Changes in psychiatric education

I have read with interest recent publications regarding the proposed changes in psychiatric education (Brown et al, Psychiatric Bulletin, June 2005, 29, 228–230; Royal College of Psychiatrists, 2005) and have wondered where psychotherapy training, as part of basic specialist training, will fit in. Currently, the recommended requirements (Royal College of Psychiatrists, 2003) are very difficult to achieve. Senior house officer (SHO) rotations have expanded in recent years and there are limited resources in many psychotherapy departments, especially for psychodynamic psychotherapy; therefore finding appropriate patients and supervisors is a problem.

In Nottingham, all SHOs attend an introductory course in psychotherapy, most have the opportunity to join a case discussion group and great steps are being taken to improve access to cases. It is hoped that consultant psychiatrists and other mental health professionals, with adequate training and supervision, may be encouraged to supervise SHOs taking on appropriate cases within the community mental health teams. At present, the training requirements are not mandatory and are easily overlooked by SHOs, who either lack awareness of the recommendations, have limited access to training or who are dealing with the pressures of the current MRCPsych exams.

With the envisaged modular/workplace-based assessment equivalent to the MRCPsych, perhaps psychotherapy training will become more fully integrated into the system. Surely, experience in psychotherapy, psychodynamic and cognitive-behavioural therapy should be an essential part of training, to help develop listening skills, to better understand our patients and the roots of their problems and to encourage us to manage patients using the biopsychosocial model to the full.