Making the Most out of the Gold Guide Recruiting Psychiatrists
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Columns Correspondence Nurse prescribing is a contentious issue Brown (2000) and Sembhi & Livingstone students (Brockington & Mumford, 2002). (Psychiatric Bulletin, April 2008, 32,136- (2000). The assessment seeks clear Earlier studies showed that postings in 139). Although the benefits of a multi- evidence and proof of achievement in psychiatry can positively influence columns disciplinary approach to prescribing both performance (workplace-based students’ attitudes and knowledge about cannot be overstated, there are two assessments) and experience (log book, the specialty. We conducted a pilot study potential problems. The main pitfall is the audit and research). Based on this, the to examine the influence of a posting in discrepancy between ability and expecta- trainees’ future needs can be identified psychiatry on the career plans of medical tion. Prescribing medication without (annual planning). students (Holmes-Peterson et al,2007; knowledge of physiology and pharma- The annual review of competence Cutler et al, 2006). Third-year students cology is a recipe for disaster. Years of progression appears a well-considered (n=72) in Singapore filled out a 30-item medical school training coupled with plan. However, there are some inherent self-report survey after their 4-week hands-on experience cannot be matched difficulties in its implementation, particu- clinical posting in psychiatry. The ques- by training through prescribing courses. larly in psychiatry. For the specialty trainee tionnaire examined the preferred specialty The second equally important issue is year 4, identifying educational supervisor before entering medical school, the related to psychiatric training for junior other than a clinical one has been an change in attitude towards psychiatry doctors. Nurses taking over such tasks as issue. Research sessions and special after the posting, the consideration of prescribing and mental state assessments interest sessions have not been consid- psychiatry as a career after the posting will reduce the training opportunities for ered in the review, probably because and the reasons for that. junior doctors who are already recovering traditionally they have not been part of The majority of students indicated an from the double blow of the European other specialties’ training curriculum. improvement in their attitude towards Working Time Directive and a curtailed Therefore, for example, getting a report psychiatry, in tune with earlier studies 6-year run-through system. There is a risk from research supervisor for the review is worldwide. About 39% had a preferred that their role might gradually be not feasible. Some centres have only 4- specialty before the psychiatry posting. restricted to chasing blood tests results, month training posts for specialty trainees For male students it was surgery, followed carrying out physical examinations and years 1-3, too short for any effective by orthopaedic surgery, and for female dictating summaries. In the course of appraisal process. The most burdensome students, obstetrics and gynaecology, time, a cohort of ‘trained’ psychiatrists aspect at the moment seems to be nomi- followed by paediatrics and surgery. Only may emerge with potentially less hands- nating people and getting feedback from one student preferred psychiatry before on experience. Expecting them to oversee the multidisciplinary team through the the posting. After the posting, 68% risk management might be a little online system. Trainees can easily find wanted to consider a career in unreasonable. themselves frantically running around to psychiatry - 20% of this group had indi- get the forms filled. cated a specific non-psychiatric career Declaration of interest Notwithstanding, this system is a better choice earlier on. Experience during the A.H. is a run-through trainee at ST3 level. way of testing and developing compe- posting was the most important factor tence progression. It has given us the for changing their career plans (this was Abrar Hussain Specialty Registrar, Broadmoor opportunity to be reflective in our regardless of the students’ gender). Hospital, Crowthorne, Berkshire RG45 7EG, email: learning experience and it has managed to The study showed that posting in [email protected] merge clinical and educational supervision psychiatry can have a direct influence on (re)consideration of psychiatry as a career doi: 10.1192/pb.32.7.275 in the best possible way. It is bound to have some initial hiccups, but the best option in undergraduates. Although way to deal with them is to take an opti- Eagles et al (2007) reported that most mistic approach, familiarise with the Gold definitive career choices will be made Guide and get on with the tasks. during the (early) postgraduate years, our findings are encouraging and more Making the most out of the research in this area could be beneficial to MODERNISING MEDICAL CAREERS (2007) AGuideto improving the recruitment of future Gold Guide Postgraduate SpecialtyTraining in the UK (The Gold Guide). Modernising Medical Careers (http:// doctors into psychiatry. While some of the trainees have not yet www.mmc.nhs.uk/default.aspx?page=281). completely recovered from the stormy DAY, E. & BROWN, N. (2000) The role of the BROCKINGTON, I. F. & MUMFORD, D. B. (2002) entry into the run-through system, others Recruitment into psychiatry. BritishJournal of are about to face their annual review of educational supervisor: a questionnaire survey. Psychiatric Bulletin, 24,216-218. Psychiatry, 180,307^312. competence progression. The Postgrad- uate Medical Education Training Board has SEMBHI, S. & LIVINGSTON, G. (2000) What trainees CUTLER, J. L., ALSPECTOR, S. L., HARDING, K. J., et al (2006) Medical students’perceptions of set out clearly the operation of the and trainers think about supervision. Psychiatric Bulletin, 24,376-379. psychiatry as a career choice. Academic Psychiatry, competence-based specialty training in 30,144-149. the UK. Its offshoot product, the ‘Gold Guide’ (Modernising Medical Careers, KarthikThangavelu Nottinghamshire Healthcare EAGLES, J. M.,WILSON, S., MURDOCH, J. M., et al NHS Trust, Psychiatric Unit, Derby City General (2007) What impact do undergraduate experiences 2007), seems to be the Bible to follow in Hospital, Derby DE22 3NE, email: mcxkt2@ have upon recruitment into psychiatry? Psychiatric the new era of training. However, several nottingham.ac.uk Bulletin, 31,70-72. months into the system this ‘golden HOLM-PETERSON, C.,VINGE, S., HANSEN, J., guidance’ has yet to become popular doi: 10.1192/pb.32.7.275a among trainees. Of particular interest is et al (2007) The impact of contact with psychiatry on senior medical students’attitudes toward the section which explains three inte- psychiatry. Acta Psychiatrica Scandinavica, 116, grated components of the process, the 308-311. ‘three As’ - appraisal, assessment and Recruiting psychiatrists - annual planning. the Singapore experience The appraisal should be a continuous Birit F. P. Broekman Adjunct Assistant Professor, process happening at regular intervals. In In view of the current shortage of National University of Singapore, Department of Psychological Medicine, National University Hospital, my opinion, it is the crucial part of the psychiatrists worldwide, it is important to 5 Lower Kent Ridge Road, Singapore119074, email: review. The importance of educational understand the impact of an undergrad- [email protected], Rajeev Kumar Senior supervision was also highlighted by Day & uate posting in psychiatry on medical Consultant Psychiatrist, Canberra Hospital, Australia 275 Columns Correspondence AUTHOR’S PROOF and Senior Lecturer, ANU Medical School, AnnY.P. dreaming, nightmares, hallucinations, College is tangential if not diametrically Toh Medical Student, National University Hospital, agitation irritability and restlessness, opposite to the focus of the trainees. This Singapore, Kua Ee Heok Head of Department which suggest that it can penetrate the situation needs to be rectified with columns and Professor of Psychological Medicine, National University of Singapore blood-brain barrier (Price, 2000; Nether- utmost urgency. Another hypothetical lands Pharmacovigilance Centre, 2007). A and thoroughly amusing argument is that doi: 10.1192/pb.32.7.275b causal relation between montelukast and the essay paper had enhanced the writing psychotic disorders and/or schizophrenia skills of the trainees. I am awaiting a study has not been established and is still that will find a correlation between the unclear. trainees’ scores on the essay paper and Montelukast and worsening the number of their publications. of hallucinations in paranoid NETHERLANDS PHARMACOVIGILANCE CENTRE The process of changing exam patterns schizophrenia (2007) Montelukast and Depressive Symptoms. is an immortal amoeba. The best pseudo- Netherlands Pharmacovigilance Centre (http:// podia now are multiple choice questions. A 29-year-old woman was admitted to a www.lareb.nl/documents/kwb___2006___4___ Whether they will breathe fresh fragrance psychiatric in-patient unit with a history of montel.pdf). or turn into a storm uprooting the validity schizophrenia. She believed that she was of the exams will only become discernable PRICE, D. (2000) Tolerability of montelukast. Drugs, being raped by strangers and that people with the passage of time. 59 (suppl1), 35-42. were performing witchcraft on her. She also had third-person auditory hallucina- Nithya Anandan Specialist Registrar in Psychiatry, Declaration of interest tions. As the patient’s