This webpage aims to provide you with an overview of specialty training in Child and Adolescent Psychiatry, how the local rotation fits into the wider world of medical education, and to help you with some local practicalities. Although this is a small scheme the opportunities are surprisingly rich, there is scope for flexibility and the South West has some of the loveliest landscapes in the country.
The Child & Adolescent Psychiatry role descriptions can be found here.
Details of the scheme can be found in the job description you received from your employing Trust. Dr Sarah Huline-Dickens is the Training Programme Director, and is also educational supervisor in Plymouth, and other Educational Supervisors are Dr Fernanda Garcia Costas (Plymouth), Dr Alison Lee (Exeter), Dr Sam Gothard (South Devon), Dr Femi Akerele (South Devon) and Dr Mark Woodgate (East Cornwall).
Medical education in the UK went through a period of enormous change at the end of the last decade, and continues to change quite rapidly. The RoyalColleges and the GMC have defined their areas of influence and there is much more clarity about processes and who is driving them.
NHS Medical Education and The Gold Guide provide a lot of valuable information about the processes of training. The Shape of Training is another document to be aware of; published in 2013 by a consortium of organisations and overseen by David Greenaway, this report could have significant implications for your training but the detail is not known about yet.
The Peninsula Postgraduate Medical Education has full GMC approval for three National Training Numbers but numbers of trainees will vary as there are some additional trainees undertaking academic fellowships and lectureships in collaboration with the University of Exeter Medical School (UEMS). Rotating between placements will give you a sense of different sub-specialties but also some insight into working for different organisations. The scheme covers one foundation trust (Cornwall), one social enterprise (Plymouth Community Healthcare) and one private provider (Virgin care). This is quite a different situation from the rest of the county currently where most services are still provided by the NHS. Usually a trainee will be in one placement per year for 3 years but less than full time (LTFT) trainees will usually train for 60% of the time and take longer to complete their training.
Our scheme comes under Peninsula Postgraduate Medical Education where it is overseen by the School of Psychiatry. The School Manager is based at the Peninsula Postgraduate Medical Education, Raleigh Building, Plymouth Science Park, Derriford, Plymouth PL6 8BY.
The Academic Programme
Trainees from the Devon CAP HST training programme, the Bristol, Bath, Swindon and Gloucestershire programme attend the academic programme in Bristol. Dr Gillian Coombes, Consultant Child and Adolescent Psychiatrist, is currently Academic Programme Organiser of the three year rolling programme. The course is on alternate Fridays in three 10 week terms per year and usually represents 15 days per year. It is usually held in Bristol and includes seminars, journal reviews, clinical case presentations, research meetings, outside speakers and a Balint group. It is also an important group for peer learning.
Appraisal & Revalidation
Please visit our revalidation pages and the GMC website for information. As far as appraisal is concerned, it is the duty of every doctor to ensure they have an annual appraisal and this is currently, in this particular area, one of the requirements for the ARCP. The processes for appraisal are Trust based. Usually your Clinical Supervisor will undertake your appraisal.
This is the Annual Review of Competence Progression, and is organised via Peninsula Postgraduate Medical Education, information is available on our ARCP Pages.
Trainees are expected to participate in audit and quality improvement projects in each of their placements.
The final version of the Child and Adolescent ST4-6 curriculum has been approved and is now available on the College website. An overview of this document can be found on pages 154-155.
This is an important way of keeping a record of your training. It is recommended that you regularly update this, and include time for doing so in your regular timetable (up to an hour per week) so that the information is collected and added to as part of an ongoing process, rather than being done in haste before the ARCP. Some changes to the site were introduced in August 2014.
Especially in the final year of training, support will be given to trainees to develop their management knowledge and experience.
Throughout the different regional placements, a broad range of management experience can be arranged. In most placements, it should be possible to chair meetings, participate in interview panels, write business plans and handle complaints. Attendance at LNC meetings is also possible.
You will also be encouraged to take the lead on quality improvement initiatives.
In Plymouth it is possible to shadow Dr Andy Sant, Medical Director, by arrangement.
You will join the on call rota on a 1 in 10 basis over a two year period, as 2nd on call to the duty core trainee. There will always be a CAMHS consultant on call with you. In turn you will be supervising a core or vocational training scheme (VTS) trainee.
The on call rota covers duties in Plymouth no matter where you are based. For this reason you will usually begin the scheme with a post in Plymouth, so that you are familiar with the procedures. A separate document gives guidance for what you might face when on call.
- Exeter: Outpatients. This post is based at Evergreen House with Dr Alison Lee as supervisor. The post has a focus on adolescent disorders and particularly mood disorders. However the caseload can be adapted to suit the training needs of the trainee. There is an ethos of multi-disciplinary working and opportunities for audit.
- Plymouth: Neurodevelopmental/Children’s Day Programme post. This post is based at the Terraces with Dr Huline-Dickens as supervisor. It can include both outpatient and day unit experience. The day programme functions as an assessment unit for complex children with neurodevelopmental problems. The post provides special experience in assessment, management (chairing ward rounds and multi-agency meetings) and interventions such as parenting and psychoeducation groups for parents in a multi-disciplinary setting.
- Plymouth: PymBridge Adolescent Unit. Based at Plym Bridge House, the regional adolescent unit is for young people between the ages of 13 and 18. Dr Garcia-Costas is the supervisor. The unit has 12 beds which are usually fully occupied. Patients have complex psychiatric disorders including eating disorders and emerging personality disorders. On placement you will be responsible for the care of some patients under supervision and will participate in the main ward round and other multi-disciplinary team meetings. Therapy experience includes community groups, family therapy and individual psychological therapies
- South Devon: Outpatient team. This post with either Dr Sam Gothard or Dr Femi Akerele is based in Dartington and provides special experience in the community assessment and treatment of eating disorders with regular eating disorder pathway meetings. Other pathway meetings occur throughout the week including those for primary mental health, therapeutic work and urgent care. The latter is the forum for discussing high risk cases and possible Tier 4 admissions. There is also the possibility of being part of the family therapy clinic.
- East Cornwall: Out-patient team. This post with Dr Mark Woodgate is based in Liskeard and East Cornwall working across the 0-18 age range with an ethos of multi-disciplinary working. There are opportunities to work with early intervention in psychosis and learning disability Teams. Dr Woodgate is part of the East Cornwall CAMHS eating disorders service (based on the Maudsley Systemic Family Therapy model) with the opportunity for experience in this area. Trainees can gain experience working alongside the Nurse Prescriber led ADHD service. Caseloads can be adapted to suit the training needs of the trainee. There are opportunities for audit and management experience.
Professor Tamsin Ford based at the University of Exeter Medical School (UEMS), is the research co-ordinator for the programme. She welcomes contact from trainees to help develop their research interests. She has a number of national studies which trainees can join. She can also help trainees develop their own projects, and advise on where to turn for appropriate research supervision.
During the first year of CAMHS training, trainees are expected to complete a literature review as defined in the curriculum.
The College website is a useful source of information.
The new curriculum is also available on the site. This sets out the competencies and standards for training. CAPFECC, the Child and Adolescent Psychiatry Faculty Education and Curriculum Committee, has overseen the development of the specialty curriculum.
The South West Division of the College (SWDT) is useful to know about and runs a number of relevant training courses throughout the year such as Section 12 courses, CV and interview skills, risk assessment, transition to being a consultant, writing court reports and workshops on clinical topics. The contact is Abigail Watts.
Section 12(2) Approval under the Mental Health Act
This is administered regionally, by Mrs Hilary Eagles, Section 12(2) Manager South West Region. In addition to being section 12 approved you now also need to be an approved clinician to practice as a consultant child and adolescent psychiatrist.
Special Interest Sessions
These can be arranged for a session per week after the completion of the research competence. Sessions will vary with the placement and may include time with the Youth Offending Team, in substance misuse, in an early onset psychosis service, or undertaking an additional training in family therapy, for example.
Specialty Training Committee
There is a Speciality Training Committee for all trainers and trainees which meets on Fridays every 3 months, of which you are a member. This meeting provides a forum for discussing changes to the scheme, providing opportunities for presenting cases or research and also for keeping up to date with educational developments, courses and conferences and the group of trainees and trainers.
It is a condition of placement approval that you should receive an hour of supervision every week from your supervisor. Obviously there may be times, e.g. during leave periods, when there might have to be arrangements for you to receive supervision from another consultant. If you do not think you are receiving sufficient supervision this should be raised with the TPD.
There is a study leave allowance of 30 days per year (to include the 15 days for the academic programme) and a training budget of approximately £550 is available. Consideration can be given to funding requirements which are greater than this. In addition there are a number of locally available courses with reduced fees for trainees.
There are various local training courses, including a Foundation Course in Family Therapy, run jointly by Plymouth Psychotherapy Services, Plymouth University Clinical Psychology Teaching Unit and CAMHS.
In addition the Professional Skills Course, currently highly regarded by trainees and free of charge, runs over 5 days and includes modules on leadership, innovation and quality improvement.
Applications for study leave should be discussed with your educational supervisor in the first instance, and there are Trust specific forms for applying for leave. The E Portfolio has a section to document the courses you have attended during your training.
The department in Plymouth has an active teaching programme. Medical students from the Peninsula College of Medicine and Dentistry (soon to be disaggregated so that students in year 3 will all be from Plymouth) are taught at various stages of their training. This includes year 1 observational placements, year 3 placements during the Worrying Child Week, Special Study Units (SSUs), year 5 placement blocks, and electives. You will be encouraged to deliver and to organise some teaching and you could also get involved in other aspects of medical school teaching such as clinical skills assessments.
There are opportunities in all posts to teach on the regional MRCPsych course, and to trainees of different disciplines, particularly paediatricians, GPs and emergency medicine trainees. You may have the opportunity of supervising a core trainee (in post 2) or foundation doctor (in post 3) and contributing to induction teaching for the core trainees and vocational training scheme (VTS) doctors. You may also like to get involved with the many opportunities for multi-professional teaching especially at the Terraces CDP placement (post 2).
You can help coordinate the journal club/grand round on a Wednesday morning for the wider postgraduate community of psychiatrists attached to Plymouth Community Healthcare, arrange taster days for foundation doctors, and participate in careers events at either medical school.
The curriculum spells out the expected competencies in various therapeutic modalities.
It is worth looking on the Peninsula Medical School website, particularly the Postgraduate Studies at the Peninsula College of Medicine & Dentistry, the Plymouth University website, and the Exeter University website for courses on CBT, individual and family therapy.
A tripartite meeting is a three-way meeting between the TPD, educational supervisor and trainee to ensure that there is a triangulated review at the beginning, middle and end of each placement. These meetings are minuted by the trainee.
Work Place Based Assessments (WPBAs)
The College-based on line system has worked well, and will continue in use. You are responsible for ensuring that your portfolio contains an appropriate spread of WPBAs aligned with competencies. Please discuss this in supervision with your consultant to ensure that these are undertaken at appropriate points in your training and remind your supervisor if there are assessments which need approval.
All educational supervisors who take on new trainees will have been trained in the use of workplace based assessments.
Please see the School Structure page for Head of School, Training Programme Director, College Tutor and School Management contact details.