1. A competency based curriculum for specialist training in psychiatry
Dr Nicholas Taylor
Consultant Forensic Psychiatrist, Leicester, United Kingdom
Training Programme Director - East Midlands Forensic Psychiatry

2. Outline www.forensicpsychiatrytraining.co.uk/resources
All slides and reading material available online
Introduction
Medical and psychiatric training in the UK (briefly)
Forensic Psychiatry training in the UK
Competency based training
Theoretical and practical difficulties
Summary

3. 1 Introduction www.forensicpsychiatrytraining.co.uk/resources
Curriculum development:
Royal College of Psychiatrists
Forensic Faculty Education and Curriculum Committee (FFECC)
UK wide
Curriculum delivery
Health Education England working across the 13 regions (previously “Deaneries”)
Training Programme Directors – often 8-12 forensic psychiatry trainees each
National Training Programme Director group – common themes
Separate systems for Scotland, Wales and Northern Ireland

4. 2 Medical and psychiatric training in the UK
Medicine is primarily an undergraduate degree
5 years, or 6 if an additional BSc degree or similar
Graduate entry
Promoted in last 20 years to reduce deficit of doctors
4 year course
After graduation – governed by The Gold Guide – sets out the rules
2 years of Foundation Training – 6 x 4 month placements
Wide range of medical and surgical specialties – including psychiatry
FY1 and FY2 years

5. Medical and psychiatric training in the UK
After Foundation Training comes Core Training (CT)
Broad choice of specialty
Surgery
Psychiatry
Medicine
General Practice, etc.
3 years of broad clinical experience
Professional exams determine entry into the relevant Royal College
CT1, CT2 and CT3

6. Core psychiatry training in the UK
Range of specialties in the 3 years
general adult and old age
plus CAMHS or LD/ID
possibly forensic and/or psychotherapy, but often not
Core Psychiatry Curriculum – link on resources page
Exams
Basic sciences
Clinical Topics
Clinical Assessment of Skills and Competencies (CASC)
Then eligible to apply for specialist training

7. 3 Forensic psychiatry training in the UK
Specialist training takes 3 years – all spent in one specialty
Forensic GA
Old Age
CAMHS
LD/ID
Psychotherapy
Leads to a Certificate of Completion of Training – recognition as a specialist
Some dual training (eg forensic and CAMHS) – 4-5 years

8. Recruitment to forensic training
National Recruitment – no contact necessary between applicant and trainers – failed applicants can reapply, and reapply, and reapply
Several interview stations – successful applicants are allocated based on performance – receiving trainers told at a very late stage
Interviews take place at Manchester City’s football ground

10. Structure of forensic training
3 years – spent within one region – often 3 posts for 1 year each
Clinical Supervisor = supervising Consultant – changes at least annually
Educational Supervisor = mentor/supervisor over entire training
Training Programme Director = oversees training programme

11. Additional requirements
Prison experience
Reflective practice
Psychotherapy experience
1 full day every week for Special Interest and Research (anything!)
Regular on call work – general adult or specifically forensic
Many trainees undertake Masters Degrees – often mental health law

13. Structure of forensic training
Learning objectives for each post
All reports and progress records held solely in an online portfolio
Assessment by frequent/monthly online forms in the portfolio
Twice yearly Multi-Source Feedback (MSF) – known as a mini-PAT
Work Place Based Assessments (WPBAs) – complex assortment of 12 types
An example
Video showing portfolio on the resources page

14. Case Based Discussion

15. Assessments 12 types of assessment within the portfolio (WPBAs)
15 Intended Learning Outcomes
each with many subsections and specified means of assessment for each
26 pages in total
Training placements should be “mapped” to ILOs to allow trainees to identify which jobs they should do in turn to provide the best training

16. 15 Intended learning outcomes
Assessment
Clinical governance
Formulation
Investigation
Communication
Risk management
Team working
Interview/Therapy
Leadership
N/A
Time management
Management of illness
Teaching
Research
Professionalism
Audit
Some of the ILOs in core training are not repeated here – record keeping, inform and educate patients, develop lifelong learning habits, reflection

22. 4 Competency based training
This curriculum is based on meta-competencies and does not set out to define the psychiatrist’s progress and attainment at a micro-competency level. With these points in mind, this curriculum is based on a model of intended learning outcomes with specific competencies given to illustrate how these outcomes can be demonstrated. It is, therefore, a practical guide rather than an all-inclusive list of prescribed knowledge, skills and behaviours.

23. Competency based training
How is progress reviewed?
Annual Reviews of Competency Progression (ARCPs)
Can actually be more frequent – if concerns
Chaired by Training Programme Director
Follow detailed interview and report from the ES
No exams or any form of exit exam
ARCP - Panel of Consultants review ONLY the evidence in the portfolio
Trainee must not be present – Gold Guide (but often is)
Presentation of evidence from portfolio by ES
Has the trainee developed the required competencies?

24. ARCPs Annual Reviews of Competency Progression
If they are progressing – they move to the next year
If more information is needed, adjourn for a week or two
If they’re not progressing, set targets
With no more time required for training
With more time required for training (maximum 1 year extra)
If they are not progressing and more time won’t help – released from the training programme

25. 3 years of training Significant national variation
Medium and low secure
Some areas have high secure hospitals
Varied prison experience
Psychotherapy provision varies
Expert witness work – provision varies hugely
Often 3x 1 year placements
Some areas provide “tapas training” – 3x 4 month placements
Challenges

26. 5 Theoretical Difficulties
Competency based with no time requirements BUT it’s 3 years overall
Competencies are very broad and subjective
ILOs are also broad and are available in all placements – “mapping” is irrelevant
WPBAs not fit for purpose – scoring is to be removed
ARCP panels should be completely independent
ES should not be involved in decision
?CS and TPD should not be involved
If a non-medic can demonstrate all the competencies, shouldn’t they be a Consultant Forensic Psychiatrist?
Causes problems with high secure placements and prison placements – “How long do I need to do?”
Formative vs summative assessments

27. 5 Practical Difficulties
“Meta-competencies” are difficult to measure, especially with WPBAs
Requirement for 12 WPBAs per year – usually about 15-17

28. 5 Practical difficulties
Concerns about trainees’ “soft skills” are difficult to pin down with WPBAs – unless documented, nothing can be done
Few people provide detailed written feedback in the portfolio
Last minute uploading of evidence to the portfolio – lock out period
Wide variations in practice
Some very clear rules (trainee is not to be present) are ignored
Lack of specific timescales for prison experience cause confusion
Psychotherapy training and supervision is increasingly difficult to provide

29. 6 Summary
It works!
Vast majority of trainees are good enough, with many excellent
The poorest trainees leave
Good level of peer support and independence
Tiny proportion of trainees are “released from training” and, despite legal appeals, the decision is usually upheld
Much of this is due to excellent training for supervisors and dedication of relatively small numbers of Consultants to training
Small numbers of trainees (8-12 in each region) allow for very individualised, bespoke training – unlike large specialties (90+ trainees)

30. All slides, FURTHER READING, additional material and my DETAILS