Mohammed T. Abou-Saleh

792 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYcolleagues, patients and relatives/carers, basic psychiatric knowledgeand appropriate knowledge of general medicine.By the time the trainee is ready to move into higher training, he/she will have completed a minimum of 3 years in approvedtraining placements and will hold the MRCPsych 9 . He/she willalso have some idea of his/her eventual career intentions. Generalpsychiatry and old age psychiatry Specialist Registrar posts maybe advertised separately, but trainees may opt to undertaketraining jointly in both specialties (see below).Higher Specialist TrainingHigher training aims to provide an educational programme toprepare a trainee for independent practice in old age psychiatry.The number of higher trainees is determined by the number ofnational training numbers (NTNs) and this is fixed centrally bythe NHS Management Executive or equivalent body. TheSpecialist Training Committee of the Royal College ofPsychiatrists (STC) sets the standard for training schemes and,under the aegis of the Specialist Training Authority (STA), setsthe standard for award of certificates of completion of specialisttraining (CCSTs), which indicate that specialist training has beensuccessfully completed. Since 1997 a CCST has been mandatorybefore taking up an NHS consultant post. Old age psychiatryfalls within the remit of the Royal College of Psychiatrists’General and Old Age Psychiatry Specialist Advisory Committee(GOAPSAC) 10 .General and old age psychiatry higher training schemes mayoffer two options for aspiring old age psychiatrists. Singleaccreditation involves training for 3 years to gain a CCST inold age psychiatry. Currently these trainees may spend 1 year ingeneral psychiatry or one of its subspecialties if they so wish.Single accreditation therefore necessitates a total of at least 6 yearsin psychiatric training. Many trainees (probably about 60%) optto complete dual training, which aims at dual certification ingeneral and old age psychiatry. These trainees complete a 4 yearhigher training programme, with 2 years in each specialty. Theymust have been appointed to their specialist registrar posts by anappropriately constituted appointments committee and will hold aNTN in old age psychiatry. Dual certification will require a totalof at least 7 years in psychiatric training.During their training, specialist registrars are expected todevelop their professional attributes, core knowledge and skills,and are set goals in research and audit, teaching and supervision,and management. Currently, six ‘‘core’’ sessions aredevoted to experience in old age psychiatry (or other specialty).‘‘Core’’ experience involves working with a multidisciplinaryteam to provide a service to a defined population. Two furthersessions are available for research, audit and personal study, andanother two can be used to develop special interests. Old agepsychiatry trainees are expected to gain experience of geriatricmedicine at some stage of their training, and this is usuallyachieved either on a short-term attachment or using specialinterest sessions.CONTINUING PROFESSIONAL DEVELOPMENTLoane and Barker 11 surveyed newly appointed old age psychiatrists’views of their higher training. Overall clinical experiencewas felt to be satisfactory, but management experience waslacking in a number of areas and experience in dealing withcomplaints, dealing with difficult professional relationships,recruitment and disciplinary proceedings were all identified asareas where training was insufficient. Higher trainees are expectedto get training in management but it can be difficult to pitch it atthe right level.The emphasis today is on lifelong learning 12 , which is regardedas essential for all healthcare professionals. Old age psychiatristsare no different and are likely to see continuing developments intheir field throughout their working lifetimes. Learning does notstop at the transition from higher trainee to consultant, and somemight say that this is the point at which learning really starts.Consultants increasingly plan their CPD programmes 13 , althoughthese need to be flexible and to evolve with the specialty, theindividual and the job. Increasingly too, consultants change theirinterests, disciplines and posts as their careers progress. This maybe a way to re-energize and deal with the stresses of their multipleroles 14 . Continuing professional development should be a positivesupportive opportunity for consultants to continue learningthroughout their working lives.LIFELONG LEARNINGLearning about old age psychiatry starts in medical school andcontinues throughout the working life of an old age psychiatrist.The context within which the specialty operates is constantlychanging. There are various threats and opportunities on thehorizon, including changes to the Mental Health Act 15 , new waysof dealing with people unable to consent 16 and the NationalService Framework for older adults. Old Age Psychiatry and itspractitioners cannot stand still. The enthusiasm which teachinghospital psychiatrists aim to impart to their medical undergraduatescan be maintained during specialist training andboosted throughout a consultant’s career by continuing professionaldevelopment and the challenge of working within aconstantly changing health and social service context.REFERENCES1. Royal College of Physicians of London and Royal College ofPsychiatrists. Care of Elderly People with Mental Illness: SpecialistServices and Medical Training. London: Royal College of Physicians,1989: 29.2. Wattis JP, Wattis L, Arie T. Psychogeriatrics: a national survey of anew branch of psychiatry. Br Med J 1981; 282: 1529–33.3. Wattis J, Arie T. Further developments in psychogeriatrics in Britain.Br Med J 1984; 289: 778.4. Benbow SM, Jolley DJ. A specialty register: uses and limitations.Psych Bull 1996; 20: 459–60.5. Faire GM, Katona CLE. Survey of undergraduate teaching of old agepsychiatry in the United Kingdom. Psychiat Bull 1993; 17: 209–11.6. Gregson CA, Dening T. Teaching old age psychiatry to medicalschools in England. Int J Geriat Psychiat 1995; 10: 883–6.7. Working Party of the Royal College of Psychiatrists and RoyalCollege of Physicians. The Care of Older People with Mental Illness:Specialist Services and Medical Training. London: Royal College ofPsychiatrists, 1998: 40.8. Royal College of Psychiatrists. Basic Specialist Training Handbook.London: Postgraduate Educational Services Department, RoyalCollege of Psychiatrists, 1999: 17.9. Royal College of Psychiatrists. Educational Policy. Occasional PaperOP36. London: Royal College of Psychiatrists, 1997; 57.10. Royal College of Psychiatrists. Higher Specialist Training Handbook.Occasional Paper OP43. London: Royal College of Psychiatrists,1998; 55.11. Loane R, Barker A. Newly appointed consultants in old agepsychiatry and the adequacy of higher training. Psychiat Bull, 1996;20: 388–90.12. Department of Health. A First Class Service: Quality in the NewNHS. London: Department of Health, 1998: 86.