CORRESPONDENCE.

Sir: Your readers might be interested to know about the changes to Irish training. Currently, the Irish Psychiatric Training Committee (IPTC) is the statutory body regulating psychiatric training in Ireland. Alongside the IPTC, the Royal College of Psychiatrists provides accreditation and educational approval to training schemes and programmes. There are currently 12 training schemes in Ireland, with approximately 500 trainees. The Certificate of Satisfactory Completion of Training (CSCT) and entry onto the specialist register of the Irish Medical Council are awarded after 3–4 years of basic training as a senior house officer/registrar followed by another 3–4 years of higher training as senior registrar.

Irish psychiatry is presently in a process of restructuring. On 1 January 2009, a new College of Psychiatry of Ireland, autonomous from the UK Royal College, came into being, and an indigenous training and assessment programme is expected to be in place from 2010. This change provides a unique opportunity for recent advances in medical education to form the basis of the new training programme. Steering groups are now developing the new training programme and its delivery. As part of this process, a pilot on workplace-based assessments is already under way in Dublin.

For Irish trainees, the initial anxieties brought on by these changes are fast giving way to corresponding levels of enthusiasm and a motivation to shape the changes as they occur. In this regard, the Trainees’ Section of the Irish College has recently embarked on a project to explore ways of optimising the awareness and participation of all trainees in College activities at this time of change, and to position themselves as key stakeholders in the emerging new College.

One key issue of concern for pre-membership trainees has been the prospect of being ineligible to sit the MRCPsych examinations after spring 2010 under the current eligibility criteria. However, the Royal College and its Irish Division are working to ensure that Irish trainees continue to meet eligibility criteria until the ‘Irish exams’ become fully established. Of note, as the Irish College emerges, Irish trainees will retain their entitlement to join the Royal College as international members, and thereby continue to enjoy the benefits that come with it, such as access to journals and rebates on conference fees.

We feel that collaboration and exchange of experiences with our peers both in the UK and in the wider European context, as occurs at the European Federation of Psychiatric Trainees (EFPT), will be beneficial. We would welcome an opportunity to retain our seats at the Psychiatric Trainees Committee of the Royal College, since we are likely to continue to sit the MRCPsych exams in the foreseeable future and an ongoing forum for exchange of ideas and experiences with our UK colleagues would be invaluable, especially in these initial stages of the Irish College’s inception.

For psychiatric trainees in Ireland, the time ahead is both challenging and exciting. We look forward to the advent of the new College of Psychiatry of Ireland – one that is committed to providing training that is comparable with the best in the world. This will ensure that Irish patients continue to enjoy the highest standards of mental healthcare.

‘Better than a thousand days of diligent study is one day with a great teacher.’ (Japanese proverb)

Sir: There are rising concerns regarding postgraduate medical training in Portugal. The lack of supervisors is one critical factor adversely affecting psychiatric training. In the past few years, employment in the public sector has been considerably reduced. New appointments for consultants have been frozen. Recently qualified specialists either look for a job in the private sector or accept insecure contracts in the public sector. Unable to compete with the private sector in terms of employment benefits, public services are losing consultant psychiatrists, and this has led to shortages in every setting, from outpatient clinics to hospital wards, from emergency rooms to rehabilitation units. This inevitably has an impact on current psychiatric training. In a process of teaching and learning, adequate supervision is an essential element of training. With its clear implications for patient safety, supervision must be carried out within clearly defined lines of responsibility.

Unfortunately, the current laws and regulations on training do not provide a clear definition of supervision, its frequency, structure and contents, or the trainee’s responsibilities. As each training institution uses its own interpretation of the law, training standards become inconsistent, with some trainees being directly and regularly supervised while others receive almost no supervision at all. There are reports of a lack of supervision in most settings, including in-patient and out-patient clinics. The situation is particularly critical in emergency rooms, where trainees, especially in their last years of training, are often left unsupervised.

A vast majority of consultant psychiatrists are in their fifties, prompting speculations that the lack of supervisors may become acute in a few years’ time, when they retire.

The situation is exacerbated by recent proposals to change the way the healthcare system in Portugal is financed and managed. There are major concerns that the model of healthcare provision based on commercial insurance will focus primarily on short-term profitability rather than maintaining high standards of medical training.

To address these concerns, the Portuguese Medical Association has begun to assess training institutions on a regular basis, while the Portuguese Psychiatric Trainee Association is monitoring the trainees’ satisfaction with supervision.

More needs to be done, however, to increase the quality of supervision. Without clearly defined laws and regulations on supervision in training, describing the roles of the trainee, the trainer and the training institution, and defining competencies for each stage of training, we cannot hope to maintain high standards in training. Compliance with those laws and regulations must be regularly monitored to motivate senior doctors to play an active role in training.

For great teachers to provide great teaching, we have to give them the proper conditions to teach.

Sir: As an invited speaker from the Western Pacific Division of the Board of International Affairs, and as a third-year trainee from Hong Kong, I attended the College annual conference in London, 1–4 July 2008. It was truly an eye-opening experience and I took home with me many wonderful memories and invaluable knowledge.

During the four days of the conference, I met eminent professors, respected psychiatrists, specialists and trainees from all over the world. I attended meetings of the Board of International Affairs, where many issues were raised, ranging from disaster management to organising training programmes and various campaigns. This was an area of psychiatry that I had not been exposed to before, and it was an introduction to what psychiatry on a global scale entails.

As for my presentation, the title was ‘Getting it across: psycho-education in primary care’. There was a lively question-and-answer session afterwards, and the feedback was positive and encouraging.

Last but not least, the conference offered a myriad of sym-onference offered a myriad of symposiums and talks to suit everyone’s specialties and particular interests. The presentations were done in a very personal and interactive manner, which made learning much more interesting than the standard lectures.

As for social events, I attended the trainees’ reception and met others from different levels of training in the UK. It gave me an opportunity to reflect on the situation in Hong Kong, and to learn about the changes and current situation in UK training as well. The highlight of the week was the cocktail reception at the House of Lords for overseas delegates. After a welcoming speech from Lord Crisp, who has been involved in mental healthcare issues for many years, we were given a guided tour around the famous parts of Parliament: the House of Lords, House of Commons and various other rooms and halls. It was an unforgettable evening spent in the company of many great people.

I realised that a career in psychiatry is more than just passing exams, getting a training post, or even publishing papers. There are so many ways in which we, even as trainees and younger members of the psychiatric profession, can serve our community. Getting into volunteer programmes, raising money for low-income countries, coordinating response protocols for disaster-stricken areas, and advancing psychiatric training and education globally are but a few ways in which we can get help, and the College provides a platform for us to participate in such activities. The satisfaction and personal experiences I gained from this conference gave me motivation to be a better psychiatrist, and provided me with a sense of direction in my professional career.

Sir: We conducted a series of 1-day sensitisation workshops on common mental disorders for primary care physicians in Delhi. The workshops were conducted as part of the National Mental Health Programme of the government of India. The workshops were kept to 1 day because of the busy clinical schedules of the medical officers. The learning objectives were that the medical officers would be able to diagnose and manage these disorders in their clinical practice using both pharmacological and basic non-pharmacological interventions, such as reassurance, encouragement and psychoeducation.

The programme consisted of three sessions, one each on anxiety disorders, depressive disorders and somatoform disorders. These conditions were chosen because they are common, often remain undetected, are associated with significant dysfunction and medical comorbidity, and are easy to treat in primary care. Three workshops were conducted and 102 primary care physicians attended. To encourage the active involvement of participants, a problem-based learning approach was used (Wood, 2003).

The participants were divided into groups of six to eight. Each session comprised a group task, presentation of the problem solution by one of the group members and a brief discussion. Each group was given a problem in the form of a case vignette along with five questions related to diagnosis and management. The groups were given 10 minutes for the task followed by 5 minutes for presentation and discussion. This was followed by an interactive presentation on the topic by one of the psychiatrists, followed by general discussion.

At the end of the presentation, 10 minutes were given for feedback from administrators and participants. The programme format was found to be very useful by most people, as it had made them participate in the learning, and they had an opportunity to discuss the difficulties of dealing with such cases during day-to-day clinical practice.

Under the National Mental Health Programme, 2-week training programmes have been conducted in different places in India and have been found useful in improving primary care workers’ knowledge of mental health issues (Sriram et al, 1990). But it has often been found difficult for doctors working in primary care to be sent for 2 weeks’ training. Most of the earlier programmes have been in the form of didactic lectures. The present programme in the form of interactive sessions lasting just 1 day can serve as a useful training strategy for use in low- and middle-income countries, where there is a major shortage of health personnel.