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PSYCHOTHERAPEUTIC SKILLS AND COLLEGE REQUIREMENTS – ARE WE READY YET?
Timing of Psychotherapy Training
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Rajasekar Basker, Staffgrade Psychiatrist , Dr. Rohan Van der Speck, Dr. Emad Salib
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raashekar{at}yahoo.com Rajasekar Basker, et al.
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PSYCHOTHERAPEUTIC SKILLS AND COLLEGE REQUIREMENTS – ARE WE READY YET? We read with interest, the recent publication by Pretorius (2006), commenting on difficulties encountered by psychiatric specialist registrars in fulfilling the recommended College requirements (The Royal College of Psychiatrists, 2003). In order to determine the extent of the problem in Merseyside, we did a survey looking at the psychotherapy experience of trainee SHOs. Of the 101 SHOs in the training scheme, we excluded the 9 GP trainees, 6 Locum SHOs and 4 F2 trainees. We were unable to collect data from SHOs on maternity leave (2), sick leave (1) or annual leave (6). Out of 73 trainees, only 31 (42%) were actually aware of the Royal College requirements. Five trainees (7%) had done a long case and 41 (56%) had done at least a short case. Of those who had cases allocated, 21 (29%) had 1 short case, 11 (15%) had 2 short cases, 9 (12%) had 3 short cases or more. Of 11 trainees who sat their MRCPsych part 2 examination in March 2006, only 2 (18%) have fulfilled the college requirements. Only 14 trainees (19%) expected to fulfill the requirements by the time they were to sit their MRCPsych part 2 examination. Of the 73 placements, 49 posts (67%) had supervision by a consultant psychotherapist. These included Balint group, which most trainees had to do in their first two placements. The remainders of the trainees were not receiving supervision by a psychotherapist at the time when the survey was conducted. Our findings are consistent with that of Webb (2005) from Nottingham, Dharmadhikari (2006) from Leeds and Pretorius (2006) among the SpRs from Scotland. With the current 3 to 4 year training scheme it is difficult for trainees to fulfill the college requirements as would appear from available information from different parts of the country. The difficulty is due to the training scheme, geography, patients, service provision factors, and also the trainees themselves. From the study by Pretorius (2006), it is found that organizational changes have improved psychotherapy exposure in different modalities. It is hoped that with improved planning and the proposed changes in modernizing medical career and stringent RITA assessments trainees will have the opportunity to fulfill training requirements and develop the basic psychotherapeutic skills and knowledge essential for any competent psychiatrist. We would like to propose that The Royal College of Psychiatrists makes it mandatory that before approving a training post at SHO or SpR level, or even the Consultant level, that the approval will be granted ONLY if the base hospital has a full time or part time consultant psychotherapist. This may apply a most needed pressure on some of the reluctant trusts and will certainly help to eliminate unequal opportunities currently present in psychotherapy in different parts of the country. References: 1) ROYAL COLLEGE OF PSYCHIATRISTS (2003) Executive Summary. Requirements for Psychotherapy Training as Part of Basic Specialist Training. London: Royal College of Psychiatrists. 2) K. Webb (2005) Changes in Psychiatric Education. Psychiatric Bulletin 29: 470-471. 3) Anupam. R. Dharmadhikari, (2006) Basic Training in Psychotherapy. E-letter for Webb. Psychiatric Bulletin. 3) Werner Pretorius and Rainer Goldbeck (2006) Survey of psychotherapy experience and interest among psychiatric specialist registrars. Psychiatric Bulletin 30: 223 - 225 Rajasekar Basker, Staffgrade Psychiatrist, Lord Street Resource Centre, St. Helens, Merseyside WA10 2SP Rohan Van der Speck, SHO in Psychiatry, Brooker Centre, Halton General Hospital, Hospital way, Runcorn, Chesire WA7 2DA Emad Salib, Consultant Psychiatrist, Stewart Assessment Unit, Peasley Cross, Marshalls Cross Road St. Helens, Merseyside WA9 3DA |
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Oliver J Lord, SHO Psychiatry Inceptor, Ann Boyle, Heather Dipple
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oliver.lord{at}leicspart.nhs.uk Oliver J Lord, et al.
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11th July Dear Editor Re. Werner Pretorius and Rainer Goldbeck Survey of psychotherapy experience and interest among psychiatric specialist registrars Psychiatr. Bull., Jun 2006; 30: 223 - 225. I read with interest the paper by Drs Pretorius and Goldbeck for their survey of psychotherapy training, demonstrating how few higher trainees have achieved the recommended level of training. The Royal College guidelines for training in psychotherapy currently suggest that they should be fulfilled by the time part 2 of membership is taken. There is clearly a widespread difficulty here. In Leicester training is offered at SHO level in CBT (short and long term), long-term psychodynamic psychotherapy, interpersonal psychotherapy, family therapy, group psychodynamic therapy in a therapeutic community and long-term supportive psychotherapy. There is also capacity to be supervised in CAT and group CBT. There are 35 SHOs spread roughly equally over 4 years. Twenty have done more then 6 months of an introductory Balint group, 19 are currently in supervision for CBT and 8 have finished a case. Five have experience of family therapy; note this is under direct supervision. One has completed a psychodynamic long case and four are still in supervision. 3 have experience of IPT and 2 are in supervision for long-term ‘eclectic’ supportive therapy. Two have spent six months in the therapeutic community. 23 SHOs (66%) have experience of a model of therapy, all CBT. Six, senior, SHOs have experience of three models only five of these also have experience in ‘group 4’ i.e. family or group therapy. None of our current SHOs fulfil the full college requirements of three short cases from different models and a long case. There is an ongoing struggle to balance the training needs of junior doctors and the needs of patients who agree to see an SHO for treatment. All new SHOs spend at least six months in a Balint group first and then go on to either CBT or psychodynamic supervision by their third post. Service -users are only assigned to trainees once the supervisors feel the trainee has the appropriate skills. Specialist posts are then provided to more senior SHOs to provide appropriate training in other models of therapy. A half-day of study leave is used to protect psychotherapy-training time in all posts. Even with the resources to offer most models of therapy, the time is too short in basic specialist training. Trainees couldn’t take on service- users for therapy in their first post. Each short case needs at least six months of supervision and a long case needs more than a year. Even if the service-user chosen for the long case were cured by 12 months of therapy, it would only just fit within the three years of basic training. There needs to be time for inevitable delays within this; such as trainees not having the specialist skills to start therapy, the service-user not improving and needing ongoing therapy, and expected absences of trainee due to shift working and leave. To ask a trainee with other service commitments to take on two service-users at once is not practical outside of specialist psychotherapy posts and would erode the training experience within core placements. In Leicester many SPRs who have worked in other parts of the UK as SHOs are only now trying to develop psychotherapy skills as senior trainees. Is it time for the college to acknowledge these guidelines are only achievable by the end of specialist training in psychiatry and not by the time MRCPsych is passed? Declaration of interest: none. Oliver Lord SHO Leicestershire Partnership Trust oliver.lord@leicspart.nhs.uk 0116 225 3700 Westcotes House Westcotes Drive Leicester LE3 0QU Ann Boyle Consultant Psychiatrist and College tutor Leicestershire Partnership Trust Bennion centre Glenfield Hospital Leicester LE3 9QP Heather Dipple Consultant Psychiatrist and College tutor Leicestershire Partnership Trust Hon. Senior Lecturer Undergraduate Medical Education University of Leicester Mill Lodge Mill Lane Kegworth Leicestershire DE74 2EJ |
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