Junior doctors are performing fewer emergency assessments

Waddell & Crawford ¹ have demonstrated very clearly that trainees are becoming more and more limited in their experience of emergency psychiatry. This is, to use their own words, a very real cause for concern. The same may, however, also apply to their experience in day-to-day psychiatric practice. With so called functionalisation, clinical teams and their members may be dealing with an increasingly narrow range, if any at all, of patients, most of whom might have the same diagnosis. This is not to deny the need and requirement for individual care pathways and treatment plans, but it may severely limit learning opportunities. Of no less concern, and possibly even more so as it may eventually effect early interest in and recruitment to our specialty, is the influence that these changes in service organisation have had on undergraduate medical students' experience of psychiatry.

The development of functional teams, the separation of in-patient care from community care, and the increasing specialisation within psychiatry mean that the clinical experience offered in undergraduate placements may not be providing either the depth or breadth of experience required to assure that students see common conditions, follow through the course of a single episode from inception to recovery, and understand the range of abnormal phenomena in psychiatry and the treatment options that are available. Most medical schools offer 6 weeks of placement in psychiatry within the 5- year course. This exposure is likely to be the only formal training in psychiatry for most doctors training in the UK.

The problems in specialist training highlighted by Waddell & Crawford extend beyond mere reduction in the number and frequency of assessments, to experience of presentation and management of anxiety-related disorders, obsessive-compulsive disorder and eating disorders, and will soon include assessment of memory disorders, most of which have been ceded to nurses or psychologists. These trends and changes will ultimately affect the clinical skills of future psychiatrists and recruitment to psychiatry from among UK medical graduates.