Psychiatric Bulletin (2006) 30: 23-24. doi: 10.1192/pb.30.1.23
© 2006 The Royal College of Psychiatrists
Psychiatric Bulletin (2006) 30: 23-24
© 2006 The Royal College of Psychiatrists
Talking together. Commentary on...Higher specialist training in child and adolescent psychiatry
Sally E. Bonnar, Chair of the Child and Adolescent Psychiatry Specialist Advisory
Committee
Centre for Child Health, 19 Dudhope Terrace, Dundee DD3 6H, e-mail:
sally.bonnar{at}tpct.scot.nhs.uk
See pp. 19–23,
this issue. 
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Introduction
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It is very encouraging to see trainees who are so enthusiastic about
training that they are prepared to persist despite considerable barriers to
carry out this type of audit. Hawkins et al are to be congratulated
for raising these issues, especially at a time when postgraduate medical
education is undergoing a revolution, and it is essential that we consider all
the evidence available in planning future higher training curricula. I am
particularly pleased because the issues raised in this paper have been
considered at some length in the course of various meetings of the Royal
College of Psychiatrists’ Child and Adolescent Psychiatry Specialist
Advisory Committee (CAPSAC), with many of the same solutions proposed here put
forward.
It seems that most of the issues raised within this paper could be subsumed
under the broad heading of communication: between CAPSAC and programme
organisers through the advisory papers; between programme organisers and
trainees; and between CAPSAC and managers through the written reports
generated by accreditation visits. As psychiatrists we rightly pride ourselves
on our excellent communication with our patients. How then can we make sure
that the same skills are used to talk to each other?
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CAPSAC and programme organisers
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The CAPSAC advisory papers are written to provide guidance to those
involved in running higher training programmes and to allow trainees to assess
whether or not the training that they are being offered is consistent with
what the College recognises as adequate experience for the training of future
consultants in their specialty. They are deliberately written so as not to be
prescriptive. The wide range of training schemes across the country precludes
standardisation and CAPSAC has never believed that standardisation of training
is necessarily a laudable goal. The richness delivered by our variety is one
of the things that attract people to child and adolescent training despite the
fact that it is somewhat at odds with the current dogma of centralisation and
sameness.
The advisory papers written in 1999
(Royal College of Psychiatrists Higher
Specialist Training Committee, 1999) are in need of updating, but
a decision has been made not to undertake this challenging task until we have
greater clarity about the shape of future run-through training. This does mean
that advice about training has not moved on as quickly as the demands of
organising a scheme. The advisory paper on academic programmes does not
specify the content of such programmes in detail. With the knowledge base in
child and adolescent psychiatry expanding so rapidly, it would be foolish to
try to delineate this too clearly. The publication of the advisory papers on
the College website is a start in the wider communication between the
committee and the faculty, and CAPSAC has also investigated the possibility of
publishing academic programmes from schemes across the country on the website
to enable better information sharing. This is something that would be welcomed
by trainers and trainees alike. The CAPSAC would therefore wish to encourage
the College to expand the use of the website to disseminate good practice in
training.
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Trainees and programme organisers
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Partnership working is one of the key themes of the modern National Health
Service and it would seem obvious to suggest that we ought to be able to do
this within our own training schemes. Within our specialty we are immersed in
systemic practice and should be able to apply these principles to ourselves.
The CAPSAC certainly encourages the formation of training committees within
schemes, which should include trainee representation. Such committees enable
better communication within schemes and can provide a forum for evaluating all
aspects of training, including the academic programme.
It is seldom possible to meet everyone’s needs within one academic
programme. The challenges of producing a 3-year rolling programme that is up
to date, of high quality, accessible to all trainees and (usually) free are
formidable. Virtually all these programmes run on a grace and favour basis
with very limited resources. Although this might be deplored, it unfortunately
represents the reality of much of medical postgraduate education. It remains
to be seen whether or not the advent of the Postgraduate Medical Education and
Training Board (PMETB) and Modernising Medical Careers will change this.
Meanwhile it behoves all of us to work together to deliver quality education.
This is time-consuming and often not programmed into job plans.
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CAPSAC and managers
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One of the real pleasures of undertaking accreditation visits is the
opportunity to see ‘how other people do it’. It gives one the
chance to ask outrageous intrusive questions and to take a rigid position on
things which, within one’s own service, one may be more flexible about.
This can often apply to the issue of protected time for training programme
directors and others with a semi-formal role in delivering training. There is
no doubt that the advent of the new consultant contract has brought these
matters into a sharper focus than previously.
A recent audit that CAPSAC carried out with training programme directors
revealed that 3 out of 19 directors had no protected time in their job plans
for organising their training scheme. Since separate organisers of academic
programmes are not formally recognised by the College, it is hardly surprising
that they have little protected time. This is not to say that CAPSAC believes
that this is a desirable situation.
Recommendations in accreditation visit reports frequently contain
statements about the necessity for programme directors, and indeed all
trainers, to have adequate time to devote to training. However, CAPSAC is an
advisory committee and employers are not obligated to act on these
recommendations. Again this is something that may change when PMETB has more
responsibility for accrediting training schemes.
Despite our challenges with communication, I believe that we do all strive
to work together to produce high quality training and excellent consultants in
child and adolescent psychiatry. Like everything else we do, there is still
room for improvement and I hope none of us yet feels that we can rest on our
laurels. The challenges ahead are many and the lines of communication must
remain open and effective.
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References
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ROYAL COLLEGE OF PSYCHIATRISTS HIGHER SPECIALIST TRAINING COMMITTEE
(1999) Child and Adolescent Psychiatry Specialist Advisory Committee.
Advisory Papers. London: Royal College of Psychiatrists.
http://www.rcpsych.ac.uk/traindev/sac/pdffiles/advisorypapernov99.pdf.
Related articles in PB:
- Higher specialist training in child and adolescent psychiatry: a survey of academic programmes
- Tim Hawkins, Alison Lee, Helen Stephens, Gisa Matthies, and Alison Bailey
PB 2006 30: 19-23.
[Abstract]
[Full Text]
- Reading about self-help for carers: books, leaflets and websites
- Jan Oyebode
PB 2006 30: 39-40.
[Full Text]
Top
Introduction
CAPSAC and programme organisers