Special interest sessions in psychiatry

Abstract

Aims and Method

While specialist registrars in psychiatry are entitled to spend one-fifth of their working week engaged in special interest sessions, little has been published on how the time is used. In order to describe what happens in practice, we conducted a semi-structured telephone survey of trainees on the South-East Thames Higher Training Scheme in psychiatry.

Results

The results indicate that while most trainees (78%) were satisfied with their use of special interest time, those using two sessions regularly for a defined training purpose were in the minority.

Clinical Implications

Use of special interest sessions is generally good in the scheme surveyed. If uptake of sessions is to be improved, there needs to be even better local support as well as existing national recognition of the educational rights of trainees. The local support should be at the level of both trust and training scheme.

Career opportunities in psychiatry have evolved over time, with an increasing number of posts advertised as having a ‘special responsibility’ or ‘special interest’ in named sub-specialities. Appointment committees take guidance from the Royal College of Psychiatrists regarding the training and clinical experience that might be reasonably expected from candidates during their period of specialist training, but these are by no means fixed or mandatory. The Joint Committee on Higher Psychiatric Training (1995) provides some guidelines on the use of special interest time which may allow trainees to develop sufficient clinical experience in sub-specialities not offered in yearly core placements. Because special interest sessions often conflict with demands on trainees' time in busy clinical placements and because of the general level of uncertainty regarding the use of special interest time by juniors, we chose to conduct a survey of all specialist registrars and senior registrars on the South-East Thames regional scheme. Our aim was to find out how special interest time was being used and to provide a qualitative description of the opinions of trainees towards the value and difficulties in taking the sessions.

The study

All trainees in the old age and general adult South-East Thames Higher Training Scheme for psychiatry were invited to be interviewed over the telephone by one of the authors. The interview was semi-structured and used open and closed questions focused on the use, content and applicability of special interest sessions. Participants were given an opportunity to comment on how service demands had impacted on their training needs and asked to make suggestions for further improvements in the scheme.

A total of 34 trainees were invited to participate, of these two were on maternity leave at the time of the study, two were acting as locum consultants and three could not be contacted or did not wish to participate. At the time of the study M.S. and A.P. were specialist registrars on the scheme surveyed.

Findings

Career aims

A total of 27 doctors were surveyed of whom four (15%) were old age trainees, and seven (26%) hoped for dual accreditation with five in adult forensic psychiatry and two in adult psychiatry/psychiatry of learning disabilities.

Use of special interest time

Twenty (74%) trainees were taking special interest sessions on a regular basis, of these nine (33.3%) were taking two sessions per week, nine (33.3%) one per week and one three sessions per month. Of those eight who were not using special interest time only three (11% of total group) stated that they would have liked to use the time but felt unable to because of the service demands and pressures and difficulties in finding someone to cover for them. Two felt unsure how to use the time and three felt that they did not need a special interest (two were in old age psychiatry and the other had additional experience in two forensic posts).

Two of the 19 trainees taking special interest time felt that they had been forced to spend the time in an attachment of their consultant's choice rather than their own. Intotal 22% (6/27) of trainees felt unhappy with their current post, either because of the quantity or content of special interest sessions.

How are special interest sessions used?

The majority of trainees taking special interest time (13/19, 68%) were using it in some form of psychotherapy attachment. Of these 13, only one was working towards a recognised formal training and three towards a psychotherapy diploma.

Three trainees used a total of five sessions in cognitive-behavioural psychotherapy; two used three sessions in cognitive-analytical psychotherapy; two used three sessions in family therapy; one used one session in dynamic psychotherapy; two used two sessions in group psychotherapy; four used six sessions in sex therapy; one used one session in neuropsychiatry; three used four sessions in forensic psychiatry; one used one session in liaison psychiatry; and one used one session in management.

Discussion

The minority who were unhappy felt that more pressure should be applied to the training consultants from the scheme organisers and suggested that timetables and job plans should be agreed with special interest time allocated prior to commencing a post.

A few trainees were unsure about how special interest time should be used and were unaware of the College guidelines on sub-speciality training. The more junior trainees asked for clearer information as to what attachments might be acceptable or possible whereas senior trainees (over two years of higher training) had been assertive in asking for what they wanted. Three trainees had received support for the funding of approved MSc or diploma training courses or gained approval to take the time to study or work in posts outside of the scheme.

Most trainees were pleased with the opportunity to develop special interest sessions and regarded it as a valuable way to broaden experience. The significance of the large number of trainees seeking psychotherapy experience was unclear. The more junior specialist registrars appeared less confident or assertive in taking special interest time.

The large majority of trainees were satisfied with the opportunities offered for special interest sessions, but the feedback suggested a need to improve the provision of more diverse special interest attachments.

Most trainees appreciated the flexibility that the scheme offered in supporting trainees who wished to use their time in novel ways (e.g. management course, attachments out of area). Not all participants appeared aware of the range of possibilities available and feared ‘upsetting their trainers’ by choosing to spend time off site from their core placements.

Many trainees had not seen the Joint Committee on Higher Psychiatric Training (1995) Handbook and relied on scheme organiser to inform and guide them in their clinical placement reviews.

Limitations to the study

Telephone interviews were chosen as they were expected to yield a better response rate than questionnaires; this may have caused some trainees to be inhibited in giving negative feedback since their identities were known. Both interviewers were personally known to many of the trainees and are strongly committed to the idea of special interest opportunities and this also may have influenced respondents' replies.

The results cannot be generalised to other schemes and a nation-wide survey from the College scheme visits would be of interest, as would a survey of the trainers' attitudes towards the use of special interest sessions.

Recommendations

1. (a) Special interest sessions are considered to be valuable by the majority of higher psychiatric trainees.

2. (b) Scheme organisers need to provide more explicit guidelines to trainees and trainers on how and where special interest sessions can be used.

3. (c) Job descriptions should allow for special interest time with appropriate cover arrangements.

4. (d) Up-to-date lists of possible placements and consultant trainers with particular special interests should be circulated to trainees.

5. (e) Further work is needed to evaluate the training value of special interest time and to explore how these sessions should be monitored, supervised and funded.

6. (f) There is a need for the College to regularly publish clear guidelines regarding sub-speciality training.