Acquisition of skills during higher specialist training

Sir: Many skills have to be assimilated during training to equip psychiatrists for the role of consultant. A survey was carried out in 1995 (Haddad & Creed, 1996) in the North-West Region among newly appointed consultants in general and old age psychiatry. While consultants in their cohort felt senior registrar (SR) training had adequately trained them in areas of clinical, research, teaching and group work they felt poorly trained in areas of general management, personal management and information technology. As a result of this survey trainers were encouraged to use the poorly rated skills as a menu of topics for discussion in supervision, the deficit areas were used as themes for SR training days and SRs were encouraged to attend management training courses.

The survey was recently repeated using the same methodology. Newly appointed consultants in old age and general adult psychiatry who had trained on the Manchester specialist registrar rotation and were appointed between 1995 and 1999 were contacted. Twenty-three consultants out of a total of 33 (70%) completed the questionnaire. Of the 14 (out of 39) skills rated as poorly prepared, 11 of these were in areas of general management, personal management, working with groups and information technology. Newly appointed consultants also felt less than moderately well prepared in three specific clinical areas: (a) use of cognitive-behavioural techniques; (b) dealing with patient/relative complaints; and (c) giving evidence in court. These three clinical areas had also been rated poorly in the 1995 survey. Of the 14 skills rated as being ‘poor’ in the 1995 survey 12 of these remained rated as poor.

Despite the introduction of several changes as a result of the previous survey of newly appointed consultants to the training scheme it was evident that there had been little change in the pattern of response. While training courses no doubt play an important part in training it was clear that the areas where consultants felt most confident were areas where they were likely to have had most practical exposure in training. It maybe that the old medical adage ‘see one, do one, teach one’ has as much relevance to learning management skills as to learning clinical skills. More novel, ‘hands on’ learning experiences need to be developed to address these areas of perceived deficit.