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HENW (North Western) MRCPsych Course

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Title: HENW (North Western) MRCPsych Course


1
HENW (North Western) MRCPsych Course Theory to
Practice
Dr Latha Hackett Course Director NW School of
Psychiatry Email latha.hackett_at_cmft.nhs.uk
Sam Abbott Medical Education Manager NW School
of Psychiatry Email sam.abbott_at_mhsc.nhs.uk
2
Background
  • The process
  • The course Academic programme, LEPP
  • Training of Educational Supervisor
  • Evaluation
  • Challenges
  • Future plans

3
Health Education North West
  • Brought together two former Deaneries, North
    Western Mersey
  • Oversees postgraduate medical education
    training with responsibility for over 7,000
    trainees
  • Process of aligning activity
  • Currently still two Schools of Psychiatry
  • Psychiatry trainees in the NW - 120 Core
    trainees, similar No of HST

4
The NW School of Psychiatry
5
Background to MRCPsych Course
  • Historically delivered via Manchester University
  • 30 day MRCPsych course
  • Delivered over 2 year period
  • Has been running for more than three decades
  • In the last three years the course moved towards
    blended learning, distant learning, face to face
    and periods of private study
  • Summer 2013 - 3,500 per trainee per year, due
    to increase for 2014...
  • Termination of contract by the Deanery in 2013
  • Point of no return, hence opportunity for a new
    NHS developed and locally delivered programme

6
From September 2014
  • No University run course for CT1s
  • CT2 trainees to continue on the University
    course. Last cohort completed in the of summer
    2015
  • No extra money
  • NHS had to provide the training
  • New NHS run course for CT1 had to start September
    2014

7
Setting up the Course
  • Commenced in Post 1.4.14 - 1 day a week
    secondment
  • Studied core curriculum, examination, Wessex NHS
    run course, Mersey University course Manchester
    University course - April 2014
  • Phase 1 completed by July 2014
  • Phase 2 commenced September 2014

8
Consultation May June 2014
  • CT/STs currently on the course or who had
    recently completed the University MRCPsych
  • Site tutors as a group, some individually, School
    Operational Board, DMEs across the patch of 9
    Trusts
  • MHSC, GMW, Pennine Care, Lancashire Care,
    Cumbria, CMFT, 5BP, Macclesfield and Calderstones
  • One half day (tutors/CTPD) and 1 full day
    (included all interested parties)

9
Consultation Findings
  • Considerable variations in training provided by
    different LEPs
  • Some really excellent models of training e.g. 555
    presentation
  • In some LEPs there was variation between own
    sites
  • Psychotherapy training - Met the College
    requirement 30 sessions of Balint group, one long
    case and one short case in two different
    modalities. Again delivery varied across LEPs
  • No consistency parity in training
  • Though every body was keen trying their best
    and there was a lot of enthusiasm for training on
    all sites

10
Disconnection Variation
  • Between
  • Learning in the Placement
  • Educational Supervisor supervision
  • LEP Programme
  • University run course
  • Psychotherapy
  • MRCPsych examination

11
Outcome
  • Curriculum Development
  • Subgroup established in June 2014
    (recommendation, major educational role)
  • LEP Programme/Handbooks/Website operational by
    August 2014
  • Delivery
  • LEP programme to commence September 2014
  • Academic course to commence September 2014 for
    CT1
  • Evaluation

12
New Course Principles
  • Psychiatrists are medically qualified doctors
    with a specialism in Psychiatry
  • Adult learning principles
  • Achievement of core skills for core trainees
  • Training close to patients, learning from
    patients, learning from ES, in MDT, in the LEP
    Programme
  • What cannot be done locally in placements done
    centrally e.g. academic day, exam preparation
  • Good practice on sites incorporated - 555,
    psychotherapy
  • Training offered on different sites are now
    comparable measurable

13
New Course Aims To
  • Reconnect the four training strands
  • Educational Supervisor supervision
  • LEP run weekly sessions
  • Academic course at the Medical Education, School
    of Psychiatry (replaced the University run
    course)
  • Psychotherapy
  • And link them to
  • MRCPsych examination
  • Achieving
  • Consistency/parity across sites and increase
    depth of knowledge to address differences in
    training provision across LEPs

14
Some Parallels To
  • PBL for Medical students in Manchester
  • Run on different sites with the same PBL format
    with PBL trained Doctors
  • Have handbooks prepared by a committee that PBL
    tutors follow handbook for tutors and handbook
    for students
  • Students do have some lectures centrally e.g.
    statistics during their Project Option etc etc
  • Discussion with Manchester Medical School lead
    for PBL re how the University reviewed its PBL
    teaching

15
Module Leads Site Leads
  • General Adult Dr Brijesh Desai, Lancs Care
    recommended by TPD
  • Old Age Dr Gareth Thomas, Lancs Care, MEF,
    recommended by TPD
  • Child Adolescent Psychiatry Dr Neelo Aslam,
    CMFT (TPD)
  • Intellectual Disability Dr Nasim Chaudhry, GMW,
    Dr Sol Mustafa Pennine recommended by DMEs
  • Forensic Drs Vicky Sullivan Hany El-Metaal,
    GMW by STP
  • Substance Misuse Dr Patrick Horgan, GMW - by
    STP Psychotherapy Dr Adam Dierckx, MMHSC, by STP
  • GMW Dr Raghu Paranthaman
  • Pennine Care Dr N Fernando MHSC- Dr Adam
    Dierckx
  • Lancashire Care Drs Brijesh Desai/Gareth Thomas
  • Cumbria - Dr Andrew Morgan, Tutor
  • 5BP Dr Joe Johnson, Tutor
  • Acute Trusts - trainees based in acute Trusts
    (CAMHS) tend to join local mental health trusts

16
Supported by
  • School of Psychiatry Postgraduate Collaborative
    managed by Samantha Abbott
  • With the enormous help of administrators, Janene
    Chesters, Laura Griffiths and Angela McMahon
  • Operational Group meets 2-4 times a year
  • 2014 - July 14, August 14, October 14
  • 2015 January 2015, July 2015,
  • 2016 - January 2016

17
(No Transcript)
18
Theory to Practice
Educational Supervisor/ Supervision - weekly an
hour
Local Educational Provider (LEP) (44) 30
sessions a year
Academic Programme Ct1-12 days Ct2 12 days
Psychological modalities 30 Balint gps Long
case Short case in 2 diff modalities
Attain core competencies MRCPsych Exam
(Progress Test Written Clinical)
19
North Western Course ESLEPPsychotherapyAcadem
ic programme Exam Practice
  • Local Education Provider Programme LEPP
  • Every LEP was providing weekly Journal club and
    case presentations (44 sessions annually)
  • Many were already providing, weekly, half day
    sessions for the whole year
  • The main difference from the old course was to
    strengthen this bit of the training
  • We recommended that all LEPs provide mandatory
    15, half day sessions every six months with the
    content recommended

20
North Western MRCPsych Course
  • LEP programme
  • Modular, two year rolling - 4 x 6 months
  • Each 6 month block has 15 half day sessions
  • Each block has General Adult, Old Age,
    Specialties CAP, ID, Substance Misuse,
    Forensic, one across ages
  • LEPs had to meet, FY,GP, CT training needs
  • Psychological modalities 30 (25) sessions of
    Balint group, one long case and one short case in
    two different modalities preparation of
    trainees for providing therapy
  • Academic Programme (2 years) 12 days a year
    for CT1 and 12 days a year for CT2 and no
    programme for CT3

21
North Western Course
  • Supported centrally from the School of
    Psychiatry, Module Leads and Course Director,
    producing
  • Handbooks for GA for 6 months, OA, CAP, ID,
    Forensic, Substance Misuse completed August
    2014
  • Trainee and ES handbook
  • Dedicated password protected on-line materials
  • Journal papers sent out 2-4 weeks in advance
  • Expert Led Sessions Prepared lectures were
    available
  • Feedback Reflective notes

22
SchoolofPsychiatry.net
23
August February annually
  • Induction
  • Communication skills training verbal, non
    verbal and written skills
  • Once the Academic programme and LEP programme is
    established we will jointly look at
    Communication skills training to share good
    practice achieve best practice

24
63 CT1/2 on the course to date
Trust Attending LEP Sessions at
5BP Leigh
Calderstones Preston
Central Manchester University Hospital Trainees join GMW MMHSCT sessions
Cumbria Carlisle
Greater Manchester West Prestwich (GMW)
Lancashire Care Blackburn Blackpool Preston
Manchester Mental Health Social Care Trust NMGH (MMHSCT)
Pennine Care Bury Rochdale Oldham Tameside Stockport
25
September/March- Programme starts LEP
academic programme
  • Local Education Provider Programme commenced
    with the same modules across all areas
  • Mandatory 15 half days (4 hours)
  • Clear guidance on what must be covered during the
    6 months
  • Modules could be delivered in any order as long
    as all were covered during that 6 month period
  • LEP still has 7 sessions available to cover
    topics of their choice e.g. audit/communication
    skills etc etc
  • Open to all trainees in psychiatry FY, GP,
    CT1-3
  • FYs/GPs can do joint presentations with CTs

26
LEP Component
  • General Adult 6 (7) sessions
  • Old Age - 2 sessions
  • Child and Adolescent 2 sessions
  • Intellectual Disability 1 session
  • Forensic 1 session
  • Substance Misuse 1 session
  • Every 6 months a theme across ages e.g.
    Psychosis across the ages
  • 2 hours on MCQs, exam practice etc during the
    whole 6 months
  • Total 15 sessions of 4 hours each every 6 months
  • Total LEP (2 years) - 60 sessions in 24 months
    25-GA, 8 OA, 8 CAP, 4 ID, 4-Foren, 4 Substance
    misuse, 3 to Psychotherapy. 4 sessions themed
    across ages e.g.. Psychosis, Depression, eating
    disorder, Mental Illness in the family

Centrally developed handbook for LEP advice on
Journal club papers, Clear learning outcomes,
Link with Competencies (ILO), Cases for case
presentation and ES handbook Centrally developed
handbook for LEP advice on Journal club papers,
Clear learning outcomes, Link with Competencies
(ILO), Cases for case presentation and ES handbook
27
Topics for LEP Programme
  • General adult topics - Topics for LEP GA (25
    sessions) Psychosis (4 sessions), Depression (4
    sessions), Bipolar 4, Personality disorder 3,
    Anxiety disorders/GAD/Phobic/Panic -2,
  • Suicide and self harm 2, MHA/MCA, PTSD
  • Organic, General Hospital, OCD 1 each
  • Papers, RCT, Meta-analysis/Systematic review,
    Economic study, Genetics
  • Old age (8) Assessment, Alzheimers dis, Other
    Neurodegenerative disor, Delirium, Mood
    disorders, Psychosis, anxiety disorders,
    Medico-legal aspects
  • CAP (8) Assessment, ADHD, ASD,
    Anxiety/Depression, Attachment disorder, eating
    disorders, ID in CAP, Legal aspects

28
Topics for LEP Programme - 2
  • Psychotherapy 3 Psychotherapy services etc,
    Emotionally unstable personality disorder, 1 more
  • ID (4) Assessment, Mental disorders, Behavioural
    issues, Offenders
  • Forensic (4) Psychiatry and CJS, Link bet Crime
    and mental disorder 1 2, Psychiatry in court
  • Substance Misuse (4) Diag and treat of Alcohol
    problems, D T problems with substance misuse
    other than alcohol, D T of dual diagnosis,
    Recovery concepts, psychosocial treatments and
    service developments
  • Across the ages 4 sessions. Psychosis across
    the ages, Depression, eating disorders, mental
    illness and Family/Carers

29
MRCPsych Academic Modules
  • Covers aspects that cannot be covered in the LEP
    course or in Placement
  • 12 days a year X 2 year course
  • 6 September-January 2015 6 days
  • 6 Feb- July 2015 6 days
  • September December 2015 6 days
  • March-June 2016 6 days
  • Run at the School of Psychiatry on Thursdays
  • Exam syllabus to follow

30
Academic course 2014-2016
  • First 6 months
  • 2 days in September, October November ( 6 days)
  • Topics covered Introduction to the MRCPsych
    including the new exams, Classification, Critical
    appraisal, Philosophy of psychiatry 1 day
  • Basic Psychology, Neurosciences 1 day each
  • Human development 1 day
  • Psychopharmacology 2 days
  • Every session they had MCQs

31
Academic course cont
  • II six months
  • Feb-July 2015 4 days for Psychotherapy, 1 day
    each for GA and OA
  • III six months
  • September 2015-Jan 2016 2 GA , 2 OA (Physical
    health), 1 stats research methodology, 1 each
    for Neuropsych
  • IV six months
  • March July 2016 , 1 GA, CAP, ID, Foren, Sub
    misuse 1 for exam
  • Total for 24 months 24 days
  • Run as seminars/Workshop, a few lectures
  • Consultant CPD Consultants welcome to attend

32
Typical Academic Day Programme
930 Expert session - Anorexia Nervosa
1100 Coffee
1115 Expert session - Bulimia Nervosa other eating disorders
1215 Lunch
1300 Group work through 3 x 30 minute case vignettes Each case 15 minute group work then 15 minute discussion. Examples include assessment and treatment of complications, medicolegal frameworks for urgent treatment, strategies for relapse prevention)
1500 Coffee
15.15 MCQ workshop
33
Exam Preparation
  • Every LEP session trainees have MCQ/EMI practice
  • Every academic programme MCQs
  • 3 hours exam Written practice every year (July
    2015)
  • Yearly Progress Test 11/12/15/16 June 2015
  • Sat by ALL CT Trainees

34
Exam Feedback to Trainees
35
Educational Supervisors
  • Pivotal in training of trainees, hence have to
    be well supported
  • Know the curriculum and know what the exam is
    about
  • Clear about competencies and training
    requirements of core trainees in their placement
  • Educational supervision to achieve consistency
    across the region - clinical and educational
    supervisor
  • ES being able to link the trainees learning
    LEP, MRCPsych, Psychotherapy etc in educational
    supervision
  • Points for us to consider how we do this in
    LEPs, across LEPs by pooling of resources across
    LEPs, this will start this Summer

36
Feedback
  • Weekly feedback from LEP programme
  • Feedback from the Academic Teaching Programme
    after each session
  • Generally extremely positive
  • Few recommendations
  • Some cancellations
  • 3 slots cancelled 1 JC on one site, 2 555
    (all 3 different sites) (Sites are 5113 11
    sites (2))

37
Academic Day Feedback
How would you Rate these Sessions?
Did they meet your expectations?
38
Encouraged Trainees to Prepare
39
Sessions were Lively Stimulating
40
Trainee Feedback
Exam focussed this is how these sessions
SHOULD be!!!
Activities related to exams and ARCP
has encouraged me to read more
Fascinating!
has sparked an interest!
Very stimulating discussions by speakers
interested in the topic themselves
MCQ enough time was given for us to discuss in
groups
The entire session was made simple and kept me
interested
there was a lot relevant to exams
41
LEP Programme
  • Greater Manchester West LEP Experience
  • Raghu Paranthaman
  • MRCPsych Tutor
  • GMW NHS Trust

42
Overview
  • Background
  • Setting up of course
  • Practical aspects of running the course
  • Feedback for the first year

43
MRCPsych - Theory to Practice
Educational Supervisor/ Supervised training
weekly an hour
Psychological modalities 30 Balint gps Long
case Short case in 2 diff modalities
Local Educational Provider (LEP) 30 sessions a
year 4 hours each
Academic Programme Ct1-12 days Ct2 12 days
MRCPsych Exam(MCQ practice, Progress test)
Slide coutresy of Dr. Latha Hackett
44
Local Educational Programme(Trust )
  • Two year rolling modular programme - 4 x6 months
    block
  • Same modules across all trusts in the region
  • Minimum of 15 half days every 6 months
  • Each block will have General Adult, Old age,
    Specialties CAMHS, LD, Substance misuse,
    Forensic

45
GMW NHS Trust
  • Provides mental health services to Bolton,
    Salford and Trafford residents in Greater
    Manchester
  • Provides a number of specialist (substance
    misuse, adolescent inpatient, forensic) services
    for a wider geographical area
  • Trainees are mainly based in 4 sites

46
Trainees in GMW
CT GPST ST FY
Salford 9 2 8 6
Bolton 6 2 3 6
Trafford 7 1 2 4
Prestwich 10 0 7 0
Total 32 5 20 14
47
Setting up of Course
  • Lead appointed - June14
  • Support from Lynda Hurst, Medical Education
    Manager
  • Meeting with tutors-variability in teaching
    across sites, feasibility of delivering 4 hour
    programme in each site
  • Attendance in directorate consultant meetings
  • Centralised Programme set up (start from
    Sep14)-race against time!
  • Support from a higher and a core trainee from
    second semester

48
GMW MRCPsych Programme
  • Started Sep14
  • Two semesters have been completed
  • Initially only for trainees in the 3
    districts(Bolton, Salford Trafford)
  • Trainees in specialist placements joined in
    Feb15
  • One centralised teaching for all junior doctors
    in our trust

49
MRCPsych Teaching
  • Wednesday afternoons (1PM till 4.30 PM) Trust
    HQ, Prestwich site
  • Protected teaching time for all trainees
  • Light sandwich lunch provided
  • Course has evolved
  • Expanded from 15 sessions to 20 sessions per
    semester
  • CASC training and audit presentations- successful
    with excellent feedback
  • Sessions have been made shorter with more breaks

50
MRCPsych Teaching
  • 20 weeks from March to July and September to
    January
  • Each week will have a theme , eg Depression
  • First 15 weeks
  • Part of school of Psychiatry MRCPsych course
  • 70 attendance mandatory for Psychiatry CT1s and
    CT2s
  • Last 5 weeks
  • Extra Forensic CAMHS sessions, CASC training
    Audit presentations

51
Example Programme Depression

1300 1345 Depression
1400 1445 Case presentation
1500 1515 555 presentation (on a depression topic eg psychological therapies)
1515 1615 Expert led session(on a depression topic eg Treatment of depression)
1615 1630 MCQ
52
Slot Allocations
  • All CTs do at least 1 presentation
  • Extra slots allocated to CT1s/CT2s and then
    CT3s
  • No trainee does more than 2 presentations
  • Trainees do case conference in the speciality
    they are working in. Same for journal clubs as
    far as possible.
  •  Other trainees(FY doctors, GP trainees and BBT)
    are not allocated slots
  • All STs chair a session

53
MRCPsych teaching
  • College(Site) tutors act as co-ordinating
    tutors for 5 sessions each every 6 months (4
    tutors x 5 sessions 20)
  • Agreement reached with the Consultant body that
    each consultant would aim to attend a minimum of
    4 MRCPsych teaching sessions every year
  • Consultants deliver all the Expert led sessions

54
Teaching
  • There are guidelines for case conferences,
    journal clubs and chairing sessions
  • All the information is embedded in a word
    document- journal papers , 555 topics, guidelines

55
Attendance- Second Semester
  • Average- 32 per session
  • Range - 22 to 43
  • Consultants- 8 per session

56
Feedback- First Semester
  • Were the overall aims and objectives for the day
    met?
  • N172

57
Feedback- Second Semester
  • How would you rate this training session overall?

58
Feedback Free text comments
  • Well organised and I have really learned a lot
  • Really useful and thought provoking
  • Interesting, Interactive, Concise, Crisp
  • Excellent Excellent session
  • Range of topics covered

59
Challenges
  • Venue
  • Cancellations- affects training of all trainees
  • IT issues
  • Lunch/range of refreshments provided
  • Local teaching(in each district) missed by some

60
Formal Evaluation
  • Focus groups of trainees (GT DM)
  • Feed back from Tutors, ES, Consultants of the day
    Spring/Summer
  • Advice obtained from Education Psychologist and
    Senior Lecturer in EP at Manchester University

61
The Challenges - 2014
  • There were a few sleepless nights.
  • Main challenge was fear of change and
    uncertainty, we get good feedback from
    trainees, what we do is very good, why should we
    change?
  • For me - having a Belief, to Listen, Develop,
    Change Support convince people it will work
  • Some rather difficult views, thankfully in the
    minority
  • The very tight timescale April to July 2014 to
    organise, convince providers and deliver

62
Positives
  • All trainees access same teaching regardless of
    Trust.
  • Expert resources pooled across the NW
  • Holding one event rather than 3 in some trusts
    saves time and money
  • Consultants across the NW contributed to the
    development/delivery not just a few academics at
    the University
  • closer links to the exam
  • ESs feel more connected to the MRCPsych training
  • Presentations are much closer linked to the
    curriculum/exams/syllabus than the University
    course which often felt detached as commented
    by a university course trainee

63
Positives cont
  • ESs feel more connected to the MRCPsych training
  • Presentations are much closer linked to the
    curriculum/exams/syllabus - University course
    often felt detached as commented by a
    university course trainee
  • School much more involved with trainee
    development/progress - therefore rapid access to
    TPD/HoS or Trusts when required to resolve issues
    - health issues, excessive on call etc, patterns
    emerge

64
Challenges
  • Trainees feedback - Being on call and missing
    some of these sessions want these sessions to
    be protected as this is their study leave
  • MCQs not being done in LEPP routinely
  • General adult LEP 24 sessions over two years.
    To do the expert led sessions on time, though we
    have got better at this. Agreeing to do it and
    not arriving on time
  • Academic programme Psychosexual and eating
    disorders
  • Some speakers wanting to be paid
  • Across the ages topics need re-thinking
  • More admin time was funded in year two, still not
    enough
  • Up keep of the website
  • Feedback forms had to be re-designed
  • Small number of trainees in some sites
  • Not all expertise available in some sites e.g.
    forensic
  • New challenges that need to be looked at e.g.
    Communication workshops etc
  • Working together will really help these
    challenges

65
Comments from a DME
  • Trainees say meets educational needs better
  • Trainees spend more time in the clinical
    placement learning on the job!
  • Teaching more organised and planned
  • Excellent resources available on the school
    website
  • We learn from each other

66
Comment from a Consultant
  • Good CPD, Id Forgotten most of what I thought I
    should have known, good to go back, read up and
    update

67
The next 12 months...
  • Re-Visit med ed committees, Meet ESs, observe
    LEPP
  • Progress test both Written and Clinical exam
    annually before RCPsyc exam
  • Review Communication skills/Simulation training
    in placements Started August 2015
  • Training the ES in curriculum and examination (on
    line module under preparation) and CASC level
    training
  • CT1and CT2 course is running from September 2015
  • Review the whole course again in Spring 2016
    Consultation with all Trainees, Educational
    supervisors, Tutors, TPDs, DME
  • Format will remain same but up to date journal
    clubs etc

68
The next 12 months...
  • Quality Assure
  • To link with the TrOn trainee online (RCPsych)
    -Trainees can evidence for Portfolio
    Triangulation, FY do it
  • Communication/Simulation training look at the
    practice across the patch and provide guidance on
    good practice
  • MRCPsych website
  • On line lectures, links to guidelines, news
    letters
  • Regional training day for all, every two years.
    Updates on every branch of Psychiatry
    Local/National/International speakers, hosted by
    the NW School of Psychiatry ...American
    Congress- North of England Psychiatry Congress
  • NW School of Psychiatry Debates Maudsley style
    debates two or three times a year
  • In conjunction with the Medical School, Royal
    College of Psychiatrists, School of Psychiatry
    etc

69
Quote
  • Change is hard at first,
  • Messy in the middle
  • And
  • Gorgeous in the end Robin Sharma

70
My experience
  • Human beings, generally are not made for change
  • But.
  • Most of us can be Persuaded
  • Some of us are Malleable
  • A few of us, have to be worked around

71
Acknowledgements
  • Wessex School of Psychiatry
  • Professor Damien Longson
  • Samantha Abbott and Team NW School of Psychiatry
  • Subgroup leads, Trust leads, Tutors
  • NW Directors of Medical Education
  • New Consultants, especially Dr Gareth Thomas
    Dr Neelo Aslam Dr Brijesh Desai
  • Trainees, especially Drs Alex Petcu, Rachel
    Thomasson, Ngozi Atulomah, Sally Makin, STs in
    CAP
  • Steve Glover, CMFT Librarian

72
Webshots
73
Tutor Resouces
74
Thank you for your time Any Questions?
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