Deskilling of junior doctors

Self-harm assessment is an integral part of any psychiatric training. The traditional training model of junior doctors has mainly focused on independent assessments routinely carried out in A&E and acute psychiatric units. However, nowadays, most self-harm assessments are carried out by the crisis teams. This has prevented trainees from actively participating in risk assessment processes, thereby resulting in reduced exposure to psychiatric emergencies (Woodall et al, 2006).

To ascertain the effect of this change on the training and the skills of junior doctors, a questionnaire was recently sent to all 22 trainees (with minimum 6 months’ experience), excluding three general practitioner trainees, working in Lincolnshire Partnership Trust. It mainly included questions on opportunities for risk assessment and the number of self-harm assessments undertaken before and after the introduction of the crisis teams as well as implications for further training.

Before the introduction of crisis teams, 15 (68%) doctors were carrying out all emergency assessments themselves. After the introduction of crisis teams 12 (55%) doctors were carrying out no assessments and the remaining were conducting only one assessment per on-call shift. This lack of exposure was felt to be affecting clinical skills and training by 15 (68%) of the doctors, resulting in gradual deskilling. Half of the trainees thought the lack of exposure and proper training would have an impact on passing the MRCPsych membership examinations.

The study shows that the opportunity for trainees to undertake independent emergency assessments has significantly reduced, resulting in gradual deskilling. There is an urgent need for further development of training facilities for junior doctors in assessment and management of self-harm and other psychiatric emergencies. As suggested by Beale (2006) using an audit system would provide a useful opportunity to examine more closely the way different health professionals undertake assessment and management of acute psychiatric emergencies.