Dr Sehrish Shafiq’s Experience of Core Psychiatry Training.

MY JOURNEY IN CORE PSYCHIATRY TRAINING

I did my core training in psychiatry from August 2016 till July 2019 in North east deanery. Just a brief overview about why I chose north east, me and my husband wanted to start training at the same time in August 2016 and he wanted to go into medicine and we were told by our colleagues is that if you apply in north east there is a better chance of you getting the training together in the same deanery and we just did it. At that time, we only worked in NHS for hardly 9-10 months in total.

Long story short little did we knew that north east covers a huge area spreads over hundreds of miles and they have divided this deanery into North and South. So, people who are appointed in north part of the deanery continue their training in north part and vice versa. If you would like to change from north to south, then there has to a lot of factors that need to be taken into account before they allow the transfer. My husband got into south part of the deanery and I got it in North part (our hospitals were nearly 60 miles apart). But living separate wasn’t the only awful thing, I applied my visa through normal route, and it got delayed until I received my visa in first week of September and joined on 05/09/2016.

CT-1: General Adult Psychiatry – Inpatient

I was told to meet one of the doctors in one of the wards and all my wards and job roles were changed as I joined late. So, at this point I had no clue what online portfolio was, what is a job role, what am I supposed to do, and how to assess a psychiatric patient as it was my very first job in psychiatry. I had absolutely no clue about anything whatsoever. I just went to meet up the doctor at the ward on my very first day, had no induction, no orientation, nothing! I was given some dates on which I had to receive some software training and orientation and that was it. I was informed that I need to meet up with my clinical supervisor (at this point I didn’t know I am supposed to have a supervisor – clinical and educational). I met with my supervisor and he told me that he hasn’t supervised anyone for really long time and isn’t fully aware of how things work now so he will get some information and then get back to me. I asked him that I am quite naïve at psychiatry, he gave me some books to read to help with my skills. I asked him if I could shadow the core trainee for 2 weeks before starting on my own in the current ward as we were 2 core trainees in the same ward to which he kindly agreed.

In a usual week there was half day for local teaching, half a day for balant group, every fortnight we had full day MRCPSYCH teaching day, and rest were ward days. The on-call rota was resident, and I used to cover few psychiatric hospitals and do seclusion reviews.

 So by medical staffing I was informed that I will cover X ward and the consultants start tossing me between their wards, one would say cover 2 days in Y ward, another would say no cover 3 days in X ward 2 in Y ward and it kept on changing for the whole 5 months. So, the cherry on top that this all chaos affected my relationship with my colleagues as well and most of them sort of labelled me as incompetent and not doing a good job as being a core trainee which further added to my stress. I was cursing myself that why I ever thought of coming to training job and that too psychiatry when I don’t know anything. I was living by myself in hospital accommodation at that time. Towards the end I asked for MSF and someone wrote awful things on my MSF encompassing around that I intentionally joined my job late and told a lie to everyone that it was visa issue, I asked for shadowing period and bla bla which had nothing to do with my training or job and I got no support from my supervisor, in fact he said, “there must be some smoke to the fire”. My end of post report, the clinical supervisor put everything as incompetent because he said you only get marked as “competent” as CT3 not before that. He said there is no proof in your portfolio that you are competent for Probity. When I asked what I had to do he said I don’t know as your colleagues. He did and submitted the report on his own without discussing anything with me. Later on, due to health related issues things got worse all of a sudden and on medical grounds I was transferred to south part of the deanery, 10 days before the start of the new job. At that time, I was informed that I had no educational supervisor at all since I started my job so I was allocated a new educational supervisor in south part of the denary. My old TPD arranged a meeting with me and my new educational supervisor just to tell him that I am an awful trainee. I still remember I tried my best to be everything I could do in my first job, but I still don’t know why everything went this way.

My educational supervisor asked me if I could stay after the meeting and speak to him. He said I don’t want to know in detail of what happened in North all I want is you taking a fresh start from this day onwards and I was in tears.

CT-1: General Adult Psychiatry – Inpatient

As I was informed that it was an immediate transfer so I got the only available job in South part of the deanery. I received proper induction, orientation to the place, was told about the supervisors and my clear job plan was handed over to me on a word document. The wards which I was supposed to cover were one of the busiest wards in the whole south part. I was covering 2 consultants and there was an F1 helping me in those wards as well. There was a board meeting every morning 9:00 -9:30 in one ward and 9:30 to 10:00 in the other ward. After which I used to see patients, assess their mental states either on my own or with consultants. They didn’t have ward rounds like in some other deaneries. I used to do the usual ward jobs like doing physicals, bloods, discharge summaries and stuff like that. My consultants were extremely nice and supportive. I started getting “above average” in all of my assessments. I took part in audits, research and felt like a new person already in first few weeks. The colleagues were so welcoming and loving, the medical staffing was so supportive, the TPD was always there if I needed to speak to her. I had regular supervisions with my clinical and educational supervisors as well. I attempted Paper A of MRCPSYCH and passed in first attempt. I got excellent end of job report and an excellent MSF. At ARCP they did a proper presentation on me to other consultants that how a system failure can affect trainees and I passed my ARCP with outcome 1 with no issues. To this day I am friends with the staff in those wards and we go out for meals.

Here as compared to north where you wold just be allocated to a job there is a meeting with TPD where you discuss what job you want to do, location of job, and why. I applied for community Old age but received in patient old age job.

There was the same work schedule, in a usual week there was half day for local teaching, half a day for balant group, every fortnight we had full day MRCPSYCH teaching day, and rest were ward days. The on call rota was non resident and resident, and I used to cover few psychiatric hospitals and do seclusion reviews while being on call. The jobs of the resident and non resident doctor were well defined and over all it was very well supported.

CT-2: Inpatient Old Age Psychiatry

Before joining this job I was told that the consultant I am going to work with is a notorious consultant who isn’t good with any trainees and in my mind I was like why me God why me? I spoke to one of the consultants and he said to me, “you aren’t going to find everyone who is supportive and matches to your calibre, there are all kinds of personalities working in NHS and this is the stage where you learn how to manage difficult colleagues” He gave me few examples from his part of training and reassured me. Even my educational supervisor said to me if you think you cant cope just let me know and we will find a solution for it. I started the job, as expected the consultant was what I would say “tough”. There was another part time consultant as well who was very nice. The staff was very supportive in the ward. I kept my head down and just said yes to almost everything. In first month I realised that she was very caring person and wanted the best for her patients and when some trainees joined the job they weren’t doing the job properly and it would frustrate her and it created misunderstandings. Just after 1 month she became so nice and caring and one time she held a dinner at her place and invited me to her place. At the end of the job she had tears in her eyes and said to me I wish I could just keep you here forever. I loved working there every single day. I received excellent MSF feedback and excellent report from my supervisor as well

The job role for me was to attend board round everyday, assess mental state, do memory tests on some patients, review patients in outpatient clinic if I wanted to. In a usual week there was half day for local teaching, half a day for long case of psychotherapy, every fortnight we had full day MRCPSYCH teaching day, and rest were ward days. The on call rota was same. For psychotherapy there was a proper supervisor who allocated a case to me. I used to see the patient for 50 minutes, then I had 1 hr for documentation and 1 hr for supervision afterwards. It was very well organised all under same building. I was allocated to do psychodynamic psychotherapy for 1year period for my patient.

This time when I had meeting with TPD I requested if I could get the job of my first choice which was Learning disability in community which I did.

CT2- Community LD (Learning Disability Psychiatry)

This was my first community job. My job role was to see patients initially with the consultant for a month and then later have my own caseload of patients and follow them up in community. I was hesitant to work with LD patients initially but later on felt very comfortable with them. I don’t know what was the hesitation- may be fear of unknown but in LD one is very well supported. I started doing special interest days in Autism clinics/assessments. I also learnt to do proper letters for the first time for community patients. I also drove along the most scenic areas in this post and loved my job even more. It was much relaxing job so I started studying for paper B as well.

In the community I would either see a patient at residential homes or their own homes or sometimes they would come to a community clinic. I would assess their mental state, make changes in medications, help in identifying social needs and then follow up on their management plan. The secretary would book the patients in my diary and I would see them as per planned. I never saw a patient on my own. I always had a social worker/Care coordinator/or someone with me when I would assess the patients in the community

I had no issues in this post, passed my ARCP with outcome 1, with no issues raised. I wanted to do more community jobs but I was allocated an inpatient forensic job as CT3.

CT-3: Forensic Psychiatry Inpatient – Medium Secure Unit

Forensic psychiatry is a different world. They have proper ward rounds where there is an MDT every week, first the patient is discussed among nurses consultant, junior doctors, psychologist, OT and then patient is invited to discuss his/her progress and further management plan. There is a CPA meeting that happened every 3 month in some wards and every 6 month in some wards. In these meetings we would discuss the detailed update of what has happened so far and what is the future management plan for this patient. Here apart from local teaching there was additional half a day forensic teaching which was very helpful. Also they had a day time GP who would review physical health needs of the patients being admitted into low and medium secure wards.

For working in this setting you need to carry alarms and keys everywhere in a belt around your waist and you cant lose them because if you did then it can cost you your job. Once inside that area of forensic services you cant carry your phone or tablet or any device like that. There also some restrictions on other items as well. One has to stay extra vigilant as most of them have committed serious crimes to be in this facility.

I thoroughly enjoyed this post. I was covering 2 consultants in 2 wards by myself. I attempted paper B and my consultants and colleagues were very supportive. One of my senior colleague offered me to share some of my work so that I can study as it’s a v tough exam. I studied 2 months day and night and passed it in first attempt. Now I had to decide if I can take the next exam within this post (CASC) for which I hardly had less than 2 months to prepare. I discussed with my consultants and colleagues and they all were happy for me to attempt the CASC as well. So I took paper B in October, got the result in November and January was CASC. So I formed a small group almost forced them to study and prepare with me. We used to stay in hospital till some days 11pm and prepared for CASC. I attempted CASC in January and passed as well in first attempt. This was one of the happiest days of my life.

Despite attempting 2 exams in one post I got excellent MSF and supervisor report and I would give major credit to my consultants, colleagues and ward staff who supported me to the maximum they could. In the end I still remembered I ordered pizzas and food for the whole ward after each exam result and I celebrated it with them because it was a combined achievement for me

Next post I wanted to do crisis team in the community which I got from TPD.

CT-3: Community Crisis Team

Till now I would say this is the most organised team I have worked with. Each and every person know exactly what they need to do and get it done asap. There used to be a MDT every week attended by staff, consultants, secretaries, psychologist and a joint plan was discussed to be implemented. All the medical and nursing reviews were discussed along with their outcomes. Any patient discharged or about to be discharged had a clear plan. My job was to assess the patients in crisis and then provide the management plan for such patients. By this time I was feeling much more confident in my assessments and treatment plans as well. I would discuss the difficult patients with SpR and consultant. During this period I have seen the whole spectrum of patients from just at the beginning of illness to the most chronic and treatment resistant patients and it was a great learning curve for me. During CT3 I also finished my short case of psychotherapy for which I did CBT for social phobia.     

I also applied for ST4 general adult in Manchester during this period. I also applied for Section 12 approval which I did in Leeds. At the end of my last placement I got desired outcome at ARCP, on MSF I got excellent remarks.     

Professional & Personal Development during Core Psychiatry Training

During my core training I was heavily involved in teaching medical students in wards, doing tutorials, lectures which helped me towards my teaching skills. I was tutorial lead throughout my core training. I also took part in OSCE in Newcastle medical school. I did a leadership and management course for senior clinicians in which I was the only core trainee and rest were higher trainees/SpRs. I also did CMI level 7 leadership and management diploma which is equivalent to a masters degree during that course. To do that I had to write 2 nearly 3000-4000 word assessments and do a leadership project along with a poster presentation. I was a trainee rep locally initially and then later on I was core trainee rep for south part of the deanery for school of psychiatry and trainee rep for Quality assurance committee. I also presented our deanery in GMC visits as well. I also participated in an audit which our team later submitted in international forensic conference in Vienna, Austria and got accepted. I went to Vienna for the poster presentation. All these achievements helped me towards my CV in ST4.

My beginning was very rough in psychiatry, but I have learnt great deal and I enjoyed every single bit from there onwards. I started from “just trying psychiatry” to “ found my true love for psychiatry”. I am actually in a job/profession which I love doing every single day and I can see myself doing it for next few decades.

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Dr Sehrish Shafique is currently a ST trainee in General Adult Psychiatry with North West Deanery.

Email: sehrishshafiq@hotmail.com