Psychiatric Bulletin (2006) 30: 226-227. doi: 10.1192/pb.30.6.226
© 2006 The Royal College of Psychiatrists
Psychiatric Bulletin (2006) 30: 226-227
© 2006 The Royal College of Psychiatrists
The International Fellowship Scheme: from Silicon Valley to the Potteries and back
Santosh K. Chaturvedi, Professor of Psychiatry
National Institute of Mental Health and Neurosciences, Bangalore 560029,
India, e-mail:
skchatur{at}yahoo.com
Declaration of interest
S.K.C. was a consultant at North Staffordshire Combined Healthcare NHS
Trust under the International Fellowship Scheme from November 2003 to November
2004.
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Introduction
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I was one of the initial applicants to the NHS International Fellowship
Scheme and joined the North Staffs Combined Healthcare NHS Trust in November
2003 as a consultant at the Greenfield Centre, Stoke on Trent. It had always
been my dream to work in the UK as a consultant. I always wondered how similar
it was to the consultant/faculty position I held at the National Institute of
Mental Health and Neurosciences (NIMHANS), Bangalore, India. Here I describe
my experiences.
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Clinical work
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It did not take me long to settle down to the clinical work. I was unused
to managing patients alone, as at NIMHANS my role was to give an expert
opinion, supervise patient care and postgraduate training. At the Greenfield
Centre, I had to do an assessment on my own, prescribe, counsel and advise. I
was impressed by policies for monitoring patient confidentiality, particularly
when patients did not want information to be shared with their relatives (even
parents or children) or partners. I was used to sharing information and
colluding with relatives back home in India.
Prescribing was a challenge. I had to frequently consult the British
National Formulary and the pharmacy. I had to be careful to use a drug
only for conditions it had been approved and at the appropriate dose. I also
had to pay close attention to the described drug interactions. In India I
could use medications based on information from textbooks and journals,
experience or even common sense. There was more freedom to use drugs for
conditions other than those for which they had been approved and at doses
above those recommended; most times this worked without problems. Patients at
the Greenfield Centre were often well informed about their conditions and
medications having accessed other sources of information.
I found in-patient care to be of an admirable standard, with involvement of
social workers, nurses, community psychiatric nurses, occupational therapists,
patient advocates and probation officers. The ward rounds were well organised
with time allocated for each patient; relatives were given a prior
appointment. I had no previous knowledge or experience of the care programme
approach or involvement of community care assistants.
I ran a clinic at a community centre at Biddulph Moor once a week. The
centre provides depot injections and runs a carers’ and users’
support group periodically. Multidisciplinary community rounds were new to me
and were impressive, being conducted by community psychiatric nurses or
occupational therapy colleagues. Community mental health as practised in the
UK is totally different from the rural clinics treating epilepsy and mental
retardation in India.
I had no prior experience of special services such as those for assertive
outreach, crisis intervention and early intervention or of user groups and
carer groups. The Greenfield Centre itself had numerous facilities, including
day care, occupational therapy, aromatherapy, Indian head massage and many
other complementary therapies. There were groups for anxiety management, anger
management, self-esteem and weight management, among others. The occupational
therapy section was very active and popular among users and carers; the last
group to start while I was there was the laughter therapy group.
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Academic programmes
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The academic department of psychiatry had a busy programme. Every week
there was a study day with a case conference followed by a seminar. It was
possible to meet all the other consultants and trainees working in the trust
on this day. The case conferences were challenging and usually had
multidisciplinary involvement. Guest speakers from different parts of the
country presented the seminars. The MRCPsych training programme continued
during the afternoon. The journal club was a lunchtime activity with specific
learning objectives. My own publication on schizophrenia was reviewed at the
journal club with a lot of polite criticism.
The certificate and degree courses on addiction started while I was
employed by the trust and I was involved in the administration and had 2
days’ teaching on epidemiology and assessments.
While in the UK I attended many teaching programmes at the University of
Keele School of Postgraduate Medicine which helped to build up my teaching
skills. I attended workshops on the objective structured clinical examination,
assessment, appraisal, small group teaching and medical teaching. Like many
consultants, I attended a number of pharmaceutical meetings, which were
organised quite differently to those in India. I had numerous opportunities to
deliver lectures to general practitioners, psychiatrists and community mental
health teams.
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Research
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While in the UK I planned to undertake a study on the quality of life of my
psychiatric patients. First, I had to write the proposal and seek approval
from the local trust, which was granted rather promptly. I applied for a
competitive research grant but was not successful. The proposal was sent for
both internal and external peer review after which I had to make some
modifications. I then submitted the project for ethical approval and was
called to the ethics committee meeting where I was asked incisive questions on
statistics, methodological issues and consent-related matters. I was advised
to make some changes and seek approval again. The process took about 9-10
months but was in vain.
Audits are very popular in the UK and in addition to attending a few
sessions on doing audits and attending presentations of some well-done audits,
I did a brief audit exercise. It was also informative to observe audit
actually being done on my patients.
Conducting systematic reviews is another preoccupation among professionals
in the UK, in search of evidence-based practice. I, with the help of a
trainee, conducted systematic reviews of published literature on the
postgraduate education system and the postgraduate examination system in the
UK. I sent an article to the Psychiatric Bulletin but it was not
accepted; the editors of the British Journal of Psychiatry said that
they were aware of the results of our systematic reviews. I sent the article
to a European and an American journal only to be told that I should send it to
the British journals! I found this frustrating but I did have a letter
published in Acta Psychiatrica Scandinavica and three in the
British Journal of Psychiatry, besides writing some invited reviews
for journals.
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The aftermath
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On return to NIMHANS, Bangalore, I am attempting to change my style of
practice, teaching and research. Communication with patients and their
relatives has improved and I am better equipped to handle difficult questions.
My style of teaching has become more systematic and allows greater student
participation. Many systems in clinical and academic practice which have
remained unchanged for decades are being reviewed to determine whether any
positive modifications are possible. My employment in the UK provided me with
a much-needed break from routine and postponed (or prevented) eventual
burnout.
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Benefits of the scheme
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For me the scheme has had many benefits. It has provided me with an
opportunity to work in a different very pleasant environment, with a different
system of high quality healthcare. In the UK there are few constraints to
practice resulting from lack of services. I realise my actual worth, in terms
of money. I received payment for different types of reports (including court
reports), domiciliary visits, applications to the Driver and Vehicle Licensing
Agency (DVLA), for the lectures I gave, telephone interviews for surveys and
even for meetings I attended. I also enjoyed the autonomy of my work.
Some of the most memorable events were the farewell meetings with the
carers’ group, the trainees and my own patients. I have never
experienced such events in my 25 years of psychiatry. No wonder some or many
consultants wish to stay in the UK. However, that should be left to the
individual.
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Conclusions
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I derived many benefits from the International Fellowship Scheme and I hope
that the scheme continues to offer opportunities for psychiatrists from
overseas to work in the UK. Consultant psychiatrists in India have limited
options, there is no locum system, no job hopping and no movement to better
jobs - consultants are stuck until they retire or resign.
Trainees, specialist registrars and consultants from the UK would benefit
from a similar opportunity to work in low- and middle-income countries such as
India. One MRCPsych trainee from Stoke has already spent a few weeks observing
Indian psychiatric practice at NIMHANS, a psychiatric nurse wants to spent a
few days at the centre and a clinical psychologist a few months!
The winds of change are blowing!
Top
Introduction
Clinical work