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FAQs – Postgraduate Training in Psychiatry

 

How do you become a specialist in psychiatry i.e. a psychiatrist?

To train to be a psychiatrist you must first qualify as a general doctor, which means completion of an undergraduate medical school qualification and then an internship in a hospital. Intern training is for a minimum of 12 months, which encompasses a minimum of 3 months in general surgery plus 3 months in general medicine. The remaining time allows opportunity to train in two medical specialities of which psychiatry is one. A general doctor must register on the ‘General Division’ of the Irish Medical Council’s Register of Medical Specialists.

Once accepted onto the College of Psychiatrists of Ireland training scheme to become a psychiatrist the doctor must register on the ‘Trainee Division’ of the Medical Council. The College of Psychiatrists is the only body in Ireland approved to train doctors to become psychiatrists.

To become a specialist doctor in psychiatry takes at least seven years.

Psychiatry training is divided into ‘Basic Specialist Training’ (BST) followed by ‘Higher Specialist Training’ (HST).

Once HST is complete, and certified, the doctor is now a fully qualified specialist in psychiatry and is eligible, and should, register on the Irish Medical Council ‘Specialist Division’. As specialists, they can then apply for consultant posts in health services but even if not in such a post, they are still fully qualified to work as a specialist.

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Structure

Training in psychiatry comprises:

  • A one year ‘Foundation Year’ followed by a further 3 years of ‘Basic Specialist Training’ (BST) followed by ‘Higher Specialist Training’ (HST) of at least 3 years. The place of training is hospitals / mental health services i.e. trainees are salaried non consultant hospital doctors (NCHDs) while on a training scheme.
  • To enter the Foundation Year in psychiatry doctors must have graduated from a university with a medical degree and completed an internship.
  • BST is a general training in psychiatry where trainees rotate through and work in various specialities and complete exams and research.
  • HST is in specific speciality areas broadly divided into Adult or Child and Adolescent Psychiatry but also involving subdivisions within each depending on the long-term career ambitions of the trainee. To enter HST, doctors must have successfully completed BST.
  • Completion of HST leads to the granting of a Certificate of Specialist Training that guarantees that the doctor has achieved all the competencies set by the College as necessary to practice safely as a specialist in the area of Psychiatry in which they trained.
  • The College holds that a doctor should not be a consultant if they are not a fully trained and certified specialist in the appropriate area of medical practice (as per the Irish Medical Council Register of Medical Specialists).

Training in Psychiatry is divided between Basic Specialist training and Higher Specialist training. There are learning outcomes for each year. A learning outcome defines what a Trainee can do after a learning experience. BST takes approximately four years and consists of an initial Foundation Year (FY) and usually another three years of BST. If a trainee has previous training experience and can demonstrate learning outcome attainment, BST may be accelerated by one year, subject to the approval of an Annual Review of Progress (ARP) Panel. The initial four years of specialist training consist of eight six month clinical attachments providing exposure to varied sub-specialties.

In order to complete BST, an ARP Panel must approve progression through and completion of training. In addition, Trainees must pass the College BST Clinical Examination.

Higher Specialist Training (HST) in Psychiatry usually lasts for three years for certification in a single recognised specialty. Training periods in HST will be longer if dual certification is pursued. Following the successful completion of HST the doctor should have achieved the skills to be awarded a Certificate of Satisfactory Completion of Specialist Training (CSCST) in one of the specialties of psychiatry recognized by the Irish Medical Council via Psychiatry, Psychiatry of Old Age, Child & Adolescent Psychiatry, and Psychiatry of Learning Disability.

 

Basic Specialist Training (BST)

BST is delivered via nine Deaneries, each with a number of Training Centres (see ‘Entry to Basic Specialist Training’ section below). Each Trainee is linked to a specified training centre and a training centre is defined as the training location where the in-house teaching takes place.  Each training centre has a Psychiatric Tutor who organises training locally which includes:

  • Weekly journal club and case conference.
  • Individual and group teaching of trainees to prepare them for the Irish College examination
  • Advice to trainees on the clinical experience required in general adult psychiatry and the various specialities.
  • Career guidance.

At the commencement of Basic Training a comprehensive induction is provided for all trainees. This induction includes details of the variety of teaching methods they are likely to experience, together with information on assessment methods.

Educational methods employed in Basic Training include:

  • Supervised clinical training and skills acquisition in approved posts
  • Attendance at an academic course suitable for preparing trainees to take the MRCPsych Examination and the Irish College examination
  • A weekly one hour face-to-face supervision session with the trainee’s consultant (Supervising Consultant). [This is a mandatory requirement. Such sessions are for the sole benefit of the trainee and cover such topics as research, careers advice, interviewing techniques and talking with patients. Elementary skills in counselling and psychotherapy, practical principles of drug prescription, some instruction in presentation techniques, use of the Mental Health Acts, and multi-disciplinary working also form part of this supervision].

Other educational activities include attendance at ward rounds, multidisciplinary case conferences, journal clubs, clinical audit and instruction in management techniques.

Experience in Community Psychiatry including domiciliary visits, home assessments with Community Nurses or other team members is essential. All trainees should also have experience of:

  • working with Community Psychiatric Nurses(CPNs), Social Workers and Clinical Psychologists;
  • giving a course of electroconvulsive treatment (ECT) in conditions meeting the College’s standards, i.e. under the supervision of a Consultant in a designated ECT suite and
  • Managing patient care under the Mental Treatment Acts.

All trainees should experience supervised research, and have a nominated Consultant/Tutor to advise them on the suitability of projects for their level of expertise. The early phase of research training could be limited to a case report or small literature review, whilst more advanced trainees might concentrate on the design and implementation of research protocols.

Assessment

Assessment is a continuous process throughout training.  It is designed to inform Trainees on their progress, to guide their development and to demonstrate learning outcome attainment.  Assessment consists of Workplace Based Assessments (WPBAs), Portfolio completion, Supervisor Reports, Annual Review of Progress (ARP) and a College Exam.  In HST there is no Exam but the other assessment methods pertain to obtain a Certificate of Satisfactory Completion of Specialist Training (CSCST).

Entry to Basic Specialist Training

Entry to the Basic Specialist Training Programme is advertised each November in the Irish Medical Press- Irish Medical News , Irish Medical Times, and Schemes on the website http://www.careersinhealthcare.ie/ [this is a website operated on behalf of the Health Service Executive (HSE)]. Application for training at BST is via the College and shortlisted applicants are interviewed. All application documentation is accessible from the College of Psychiatrists of Ireland website.

Successful applicants will be allocated to a Deanery based on their preference and performance at interview.  It is not ordinarily possible for a Trainee to switch between Deaneries during training (please see Regulations Document page 28 for protocol regarding same). There are currently 9 Basic Specialist Training Deaneries in Ireland, each of which is linked to a university – see list below:

  • NUIG Deanery
  • NUIG/RCSI Deanery
  • RCSI Deanery
  • TCD Deanery (x2)
  • UCC Deanery
  • UCD / MMUH Deanery
  • UCD / SVUH Deanery
  • UL Deanery

 

Higher Specialist Training (HST)

HST is undertaken in a national scheme in a series of Senior Registrar posts approved for that purpose by the College of Psychiatrists of Ireland and takes a minimum of three years. While many of the learning outcomes for HST are similar to those of BST, a greater level of clinical autonomy and case complexity is expected of the Higher Specialist Trainee. In devising an individual’s training programme account is taken of the trainee’s preferences, past experience and special interests. Following the successful completion of specialist training the Doctor will have achieved the skills required to be entered on to the Specialist Register of the Medical Council of Ireland.

Entry to Higher Specialist Training

Entry to HST requires the completion of BST (or equivalent from another jurisdiction).  However, progression from BST to HST is not automatic but is by competitive interview.  Separate interviews are held for the Adult Psychiatry & Related Disciplines and Child & Adolescent Psychiatry Schemes.  BST Trainees appointed prior to July 2011 who wish to progress to HST must have completed at least three years’ training in Psychiatry prior to commencing higher training and must have passed the MRCPsych Examination (or equivalent from another jurisdiction).  For Trainees entering BST from July 2011 onwards, the entry criteria for HST will be the completion of BST, which is based on completing a minimum of 36 months of experience in approved BST training placements, attainment of learning outcomes, passing the College BST Clinical Examination, and satisfactory progression at each Annual Review of Progress.

All of the examination and continuous assessment criteria for entry to HST must have been met by the closing date for application to the HST Programmes.

All application documentation is accessible from the College of Psychiatrists of Ireland website.

Streamlined Training

From July 2015 onwards Trainees who have successfully completed BST with the College of Psychiatrists of Ireland will be automatically deemed eligible for HST. There are additional eligibility criteria for the fully integrated Lecturer posts and for those who entered Foundation Year in July 2014 and subsequent years (see Regulations Document page 7). Final year BST Trainees must confirm that they wish to continue to HST and must attend an interview.

In order to retain streamlining status all trainees who leave BST must apply for HST at the first intake for which they are eligible [Eligibility requirements are i) Completion of the minimum duration of BST; ii) Satisfactory ARP Outcome; iii) Completion of the CPsychI Clinical Examination].  Failure to apply for HST (or failure to accept an offer of a HST placement) will result in the loss of streamlining status.