncertainty about the responsibilities of speciality tutors.
It would be useful to have a framework to guide the work of the speciality tutor, so that both they and the clinical tutors can use their time and expertise most effectively.This is a proposed outline of how the work of the speciality tutor might be organised.
(1) Identify learning objectives for the trainees.These may be conveniently considered as knowl edge, skills and attitude objectives.They should cover the learning that the trainees should get pre-membership in the speciality to equip them both for the membership examination and, more importantly, to take up a post as a specialist registrar either in general adult psychiatry or in one of the specialities.
Giving learning objectives is one good way to communicate with trainees.The more detailed the learning objectives, the more clarity there will be for the trainees and their trainers about what is expected of them.A longer list may not mean that more learning is being asked, but rather that everyone is clear about precisely what that learning should be.
The learning objectives must be congruent with the College curriculum for the membership exam.They must also be agreed with the clinical tutors lest the specialist's enthusiasm for the speciality leads to unrealistic expectations of trainees and trainers.
(2) Identify learning opportunities for trainees in the Region.This has been outlined in the Psychiatric Bulletin (1997) (3) Explicitly match learning objectives to train ing opportunities, detailing what is best learned where.For example, the knowledge objective "outline the classification of disorders asso ciated with the use and abuse of alcohol" may be best learned on the Regional MRCPsych course, and from books and journals.The skill objective "demonstrate that you can identify and treat symptoms of acute alcohol with drawal" may be best learned in A&E, in the acute medical ward, in the psychiatric admis sion ward, from supervision from the consul tant, and to an extent from the membership course.
(4) Ensure that trainees and educational super visors have a written list of the learning objectives and find them feasible.As most trainees will not have the opportunity to work in specialist posts in every speciality, there is a case for the log book scheme to monitor core clinical experience and clinical teaching.
(5) Negotiate course content with course organi sers (MRCPsych), so that the necessary learning for the exam is covered in the course.The publication of the College Curricula for the MRCPsych examinations (Royal College of Psy chiatrists, 1994) has facilitated this for tutors.The speciality tutor is well placed to advise about further reading and references for trainees.
It is simply not feasible for the speciality tutor who does not have designated time to ensure that library facilities are adequate in all districts throughout the Region.Nor can the tutor monitor the content of journal clubs in all districts.It is, however, possible to check that a central resource, such as a university library, is adequate for the speciality, and that the speci ality is represented in a Regional journal club.This leads on to the very necessary sixth step.
(6) Organise regular meetings, perhaps once a term or twice a year, for those involved in speciality training in the Region, such as speci ality educational supervisors for audit of training in the speciality.These educational supervisors are in a position to collaborate with the clinical tutor in the district to ensure representation of their speciality in district journal clubs and local hospital libraries.
(7) Attend Regional Postgraduate Education meet ings and Regional Tutors meetings where issues relating to senior house officer training are discussed and organised.
(8) Organise a system of feedback from trainees to monitor the delivery of training.Again, the log book, with explicit feedback from trainees about the quality of the teaching and supervision in individual posts and districts, may be a useful means of communication.Meeting with trainees as a group may be desirable, but unless they can be captured at the Regional MRCPsych course, poor attendance may be a problem.
(9) Give advice about higher training in the speciality to SHOs seeking training posts at specialist registrar level.

Conclusion
In many Regions this scheme may be seen as redundant, since the clinical tutors and course organiser already include speciality training in the overall organisation of SHO training.