My experience of Core Psychiatry Training by Dr Jen Rankin
I applied for Core Psych Training after completing Core Medical Training. I decided that I wanted a more family friendly and flexible working career and psychiatry appealed to me. The application form was done online and was reasonably straight forward. It was useful having completed some audits, Work Placed based Assessments and teaching during Foundation Years and CMT so I had a well rounded portfolio.
I was very nervous going to interview but it was a fairly relaxed experience. There was one clinical scenario which went reasonably well. My portfolio station was straightforward. Having a portfolio which is well organised really helped. I took it in a lever arch file and split it into key domains ( CV, WPBA, audits, teaching, courses). This gave me plenty to talk about. I also had prepared some examples of using good communication skills and team work just in case they asked.
Core Training Year 1 (CT1)
I was fortunate enough to get a CT1 post in Aneurin Bevan University Health Board. My first post was in General Adult Psychiatry combining both inpatient and community work. Before I started, I was anxious about my level of knowledge about mental health – particularly as I had just returned from maternity leave. However, the Consultants did not expect me to hit the ground running. I initially shadowed their clinics and then gradually began to see my own patients. When I covered the inpatient wards, it was mostly sorting out physical health problems or clerking in new patients. I quickly became used to history taking and Mental State Examination.
CT1 was the busiest year as it was working in General Adult Psychiatry. However, it was fantastic for learning the basic skills for a career in psychiatry. I was well supervised, meeting with my consultant weekly to discuss patients I had seen as well as discussing different clinical topics. I completed an audit of the standard of clinical notes and undertook a case presentation and journal critical appraisal at our weekly postgraduate teaching. I was released to attend the MRCPsych course.
I didn’t sit any MRCPsych exams during CT1. I chose to spend this year getting to grips with the fundamentals of psychiatry. I saw as many patients as possible in a variety of settings (ward, domiciliary visits, out patients) to give me as broad an experience as possible. It was hard work but I had a lot of fun and made some lasting friendships within the multidisciplinary team.
Core Training Year 2 (CT2)
For me, CT2 was divided into 6 months of Learning Disabilities (LD) and 6 months of Child and Adolescent Mental Health Service (CAMHS). LD was a bit of a contrast to the fast pace of General Adult. I covered a small ward of 6 patients, reviewing their psychical health and supporting the Consultant with the ward round. I did a small outpatients twice a week which was supervised by my Consultant. This was a great opportunity for getting WPBA done. I also visited a residential home once every 2 months and did a small clinic there. I learnt a lot about behavioural management of people with a learning disability as well as Epilepsy Management.
As this was a quieter job, I decided to use this time to sit both Paper A and Paper B for MRCPsych exams. I used the SPMM website and was lucky to pass both.
During this time, I also began to develop my leadership and management skills. I was voted to become Junior Doctor Representative. This meant I was the voice of junior doctors to senior clinicians and managers. I began attending various divisional meetings and allowed me to begin to make changes to improve training and working conditions for Junior Doctors working in psychiatry in our trust. I really enjoyed taking on this role, I managed to negotiate for a rest room for junior doctors working at night. I also took over writing the on call rota, giving juniors autonomy over their out of hours rota. This allowed me to evidence leadership and management – necessary for higher training applications.
My second rotation in CT2 was in CAMHS. This was an interesting job and very well supported. I shadowed my consultant for a month and then began running my own small clinics. Each case was selected for my own learning – I saw a good mixture of Autism spectrum disorder (ASD), Attention deficit hyperactivity disorder (ADHD) as well as depression, anxiety and eating disorders. I also spent a small amount of time with the Youth Substance Misuse Service.
During CT2 I completed a short psychotherapy case in CBT, attended Balint groups and completed a qualitative survey into psychotherapy training in Wales. This survey was accepted in poster format to RCPsych International Congress and RCPsych medical education conference.
Core Training Year 3 (CT3)
This year was split between Old Age liaison Psychiatry and Substance Misuse Psychiatry. I really enjoyed my liaison post. It was great to be back in a general hospital and I learnt a lot about risk assessments in the elderly population, dementia and delirium.
During this post, I also sat CASC exam. Two other trainees were sitting it at the same time and we would meet twice a week to practise scenarios. Consultants also ran practise sessions. This was better than any text book revision. The CASC exam was very stressful but I felt reasonably well prepared with lots of practise. I passed this with my first attempt and I am sure it was due to the face to face revision sessions that were arranged for us.
Substance misuse psychiatry was a community based job. I enjoyed the post and learnt a lot about alcohol and opioid dependence. However, I did miss working in a ward.
CT3 is a great year as it provides time to prepare for higher training – CASC preparation, audits, teaching etc. You also get the opportunity to do a long psychotherapy case. I saw my case for one year and found this an invaluable experience. I was given more autonomy to run my own Quality improvement (QI) projects. I was well supported by senior colleagues and I was able to set up a mentorship scheme for International Medical Graduates working in Psychiatry within our health board. I am really proud of this piece of work and it continues to go from strength to strength. On the back of this, I was nominated for 2019 Core trainee of the Year by my supervisor.
This is one of the key components of core training. This is different to Psych training in other countries where this may not be available.
CT1 – attend Balint group. This is essentially a Cased Based Discussion group but aims to identify and discuss the different feelings and thoughts that cases may stir up in us.
CT2 – Short case in psychotherapy. This is normally Cognitive Behavioural therapy for 12 sessions. You also have a supervisor to help guide you through it.
CT3 – Long psychotherapy case ( eg psychodynamic psychotherapy). For 30 sessions again with supervisor.
My experience of this was that it is an invaluable component of our training. It improved my communication skills as well as help me look at patients from a different angle. I enjoyed CBT and found the structure of it rewarding. The long case takes a bit of organising but I really built up a rapport with my patient. I was sad when it had to end!
Reflecting on Core Training years:
For me, Core Training was a great 3 years. Not only did I gain vast experience in the basics of psychiatry, I also gained other core skills such as psychotherapy, leadership, management and teaching skills. Over time, I was allowed to focus on particular areas of interest to myself which has set me up well for higher training. You do need to be prepared to take any opportunities offered. On calls can be busy and challenging but these are often the times that you learn the most.
I had a lot of fun during this time and made some wonderful friends along the way – I cannot recommend core training in psychiatry enough.
- Portfolio, Portfolio, Portfolio. IMG’s have to compete against doctors already working in the UK who already have a Foundation Training Portfolio. The sooner you start building your portfolio, the better.
- Think about covering the following areas
- Clinical experience and skills (cannulation, catheterisation, venepuncture)
- Work Place Based Assessments. Examples of these can be found online.
- Audits (these can be small projects but you need to show an awareness of the audit cycle as well as re-audit.
- Teaching (ideally with feedback sheets). This can be to anybody – nurses, med students, health promotion.
- Research experience is not essential
- Check that you can have your foundation competencies signed off to allow you to apply.
- Prepare, prepare, prepare your portfolio.
- Buy a lever arch file and sort your portfolio into areas that you can talk about.
- Learn your portfolio well – you need to be able to evidence all your work!
- Practise the clinical scenario which is available before the interview. It tends to be the same scenario around breaking bad news. Practise with your friends!
- RCPsych website – information on training as well as excellent patient information leaflets (these are great for revision).
- Oxford Handbook of Clinical Psychiatry
- Maudsley Guidelines
Jen is currently a ST trainee in Psychiatry