Training Requirements for Old Age Psychiatrists in the UK Susan Mary Benbow and Aparna Prasanna

BACKGROUND: GROWTH OF THE SPECIALTY

In the early 1980s two surveys of old age psychiatry services reported considerable growth in the developing specialty^2,3, and over 200 consultants were identified by late 1983. The authors predicted continuing growth in the specialty and a need to expand training placements. At that time the Joint Committee on Higher Psychiatric Training at the Royal College of Psychiatrists required higher trainees to spend 12 to 18 months in posts where the majority of the work was in old age psychiatry, and 28 senior registrar placements were identified.

In 1990 there were 360 consultants working mainly in old age psychiatry and by 1993 the total had increased to 405⁴. Figures collected by the Faculty of Old Age Psychiatry showed a continuing gradual increase in consultant numbers, but with a high vacancy rate.

The first Joint Report¹ had recommended that each medical school should have a senior academic in old age psychiatry and that all medical undergraduates should receive training in the subject. Faire and Katona⁵ surveyed undergraduate teaching in the UK and reported a considerable expansion in academic old age psychiatry posts. However, they also found a great variation in the amount of clinical experience on offer and the authors felt there was a strong case for all medical students having clinical experience in the specialty as recommended by the Joint Report. Gregson and Dening⁶ surveyed teaching hospital psychiatrists and found that many teachers set no learning objectives in old age psychiatry. Most respondents wanted their teaching to impart enthusiasm for the subject, a sense of hope in working with mentally ill older adults, and an awareness of issues specific to ageing and ageism.

The second Joint Report⁷, published in 1998, recommended that the characteristics of mental disorders in older people and the principles of good quality care should be included in the core curricula of all schools of medicine and nursing, and by the time the second edition of this book was published, there were chairs or readerships at a number of medical schools in the UK, although some gaps remained. The twenty-first century brought with it the National Service Framework for Older People⁸, which estimated that by 2009, extrapolating from the numbers of existing trainees, there would be 670 old age psychiatrists. It argued the case for increased staff numbers to improve the mental health of older people, and also noted that its recommendations had implications for education and training in undergraduate and postgraduate medicine.

Despite growth in the specialty of old age psychiatry, the long-term prospects continue to cause concern. The Dean of the Royal College of Psychiatrists wrote in his May 2009 newsletter⁹ that recruitment into psychiatry as a medical specialty is ‘in crisis’ with only 6% of candidates for paper 2 of the Membership examination in summer 2008 having gained their primary medical qualification in the United Kingdom. One response to this has been initiatives to try to attract more UK medical students into the specialty, e.g. an official Royal College of Psychiatrists group has been set up on a popular social networking website.

Alongside these developments, postgraduate education has undergone considerable reorganization over recent years. Modernising Medical Careers¹⁰ was published in 2004. It aimed to streamline training based on competency-based curricula, and also brought in the foundation programme for newly graduated doctors. In 2005 the Postgraduate Medical Education and Training Board (PMETB)¹¹ took over responsibility for standards and quality assurance of postgraduate education, training and assessment in medicine and dentistry. The foundation programme has introduced foundation posts in psychiatry to many areas, and with it an opportunity to attract new medical graduates into the psychiatric specialties.

SPECIALIST TRAINING IN OLD AGE PSYCHIATRY

Advanced Training

The total minimum duration of specialist training in old age psychiatry is currently six years, of which three years is in core or generic training (core trainee CT1–3) and three years in advanced training (specialty registrar ST4–6). A new curriculum for specialty training in psychiatry and its specialties was approved by PMETB in April 2009 and was introduced in August 2009¹². Figure 138.1 illustrates the structure of training.

Core Training

A newly qualified doctor intending to specialize in psychiatry will first spend two years on a foundation programme. Following this, competitive recruitment into psychiatry in England is by a standardized national recruitment programme through the Royal College of Psychiatrists. The trainee will undertake core training, which lasts three years and concentrates on providing a range of experience in the specialties and subspecialties of psychiatry. This part of training is common to the various psychiatric specialties. Core training aims to develop history taking, formulation and case presentation skills, therapeutic skills and clinical judgement, relationship with patients/carers and colleagues, and appropriate use of mental health legislation. Experience in old age psychiatry is regarded as an important part of core training because of the increasing elderly population and the high rates of mental illness in older people.

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