This webpage aims to provide you with an overview of specialty training in Child and Adolescent Psychiatry (CAP) in the Southwest.
Although we are a relatively small scheme of up to 7 Child and Adolescent Psychiatry higher trainees, the opportunities are still rich and varied. We have a friendly and approachable team of consultant trainers in Devon and Cornwall across three mental health trusts. As we have a greater number of placements than trainees, there is scope for flexibility where you train. Furthermore, and maybe more importantly, the Southwest has some of the loveliest landscapes in the country ranging from beautiful sand and surf beaches to temperature rainforests in Dartmoor, Bodmin Moor and beyond.
The Child & Adolescent Psychiatry role descriptions can be found below.
Introduction
Dr Ben Parker is the Training Programme Director. Our psychiatric / educational supervisors are Dr Fernanda Garcia Costas (Plymouth), Dr Sarah Huline-Dickens (Plymouth), Dr Jo Godfrey (Plymouth), Dr Oana Mitrofan (Exeter), Dr Rory Conn (Exeter), Dr Sam Gothard (South Devon), Dr Femi Akerele (South Devon), Dr Hermione Roy (West Cornwall), Dr Laura Flaherty (St Austell, Cornwall), Dr Sanjida Sattar (Truro, Cornwall), Dr Hattie Tan (Truro, Cornwall) and Dr Seb Rotheray (East Cornwall).
The Peninsula Postgraduate Medical Education used to have full GMC approval for three National Training Numbers, but this number has increased to 6 or 7 trainees now. We also have additional ACF (Academic Clinical Fellows) who join us. 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 (Livewell Southwest) and another NHS provider (Devon Partnership Trust). Usually, you will be in each placement for a year but some placements may need to be for only 6 months (e.g. in the adolescent in-patient unit - there can be a bit more demand for Plym Bridge House in particular as it is the likely destination in the second year (ST5) for both Plymouth and Devon trainees).
As we currently have more trainers and GMC approved sites than we have CAMHS higher trainees, we endeavour to be responsive to your needs in terms of both education, but also in terms of reducing travel time (particularly if you have medical needs or childcare responsibilities), whilst also trying to do our bit for the environment.
Our scheme comes under Peninsula Postgraduate Medical Education where it is overseen by the School of Psychiatry.
The Academic Programme
Trainees from this training scheme in the Peninsula Deanery join up with the Severn Deanery CAP higher trainees (Bristol, Bath, North Somerset and Gloucestershire) to attend the academic programme. This used to take place in Bristol but now occurs virtually. The teaching is in a three-year rolling programme with oversight at consultant level. The course is on alternate Friday mornings in three 10-week terms per year and usually represents 15 days per year in total. It includes seminars, clinical case presentations, research meetings and outside speakers. It is also an important group for peer learning.
ARCPs
This is the Annual Review of Competence Progression, and is organised via Peninsula Postgraduate Medical Education, information is available on our ARCP Pages.
Audit
Trainees are expected to participate in audit and quality improvement projects in each year of their training.
The Curriculum
The Child and Adolescent ST4-6 curriculum is available on the GMC website.
The Deanery
The Deanery covers Peninsula and Severn regions. It is geographically very large. There are separate Schools of Psychiatry in each of the two ends (the Peninsula end and the Severn end). Each had been led by a different Head of School, but at the time of writing, the post of the Head of School for Peninsula is vacant. The Deanery coordinates the ARCPs and is an important source of information on training matters. It is also served by a Professional Support and Wellbeing unit (PSW) to which you can confidentially refer yourself to if you have any difficulties that you need help with. The PSW has a site on the Deanery webpage which lists the resources available to trainees and what kind of support can be offered.
Portfolio Online
This is an important way of keeping a record of your training. It is recommended that you regularly update your portfolio 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.
It is also important to keep a case log of all the patients that you have seen, also keeping a running total of any emergency / urgent assessments that you have completed.
Management Experience
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, review incidents, and handle complaints. Attendance at LNC meetings is also possible.
You will also be encouraged to take the lead on quality improvement initiatives.
On Call (Plymouth and Devon Trainees)
Plymouth has a dedicated CAMHS on-call rota and not one that is combined with an adult on-call rota. There is not a dedicated CAMHS on-call rota in Cornwall. In Devon the CAMHS on-call rota does not cover a CYP-POS, nor an in-patient unit. Therefore the arrangements for being on-call, at the time of writing, are that, if you are based in Devon or Plymouth, you will join the CAMHS on-call rota for Livewell (in Plymouth). The main reason for this is because the Devon CYP POS is based in Plymouth and this will give you greater access to emergency assessments (through Section 136 presentations). Plymouth also has the adolescent in-patient unit, Plym Bridge House, which provides experience of managing in-patient cases outside of normal working hours. Furthermore, you will need to provide input for emergency out-of-hours cases presenting to Derriford Hospital.
You will join the Plymouth The Plymouth CAMHS on-call rota is a 1 in 7 rota (for a whole-time equivalent post). There will always be a substantive CAMHS consultant psychiatrist on-call with you.
We have an agreement that we are funded for up to three CAP trainees on the Plymouth on-call rota at any one time. Owing to the increased number of CAP NTNs in the Peninsula region, there is greater demand for these places on the on-call rota. We will therefore need to prioritise those trainees who are closer to completing their training, but we aim to have everyone on the on-call rota for at least 2 out of the 3 years at the moment. We recognise that this has a pay implication, so please do let us know if this is particularly problematic.
The RCPsych Psychiatry Silver Guide says that:
‘We recommend that trainees gain experience of emergency CAP, via 55 (indicative) on-call shifts (including ‘out-of-hours’ work); assessing and managing at least 50 cases in this context during the course of their training in CAP’.
Two years on the Plymouth CAMHS on-call rota will meet the requirement for 55 on-call shifts, but spending time in the adolescent in-patient unit at Plym Bridge House can in particular build up the exposure emergency cases through Section 136 presentations to the CYP-Pos.
On Call (Cornwall Trainees)
As the CAMHS on-call rota in Cornwall only covers the in-patient unit (Sowenna) this will not allow enough exposure to managing emergency out-of-hours cases during your training. We would recommend that you therefore also join the adult on-call rota where you will get exposure to both adult and young people with emergency psychiatric presentations. You may also like to join the S12 list to make yourself available for MHA assessments, particularly those involving young people.
Placements
- Exeter: CAMHS Outpatients: this post is based at Evergreen House with Dr Oana Mitrofan as the psychiatric 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. There are plenty of opportunities for gaining experience in working with young people (and their families) with neurodevelopmental conditions and eating disorders (including ARFID). There is also a multidisciplinary complex assessment clinic that runs weekly.
- Exeter: CAMHS Outpatients and Paediatric Liaison: Dr Rory Conn is the psychiatric supervisor. This post is based at Evergreen House and has three principle areas of focus. Firstly, working as part of the Crisis Home Treatment Team (one morning a week), conducting assessments of children and young people admitted to the paediatric estate with self-harm and overdoses. Secondly, providing psychiatric support for young people at risk of admission for Eating Disorders, and those undertaking “refeeding” admissions under paediatrics. Thirdly, caring for young people with perplexing presentations – medically unexplained symptoms, and those at the interface of physical and mental health – for example children with diabetes or gastro problems, with co-morbid mental health difficulties. The trainee will also be timetabled to complete one “Initial Assessment” in our specified MDT CAMHS clinics, per week.
- Plymouth: Plym Bridge House – General Adolescent In-Patient Unit: Plym Bridge House is a purpose-built General Adolescent Unit (GAU) for young people between the ages of 13 and 17. Dr Fernanda Garcia-Costas is the psychiatric supervisor. The unit has 12 beds. Patients tend to have complex psychiatric disorders including eating disorders and emerging personality disorders / Complex PTSD / significant attachment difficulties. On placement you will be responsible for the care of some patients, under supervision from Fernanda, and you will participate in the weekly MDT meeting and other meetings including CPAs and Tribunals. Therapy experience includes community groups, family therapy and individual psychological therapies.
- South Devon: (Dartington): Outpatients: This post, with either Dr Sam Gothard or Dr Femi Akerele acting as psychiatric supervisor, is based in Dartington and provides opportunities for exposure to a wide variety of adolescent psychopathology & multi-disciplinary working. There’ll be opportunities develop particular experience in Eating Disorders, Learning Disabilities and Neurodevelopmental disorders. Trainees will also have access to psychological training & supervision, including CBT, DBT, Family therapy & Trauma Focused CBT. This placement will provide opportunities for leadership & management experience.
- Bodmin: Sowenna - General Adolescent In-Patient Unit: Sowenna, is a purpose built, state of the art inpatient facility. Working under the supervision of Dr Seb Rotheray, you will have the opportunity to lead on the care of some patients and gain skills in inpatient management, with a focus on trauma-informed care. There are a range capabilities to be learnt and then taught and there is plenty of opportunity for MDT working, including but not limited to, working in reflective teams, developing the education programme and gaining individual therapy competencies.
- Plymouth: Revive - Outpatients (Mount Gould Hospital). Dr Ben Parker is the psychiatric supervisor and there are a wide variety of opportunities besides Core CAMHS. These include spending time with the Neurodevelopmental Pathway, the Severe Learning Disabilities team, DBT, CBT, Family Therapy, Art Therapy, Child Psychotherapy, Children in Care Team, CAMHS Eating Disorder Pathway, and Infant Mental Health. Dr Ben Parker works specifically with the CAMHS Liaison, CAMHS Crisis Pathway, CAMHS Home Treatment Team, CAMHS Early Intervention in Psychosis Pathway and I-TASC (specialist pathway working with families with developmental trauma) and a post working just within some or all of these teams can be created, depending on the needs of your training.
- Plymouth:The Terraces – Neurodiversity Pathway - Outpatients (Mount Gould Hospital): Dr Jo Godfrey and Dr Sarah Huline-Dickens are the psychiatric supervisors in the CAMHS Neurodiversity Pathway. You will have the opportunity to work with patients with neurodiversity requiring psychiatric input, but you will also be able to learn about the assessment of young people with autism and ADHD.
- Penwith: Community CAMHS: This post is based in Penzance at Bolitho House with Dr Hermione Roy as the psychiatric supervisor. It is a friendly team who enjoy MDT working. The caseload can be adjusted to the needs of the trainee and there are opportunities in gaining experience in family therapy as well as other therapeutic approaches. Neurodevelopmental assessment occurs within the team and extra experience of complex neurodevelopmental assessment and intellectual disability can be gained, if desired, by short term mini placements with local specialist teams. The service is currently making steps to improve participation and nature-based interventions.
- Truro: Cornwall Neurodevelopmental Assessment Team (Countywide Specialist CAMHS): This post is based in Truro at Trevissome Park with Dr Sanjida Sattar as the supervising Consultant Psychiatrist. It is a large but friendly team, and all assessments are done with a minimum of two clinicians of differing disciplines, promoting MDT working. Assessments across of range of neurodevelopmental conditions occurs within the team including ASD, ADHD, FASD, ID, DCD, DLD and Tic disorders, alongside other co-morbid conditions. As a countywide service, although the main base is Trevissome, there are regular satellite clinics in Hayle, Saltash. Assessments are also done in education settings as well. The service has a CPD half day once every 2 months and is active in quality improvement.
Research
Dr Tamsin Newlove-Delgado based at the University of Exeter Medical School (UEMS), has a research interest. She welcomes contact from trainees to help develop their research interests. She is involved in 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 Royal College Of Psychiatrists
The College website is a useful source of information.
The new curriculum is also available on the site. This sets out the capabilities and standards for training. CAPSAC, the Child and Adolescent Psychiatry Specialty Advisory 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. It is based at Coombe Lodge, Blagdon, Bristol BS40 7RE and the telephone number is 01761 463979.
Section 12(2) Approval under the Mental Health Act
This is administered regionally by the Section 12 and AC Approvals Office, Winterhead Ltd (office@winterhead.co.uk) . In addition to being Section 12 Approved, you 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, following completion of the research project. Sessions will vary with the placement and may include time with the Youth Offending Team, the Forensic CAMHS team, in Substance Misuse, Learning Disabilities, Infant Mental Health or undertaking a additional training in family therapy, for example.
Specialty Training Committee
There is a Specialty Training Committee for all trainers and trainees which meets every 3 months. We alternate between meetings just for the trainees and then meetings for both trainees and trainers. 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.
Study Leave
There is a study leave allowance of 30 days per year (per whole time equivalent). This is inclusive of the days for the academic programme (usually 13-15 days are needed for this). A training budget is available and study leave budgets are now held by the Deanery, although you should apply for study leave from your employing Trust. The Peninsula Deanery have published a fairly wide list of mandatory trainings (that are funded) and non-mandatory trainings (that trainees have to self-fund). 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 psychiatric supervisor in the first instance, and there are Trust specific forms for applying for leave. The Portfolio Online has a section to document the courses you have attended during your training.
Teaching
There are opportunities in all posts to teach medical students, 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 or foundation doctor and contributing to induction teaching for the core trainees and vocational training scheme (VTS) doctors.
Therapy Training
The curriculum describes the expected capabilities 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.
Work Place Based Assessments (WPBAs)
The College-based online system (Portfolio Online) has generally worked well, and continues to be used. You are responsible for ensuring that your portfolio contains an appropriate spread of WPBAs aligned with competencies. Please discuss this in supervision with your psychiatric supervisor to ensure that these are undertaken at appropriate points in your training and remind your supervisor if there are assessments which need approval.
Psychiatric Supervision / Educational Supervision
You will have access to weekly psychiatric supervision with a consultant psychiatrist who is registered as a trainer in each placement. You will also be allocated to an educational supervisor at the start of your higher training, and it is expected that you will meet with your educational supervisor 4 to 6 times a year. Your educational supervisor will remain allocated to you throughout your higher training and the intention is that they can have greater oversight of your progress in training and your future career development.