Psychiatry

Psychiatry is a large, diverse specialty. Psychiatrists work in hospitals, community clinics, care homes, prisons, schools, people’s homes etc. There are currently about 4,000 consultant psychiatrists (an increase of about 25 per cent in six years). Numbers are expected to rise further due to population ageing, increasing emphasis on reducing crime by treating substance abuse and mental illness in prisoners, and changes to mental health legislation.

Training pathway

Significant changes are being made to the structure of postgraduate medical education currently. It is likely that postgraduate training in psychiatry will be of six years’ duration, following the new foundation years. Assessments will be modular and often workplace-based (WPBA) and will be taken when the candidate chooses.

Key skills and aptitudes

Ability to communicate is key in diagnosing (and treating) psychiatric illness and in working with staff and patients from a variety of backgrounds. Teamwork is increasingly important – psychiatrists work with nurses, pharmacists, occupational therapists, social workers etc. An ability to cope with uncertainty is useful – human nature, the basis of work in psychiatry, can be unpredictable. Self-awareness and self-monitoring is vital in an area where emotions can run high but patients’ interests should be paramount. ‘If you can keep your head when all about you are losing theirs…’

Training posts and competition

Junior doctors rotate through different psychiatric specialties every six or twelve months. The work is similar to responsibilities in other disciplines (assessing new patients, outpatient clinics, ward rounds, reviewing inpatients, team meetings) but in psychiatry you have more time with patients and can provide more continuous long-term care after discharge. There are many training schemes throughout the country, some very competitive to get onto, but in general there is a shortage of psychiatrists.

Best and worst

The great reward is working with people (but this can be a disadvantage as some may be difficult to deal with!). Understanding mental symptoms and illness is a practical and intellectual challenge and there is great research potential. Teaching and supervision are excellent (one-toone with consultant; an hour of protected time weekly in addition to regular clinical training; protected time to attend weekly teaching course). New rotas and nursing teams doing initial assessments make on-call more pleasant.

Specialties and subspecialties

There are nine main specialties in psychiatry: general adult, old age, child and adolescent, forensic, learning disability, psychotherapy, addictions, liaison and rehabilitation. Emerging subspecialties include perinatal psychiatry (dealing with mental illness in pregnancy and postnatally) and neuropsychiatry (mental illness due to brain injury and neurological illnesses).

Key information resources

• Royal College of Psychiatrists
• Information on psychiatry – Cochrane Collaboration, Trick Cyclists
• Information about MRCPsych exams – Superego Cafe 

Dr Rory O'Shea MB BCh MRCPsych is specialist registrar in psychiatry at Queen Elizabeth Hospital, King's Lynn and former chair of the collegiate trainees’ committee of the Royal College of Psychiatrists.