Overview of process for ST4 Application in Psychiatry (for IMGs) by Dr Wajiha Zia
In this blog I will go through the steps I had to take to apply for ST4 seats in General Adult Psychiatry and hurdles which you can come across.
Before I begin, I would outline my background. So I graduated from Pakistan and moved to Ireland in 2011, I did my MRCPsych exams whilst working in psychiatry in Ireland (I have written a separate blog for preparation for MRCPysch exams).
Here is the link to it
I applied for ST4 in Feb 2019 and got successful and will be starting my post in August 2019.
Before I begin I must emphasize the process for ST4 application requires time and most of the information is given online as to what documents you need, but here is a summary:
- To apply for ST4 post you need to complete you MRCPsych and your GMC registration via MRCPsych route(or any other route), they will ask you English reference or you have to sit in IELTs or OET exam.
- There are 2 rounds for intake, application for August starts in Feb and application for Feb starts around Sept/Oct, this is all announced on Oriel account so you must make one as national recruitment vacancies are advertise on Oriel. (https://www.nwpgmd.nhs.uk/st4_psy_train_rec_oview)
- If you did not complete your Core Psychiatry Training in the UK, you will need to have C- Cert Complete for your st4 Application. This is also called core competences form. (https://www.nwpgmd.nhs.uk/sites/default/files/Certificate%20C%20%28Core%20Competence%20Equivalence%20Form%29%20for%20August%202018%20onwards%20intake%20LIVE.pdf)
- Make an account on oriel and update your details and you can also upload your Workplace based assessment, Letter of Recommendations or any other Certificates. (https://www.nwpgmd.nhs.uk/st4_psy_train_current_record) Please look at Applicant guide once the recruitment begin the document will be accessible.
Your portfolio should include the following information. Please note this list is not exhaustive:
- A copy of your CV including previous posts, qualifications and core psychiatry competences
- Your personal development plan
- Any assessments you have undertaken, WPBA, CBD, SAPE form
- Any other supporting information, such as feedback from previous posts, patients, colleagues or references
- Evidence of any courses / training / CPD
- Evidence of reflective practice (this could be some short pieces that you have written where you have thought about an interaction with a patient)
- Letter of recommendation
- Copies of any audits you have completed
- Copies of any presentations / posters you have done
- Copies of any publications
- Records of any teaching you have undertaken along with feedback.
I cannot emphasize enough on this whatever you put in your CV or say in the interview or self-assessment criteria make sure you have proof of it( for eg. I made roster for junior doctors and they asked me proof of it and I had it written in couple for LORs)
For 2019, Interviews for ST4 posts in psychiatric specialties consist of two stations.
Full information will be given approximately one week before the first interviews (available to download from https://www.nwpgmd.nhs.uk/st4_psy_train_current_record) but here is a brief guide to the stations:
Portfolio Station (20 mins) – Use your portfolio to demonstrate and validate your self-assessment scores for up to 10 minutes and then use the remainder of your time to demonstrate how you meet the person specification and your commitment to the chosen specialty/specialties. Please look at Self-assessment criteria and person specification criteria on the link below (https://www.nwpgmd.nhs.uk/st4_psy_train_guidance_docs)
Communication and Clinical Skills Station (20 mins) – Demonstrate these skills in your chosen specialty, in a simulated clinical scenario, interacting with a patient, relative or carer; played by an actor, followed by 5 minutes of questions relating to the clinical scenario. I have posted the clinical scenario in the end as they are repeated for every interview, plus they are published one week before interview
Now practical tips make sure you prepare and practice well with your colleagues or seniors for this interview (both stations are equally important).
- Organize your portfolio accordingly and mark it well (colour coding so you know where is your relevant documentation) , I used Big box file with transparent plastic pockets to put my forms in.
- Interview venue in 2019 it was Etihad stadium Manchester, but this will be confirm to you for your round, try to reach in ample time to get your nerves under control, dress smartly. Keep a spare suit with you as sometimes coffee has its way to ruin your clothes!!
So just to discuss about my ST4 interview. First station for me was portfolio station where they asked me to go through SELF ASSESSMENT form which I have done, I had one copy of it which I marked while filling my application. The interviewers will have an iPad or tablet on which they are checking the same thing, they will ask u evidence for each mark you have given yourself on SELF ASSESSMENT FORM. (eg I did mark having distinction in my medical school, so they asked to see prove of it and I showed them my mark sheet).
So, go through the self-assessment form and mark it accordingly, make sure you have proof of everything you marked (another example is I am doing a research so they asked me about my project and my contribution to it so I have the proposal with me and I told me about it and my role in it)
I also did professional certificate in CBT which I forgot to mark but I did show them, so the panel gave me marks for that under heading of postgrad certificate. This was in 10 minutes.
Then in next 10 mins they asked about PERSON SPECIFICATION CRITERIA, that how do I meet that CRITERIA. So, I Spoke about what I have done so far in terms of exams, clinical rotation, teaching job, research and audit, and management of rosters. I also wrote my personal development plan which includes my next 3 to 5 years planning in terms of taking up masters and doing my clinical rotations. I also wrote 2 cases for reflective practice so this was also asked in interview. Last question asked was what are my qualities which make me suitable candidate, I did say that I am hard-working, motivated, keen to learn and a team player.
Time flies in the portfolio station.
Next was clinical station, so you need to recall your CASC scenarios and make sure you practice them well with your colleagues.I have posted the clinical scenario in the end they are published one week before interview. Practice them Well!!
- Once you are done with interview they will ask your preferences, so choose wisely as everyone has different life circumstance (do consider place you want to live and work) considering other factors like family, kids and schooling, commute.
- Right to work in UK, since I have EU passport I didn’t have to go through Visa process, however I understand the Doctors need Tier 2 visa and that is a separate process in itself.
- Once offer a post there is a pre-employment check, the NHS trust who will be your employer will send you number of forms to fill.
- You would need police clearance cert from your country of residence.
- You will also need address in UK to process things further so plan ahead in time to travel. They Trust vary in policy some also offer relocation package.
- You will need UK address for DBS (Disclosure and Barring service)
- You would need to have bank account and national insurance number from your employers once you land in UK.
Clinical Scenarios (August 2019 take):
You are a newly appointed ST4 in Child and Adolescent Psychiatry. You have been allocated a patient for a new assessment – a 15 year old young person referred by the GP due to concerns regarding low mood, repeated secretive self-harm, and the GP’s worry regarding the risk to self. The patient was accompanied by a friend (same age peer) to the GP surgery and this friend has also come with the patient to the CAMHS Clinic, she is waiting outside the consulting room. The GP has indicated in the referral letter that the patient did not want their parent (mother) informed or involved in the appointment.
1) The reasons for the GP’s concerns about risk (including self-harm),
2) The patient’s understanding of the issue of confidentiality and view about involving parent(s).
You will have fifteen minutes with the patient and should summarise back to patient at about 13 minutes.
You are a newly appointed ST4 in forensic psychiatry. Your consultant asked you to speak to John Smith, who is a single 26 year old man who has been referred by his social worker. A social worker has reported that Mr Smith has been harassing a young female neighbour who lives alone. He has called her house on multiple occasions and left several presents on her doorstep, despite requests he should not do this. Mr Smith has no past psychiatric history but has three previous convictions for assault. On each of these occasions Mr Smith was intoxicated and became involved in larger brawls. The social worker is concerned about the risk Mr Smith may pose to his neighbour, but also feels the harassment is out of character for Mr Smith and would like some assistance in understanding what is going on.
Please assess the potential risk of violence in this case and communicate to Mr Smith what you are going to say to his social worker.
General Adult Psychiatry
You are an ST4 in Psychiatry in a community team. A care co-ordinator informs you that Sam, a carer, is in reception appearing anxious and distressed. He/she is demanding to see a senior doctor and has a complaint following a consultation with a CT1 doctor last week.
Sam’s son Adrian has just recovered from a first episode psychosis and was discharged one month ago after admission under the Mental Health Act. Following last week’s consultation he is refusing medication Olanzapine due to worries about weight gain.
You have Adrian’s
permission to talk to family.
You have 15 minutes with the carer but you can finish earlier if you choose to do so.
You are seeing a patient, Sam Smith, in the outpatient department. She/he is expressing dissatisfaction with her CPN, care coordinator, Michelle. Sam has repeatedly presented to A&E with self-harm but is not attending care coordinator reviews. You know her care coordinator and respect her clinically. Your consultant, Dr Green, is not available but has asked that you see the patient.
The clinical background is that Sam is 24 years old and has presented with repeated episodes of self- harm. There is anxiety about Sam’s risk.
Sam is described as having an idealised relationship with the father and an aggrieved relationship with the mother who left home when the patient was 11. The behavioural aspects of the relationship with the mother in adolescence included resenting and reacting aggressively against the boundaries the mother tried to impose. The rejection of the mother was complete; the patient has nothing to do with mother and remains very angry.
You are not expected to take a full history or carry out a risk assessment. Your two tasks are:
- To explore the dynamics of the patient’s relationship with mental health professionals.
- To persuade the patient to come to a CPA meeting next week involving consultant and care coordinator.
The station will last 15 minutes. The role play will run for 10 minutes but you can finish earlier if you choose to do so. The interviewers will then ask you questions about it for a further 5 minutes. They will assess your communication skills and your ability to form a successful doctor – patient partnership (Good Psychiatric Practice CR 154).
Old Age Psychiatry
You are a newly appointed ST4 trainee in old age psychiatry. Martha Jones is an 84 year old lady who has been admitted to the organic in-patient ward 2 weeks ago having been found wandering. She had an ACE of 68 and was found to have a urine infection that has been treated. A diagnosis of Alzheimer’s has been made following a CT scan that showed atrophy. A repeat ACE has improved to 73 – dropping marks in recall and orientation, with errors copying a star. She was previously living independently. She wants to go back home when she is feeling better, however her daughter/son wants her to move straight into a local dementia registered residential home. The occupational therapy assessment indicates she would probably manage at home with a care package three times a day. In the last ward round the consultant noted she had capacity to decide to go home.
notes indicate she lives alone in council rented downstairs flat with a cat.
Martha’s daughter wants to speak to you about discharge plans. You have Martha’s permission to speak to family. You have 15 minutes with the daughter/son but you can finish earlier if you choose to do so.
The interviewers will assess your communication skills and your ability to form a successful doctor – carer partnership (Good Psychiatric Practice CR 154).
Psychiatry of Intellectual Disability
You are a newly appointed ST4 trainee in psychiatry of intellectual disability, and have been asked by your Consultant to see Chris, the mother/father of Alex who is 20 and who has a moderate degree of intellectual disability and autism who lives in the community.
His behaviour has been extremely unsettled for the past 3 months.
There is input from the local CLDT as well as Social Worker. He has a 1:1 support package based at a day service for 30 hours per week.
There are no beds available locally and in order to prevent an admission, Alex may need to commence medication to help manage anxiety symptoms whilst a full behavioural assessment is carried out.
The parents have said to the Psychologist that they are against an admission as well as medication. They think the behaviour is being caused by issues at the Day Service, however this is not certain.
Demonstrate that you are able to manage this potentially difficult situation.
Of note, Alex has been seen by his GP, has no physical health problems and recent blood tests were normal. Alex lacks the ability to make informed decisions regarding welfare matters and his parents have the ability to make such decisions on his behalf under the appropriate legislation.
Thank you and I hope you find this helpful
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