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Original papers: Jules Mason, Tina Irani, Garyfallia Fountoulaki, Sylvia Warwick, Jane Da Roza Davis, and Peter Sudbury Psychiatry at night: experience of the senior house officer Psychiatr Bull 2006; 30: 329-333 [Abstract] [Full text] [PDF]

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Impact of Crisis Team on SHO training

SIRAJ SALAHUDEEN, Raman Bhardwaj, Jayraj Padmanabhan   (4 October 2006)

Minimum training requirements needed for SHOs working out of hours

Oliver White   (5 October 2006)

Impact of Crisis Team on SHO training 4 October 2006
SIRAJ SALAHUDEEN, Staff Grade Psychiatrist Derbyshire Mental Health Services NHS Trust, Raman Bhardwaj, Jayraj Padmanabhan Send letter to journal: Re: Impact of Crisis Team on SHO training drsirajs{at}hotmail.com SIRAJ SALAHUDEEN, et al.	We read with interest the article by Jules Mason et al (Psychiatric Bulletin, September 2006, 30, 329-333) regarding on-call activity of Senior House Officers (SHO). It is not surprising to find that the crisis service reduced the number of assessments made by SHOs, out of hours by 68%, as mentioned by the authors. Having worked as SHOs both before and after the introduction of the crisis team, we could definitely agree with the findings. However for a new trainee in Psychiatry, it could potentially affect their training if exposure to acute presentations are reduced. Crisis Resolution Teams have become gatekeepers of the psychiatric services in most parts of the country following the Department of Health policy guideline (DOH 2001). Some crisis teams involve the SHOs in joint assessments although most of the time the crisis team alone undertakes the initial screening. It would be prudent for a trainee starting their career in psychiatry to shadow the crisis team. However as their training progresses the SHOs should take the lead role whenever there is a joint assessment to gain more confidence. With the implementation of the European Working Time Directive and crises teams, we feel that the experience gained by the SHOs, out of hours has been significantly reduced. Nonetheless the onus is on the current trainees to address any such gaps in their training to be rectified, by making themselves available to help out the crisis teams. Siraj Salahudeen, Staff Grade Psychiatrist, Derbyshire Mental Health Services Trust Raman Bhardwaj, Senior House Officer (Keele rotation), St. George's Hospital, Stafford Jayraj Padmanabhan, Staff Grade Psychiatrist, South Staffordshire Healthcare Foundation Trust References Jules Mason, Tina Irani, Garyfallia Fountoulaki, Sylvia Warwick, Jane Da Roza Davis, and Peter Sudbury (2006) Psychiatry at night: experience of the senior house officer, Psychiatric Bulletin 30: 329-333 Department of Health (2001) The Mental Health Policy Implementation Guide: Crisis Resolution/Home Treatment Teams. London: Department of Health.
Minimum training requirements needed for SHOs working out of hours 5 October 2006
Oliver White, SHO in Psychiatry Send letter to journal: Re: Minimum training requirements needed for SHOs working out of hours olliewhite{at}mac.com Oliver White	Dear Editor, Mason et al's study (2006) adds objective evidence to the concern that SHOs are not gaining sufficient experience out of hours. For example, in the 2 year period studied there was a 76% reduction in the number of assessment conducted out of hours by SHOs on call. This has important implications for training as experiencing a range of acute assessments has an important role in the development of psychiatrists who will manage the more complex cases as outlined in New Ways of Working (DoH, 2004). The study highlights the impact of introducing nurse-led overnight services on SHO experience. Such services are now widely established and are driven by both the European Working Time Directive (EWTD) and Government policy (DoH, 2001). Any new measures to ensure SHOs gain sufficient experience needs to therefore focus on the training benefits rather than that of service provision. The study advocates the encouragement of SHOs to be present at the more challenging assessments but recognises the limitations of this. A similar scheme has been implemented in our SHO training scheme following a similar experience of a reduction in SHO experience out-of-hours (White, 2005). Psychiatric emergencies frequently present out of hours and SHO participation in the assessment process is key to ensuring training standards are maintained. The new competency based specialist training curriculum (Royal College of Psychiatrists, 2006) includes competencies in the assessment and management of psychiatric emergencies. However, it provides no details as to what should be achieved during out-of-hours experience. Although a competency based curriculum cannot stipulate minimum numbers of assessments conducted, more explicit centrally agreed guidelines would help trainees focus their training and ensure minimum requirements are met. References Department of Health (2001) The Mental Health Policy Implementation Guide: Crisis Resolution/Home Treatment Teams. London: Department of Health. Department of Health (2004) Guidance on New Ways of Working for Psychiatrists in a Multi-disciplinary and Multi-agency Context. London: Department of Health. Mason, J. Irani, T. Fountoulaki, G. Warwick, S. Da Roza Davis, J. & Sudbury, P (2006) Psychiatry at night: experience of the senior house officer. Psychiatric Bulletin, 30, 329-333. Royal College of Psychiatrists (2006) A Competency Based Curriculum for Specialist Training in Psychiatry – Core & General Module. London: Royal College of Psychiatrists. White, O. (2005) Training of Senior House Officers. Psychiatric Bulletin, 29, 315.