Psychiatric Bulletin (2005) 29: 276. doi: 10.1192/pb.29.7.276
© 2005 The Royal College of Psychiatrists
Psychiatric Bulletin (2005) 29: 276
© 2005 The Royal College of Psychiatrists
Patient-centred psychiatry
Rory O’Shea, Chairman of Collegiate Trainees Committee of Royal College of
Psychiatrists and Specialist Registrar in Old Age Psychiatry
Psychiatric Service for the Elderly, Box 311, Fulbourn Hospital,
Cambridge CB13RR (on behalf of the Collegiate Trainees Committee)
We welcome the article ‘Patient-centred psychiatry’ (Bhugra
& Holsgrove, Psychiatric Bulletin, February 2005, 29,
49–52) providing information and stimulating debate on the likely future
of postgraduate psychiatric training.
Currently most trainees spend substantially longer than the proposed 5
years training. It seems that future trainees will have to learn less, learn
more intensively or do less service work. The impact on patients and trainers,
and resources necessary to implement changes, must be examined in advance.
There may be further deterioration in continuity of care, particularly if all
posts are for 6 months. Psychotherapy higher specialist training currently
takes 5 years; how would this be incorporated into the proposed model? Will
sub-specialist (‘super-specialist’?) training exist as we know it
now? Will special interest and research sessions remain unchanged? Information
is also needed on what form assessments might take. It is crucial that factual
knowledge remains important within any new competency-based assessment.
What flexibility will exist within the new system; for example: if a
trainee wants further experience in a sub-specialty; if a trainee does not
achieve necessary competencies within the 5-year period; or achieves them well
before this? Consideration should be given to transitional arrangements, for
example, for trainees taking time away from psychiatry and returning to a new
system.
The College runs training programmes and examinations in jurisdictions not
affected by Modernising Medical Careers or the Postgraduate Medical Education
and Training Board; trainees in such areas wonder how the proposed new system
might affect them.
The authors suggest using the MRCPsych Part I as a ‘suitable screen
for entry into the specialty’. We would welcome clarification of this.
We worry that the College wishes to control entry to training by deeming
people suitable or unsuitable for psychiatry. Currently even repeatedly
failing the MRCPsych examination does not prevent one from working in
psychiatry, but under the new system would this remain the case? Should
it?
