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Opinion & debate |
Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG
Royal College of Psychiatrists
See related papers, pp. 41-42;
43-45;
46;
47-48; this issue. 
Patient-centred psychiatry depends upon delivering care which is patient focused. Patient-centred care is defined as A key advantage in psychiatry compared with many other medical specialties has been its focus on teamwork for managing patients. Much of the content of Stewart’s definition has already been happening in psychiatry, although this may have been patchy.
(Care) which explores the Patients’reasons for their visit, their concerns and need for information, seeks an integrated understanding of the patient’s world i.e. their whole person, emotional needs and life issues and finds common ground on what the problem is and mutually agrees on management, enhances prevention and health promotion and enhances the continuing relationship between the patient and the doctor (Stewart, 2001)
The six interactive components of the patient-centred process are listed in Box 1.
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Characteristics of a good psychiatrist
The core attributes listed in Good Psychiatric Practice (Royal College of Psychiatrists, 2004) are: clinical competence, being a good communicator and listener, being sensitive to gender, ethnicity and culture, commitment to equality and working with diversity, having a basic understanding of group dynamics, being able to facilitate a positive atmosphere within a team, ability to be decisive, ability to appraise staff, basic understanding of operational management, understanding and acknowledging the role and status of vulnerable patients, bringing empathy, encouragement and hope to patients and carers, critical self awareness of emotional responses to clinical situations, being aware of potentially destructive influence in power relationships and acknowledging situations where there is potential for bullying.
A comparison between the components of Box 1 and the attributes of a good psychiatrist indicates a tremendous area of overlap in the qualities of an individual as well as the characteristics of a service which will be acceptable to patients and their carers.
As the consultant of the future will have to have a range of competencies in clinical management, teaching, research and other areas, the training of such individuals will have to take on board a number of parameters which will include peer group based learning, learning across disciplines and teams, and continuing professional development.
Current developments in postgraduate medical education
A number of major changes are taking place in postgraduate medical education. In fact, the scale of changes is almost certainly unprecedented, and it is likely that they will need to be put into practice fairly rapidly. This is because they will be required or affected by legislation that will come into force in 2005.
Five main driving forces are:
The way forward
Following detailed and extensive discussions at the Court of Electors it
was agreed that the following options should be discussed and debated more
widely:
Assessment in psychiatric training
Assessment and the Postgraduate Medical Education and Training Board
It is possible that the PMETB might propose a common examination across all
the Medical Royal Colleges. It is likely that initially they will ‘start
where we are’. Nevertheless, we need to think about the content and
timing of MRCPsych Part I and be prepared to make changes reasonably swiftly
if necessary. One option is shown in Box
2.
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Modular assessments
Modular assessments could be appropriate in the following areas: child and
adolescent psychiatry; learning difficulty; forensic psychiatry; psychiatry of
old age; and substance abuse. It could be that a proportion of the marks for
the MRCPsych II should come from modular and place of work assessments (PWA).
Modular assessments could include theoretical examinations conducted locally,
but with standards monitored and maintained centrally. These might be held
perhaps once a year, but the resource implications for the examinations
department could be immense.
Workplace-based assessments
It seems likely that the PMETB will place considerable importance on
workplace-based assessment as they have constituted a special subcommittee for
this specific purpose.
There are several options under consideration for workplace-based assessments:
There is also a well-developed workplace-based assessment method called mini-CEx that is likely to be appropriate for this purpose.
Postgraduate Medical Education and Training Board principles of assessment and standards
The PMETB has repeatedly emphasised that assessments must be based, not on the factual recall of knowledge, but on competency (what the doctor can do) and performance (what the doctor does do). This is why workplace-based assessment is likely to be so important and the emphasis on traditional written examinations will decrease.
The PMETB has set out 9 governing principles for assessment — these are illustrated in Box 3.
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Training models
In view of the two foundation years (Modernising Medical Careers) it is our intention that all trainees have a minimum 5-year training in psychiatry. The psychiatry training in foundation years will not be counted towards postgraduate training, nor are they expected to be in any other specialty.
The foundation year 2 and its contents and any assessment at the end of it is not dealt with in this paper (see Brown & Bhugra, 2005a).
Entry criteria for postgraduate training in psychiatry will remain the same.
We need to consider the possibility of MRCPsych Part I as a suitable screen for entry into the speciality and for sitting the examination within 6-9 months of starting the training. The assessments will have to be competency-based.
Exit criteria are almost certain to include a satisfactory record of workplace-based assessment, probably supplemented by modular assessments, a competency-based examination towards the end of year 4, along with Record of In-training Assessment Form G award.
Two possible models of training are illustrated in Figs 1 and 2.
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Sub-specialist training
After the CCT, trainees could choose to super-specialise in various areas. These could include academic psychiatry, for example, or a combination of more than one super-speciality such as forensic psychotherapy.
Some guidelines for super-specialist training are listed below.
Table 1 illustrates the roles and methods of learning.
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References
ACADEMY OF MEDICAL ROYAL COLLEGES (2004) Implementing the European Working Time Directive: Guidance from the Academy of Medical Royal Colleges. London: Academy of Medical Royal Colleges.
BROWN, J.B., STEWART, M., WESTON, W.W., et al (2003) Introduction. In: Patient Centred Medicine (eds M. Stewart, J.B. Brown, W. W. Weston, et al), pp. 3 –15. Abingdon: Radcliffe Medical Press.
BROWN, N. & BHUGRA, D. (2005a) Modernising Medical Careers. Psychiatric Bulletin, in press.
BROWN, N. & BHUGRA, D. (2005b) European Working Time Directive. Psychiatric Bulletin, in press.
DEPARTMENT OF HEALTH (2002) Unfinished Business Proposals for the Reform of the Senior House Officer Grade. London: Department of Health.
DEPARTMENT OF HEALTH (2003) Modernising Medical Careers. The Response of the Four UK Health Ministers to the Consultation on Unfinished Business: Proposals for the Reform of the Senior House Officer Grade. London: Department of Health.
DONALDSON, L. (2004) Towards Excellence in Assessment in Medicine: A Commitment to a Set of Guiding Principles. London: Department of Health.
GENERAL MEDICAL COUNCIL (1993) Tomorrow’s Doctors: Recommendations On Undergraduate Medical Education. London: General Medical Council.
ROYAL COLLEGE OF PSYCHIATRISTS (2004) Good Psychiatric Practice (2nd edn) CR125. London: Royal College of Psychiatrists.
SOUTHGATE, L. & GRANT, J. (2003) Principles and Standards for an Assessment System for Postgraduate Medical Training. PMETB Subgroup on Assessment. Discussion paper. London: PMETB.
STEWART, M. (2001) Towards a global definition of
patient centred care. BMJ,
322, 344
–345.
Related articles in PB:
This article has been cited by other articles:
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  A. Naeem, A. Kent, and A. Vijayakrishnan Foundation programme assessment tools in psychiatry Psychiatr. Bull., November 1, 2007; 31(11): 427 - 430. [Full Text] [PDF]
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S. Dinniss, R. Bowers, and A. Christopher Teaching psychiatrists to teach: qualifications in clinical education for psychiatrists Psychiatr. Bull., March 1, 2007; 31(3): 107 - 109. [Full Text] [PDF]
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 R. Chaplin, P. Lelliott, A. Quirk, and C. Seale Negotiating styles adopted by consultant psychiatrists when prescribing antipsychotics Advan. Psychiatr. Treat., January 1, 2007; 13(1): 43 - 50. [Abstract] [Full Text] [PDF]
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S. George and V. Math A trainee's perspective: Commentary on... The Postgraduate Medical Education and Training Board (PMETB) goes live Psychiatr. Bull., November 1, 2005; 29(11): 433 - 434. [Full Text] [PDF]
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