Psychiatric secrets of success: who wants to be a specialist registrar?

This paper aims to help trainees successfully negotiate the important ‘
step up’ from senior house officer or equivalent grade to 
specialist registrar. It outlines the current structure of higher specialist 
training programmes in psychiatry, stresses the importance of early planning 
during basic specialist training and provides a guide to success in the 
shortlisting and interview stages.

Psychiatric secrets of success: who wants to be a specialist registrar?
Naeem's excellent and informative article (Psychiatric Bulletin, November 2004, 28, 421-424) provided useful tips and advice for trainees aiming for higher specialist training as specialist registrars. However, we would like to point out certain factual inaccuracies which require further clarification.
First, the College's Higher Specialist Training Handbook (Royal College of Psychiatrists, 1998) clearly states that higher specialist trainees in lecturer posts who do five or six clinical sessions become eligible for a single certificate of completion of training (CCT) (formerly CCST) after 3 years. It is only when they do 4 clinical sessions that the single CCST is after 4 years.
Second, overseas doctors who are non-European Economic Area nationals and do not have indefinite leave to remain in the UK, are also eligible to apply in open competition for type I specialist registrar training programmes leading to CCT (Department of Health, 1998). If appointed, they are provided with a visiting national training number (VNTN). They can then also apply to the Immigration and Nationality Directorate (IND) of the Home Office for permit-free training leave to remain in the UK. This can be further extended by up to 3 years at a time depending on the training needs of the individual and satisfactory progress (UK Visas, 2004). The VNTN automatically becomes a NTN once the doctor gains indefinite right to remain in the UK. Overseas doctors without UK indefinite residence leave therefore are not limited to taking up fixed-term training appointment (FTTA) or type 2 posts, which do not lead to award of CCT, and conversely FTTAs are not limited to overseas doctors without residency rights. DEPARTMENT OF HEALTH (1998)  There followed a wide range of discussion by participants at the seminar. This paper seeks to gather together these presentations and discussions and presents a summary based around various themes. Particular points or views are not credited to any particular person and the four presentations are amalgamated into the body of this report rather than being individually reported.
The issues raised were profoundly complex and, not surprisingly, where issues of personal morality and ethics were concerned, there was a wide variation in individual executive members' response. There was a common feeling of intense unease in relation to our work with courts and public protection agencies. What clearly emerged was that there is no current adequate ethical framework to address the profound issues we face in our interface with public protection/criminal justice system. This is of very particular concern to forensic psychiatrists but we believe that the issues we face, because of our day-to-day interaction with the criminal justice system, will not be confined to forensic psychiatrists only but will be of concern to all psychiatrists. There was representation from the Child and Adolescent Faculty at our meeting and they confirmed that child psychiatrists equally face profound ethical dilemmas in their everyday work, particularly when issues of child protection reach the courts. These concerns are likely to be amplified greatly for all sections of the College if the proposals of the new Mental Health Bill reach Parliament and eventually form the basis of a new Mental Health Act.

Why are there ethical dilemmas?
The basic dilemma that faces forensic psychiatrists is their dual role. Most forensic psychiatrists act as catchment area forensic psychiatrists responsible for comprehensive services to a specified geographical area, and with gatekeeping functions in regard to secure services (both National Health Service and private). However, in the interaction with the criminal justice system, the forensic psychiatrist is also responsible to courts and other criminal justice agencies when they provide reports on their behalf. columns Columns The College