We agree that ‘psychiatrists need more structured clinical training in assessing and managing [movement] disorders to provide the best clinical care’ (Kuruvilla et al, Psychiatric Bulletin, August 2006, 30, 300–303). However, we were surprised that almost all respondents thought that the training should be undertaken in the first year of the MRCPsych course. As senior psychiatric trainees who have recently attended a ‘bedside’ teaching session on movement disorders, we would argue that there is a need for refresher courses at a later stage of training. Effective continuing professional development should include a regular revision of clinical skills, which cannot be achieved through reading alone. Furthermore, we feel this skill is best learnt in a small group setting with direct patient contact rather than in the more didactic MRCPsych setting. In a small group the learner is able to ask questions more freely.
Kuruvilla et al raise wider issues concerning the competency of psychiatrists in physical examination. Given the increased awareness of biological mechanisms in aetiology, particularly in old age psychiatry and liaison psychiatry, it is becoming increasingly important for psychiatrists to be competent not just in the assessment of movement disorders but all aspects of neurological examination. These are difficult skills to master and should be taught by competent teachers, often working in medical specialties at the clinical interface of psychiatry. Only by identifying our clinical weaknesses and then actively seeking teachers to address our learning needs will we be able ultimately to provide the best clinical care.
- © 2006 Royal College of Psychiatrists