Joint Grampian, Highland and Tayside Postgraduate Teaching Programme

NHS

Grampian

Highland

Tayside

JOINT GRAMPIAN, HIGHLAND AND TAYSIDE POSTGRADUATE TEACHING PROGRAMME

2015 – 2016

FIRST SEMESTER

CONTENTS

1.INTRODUCTION

2.POSTGRADUATE COURSE

Special Study Days, Seminar Programme

3.MENTAL STATE MEETINGS

4.EVIDENCE-BASED CASE CONFERENCE AND JOURNAL PRESENTATION

5.MULTIDISCIPLINARY JOURNALS CLUB

6.PSYCHOTHERAPY SUPERVISION GROUPS

7.ATTENDANCE RECORD

POSTGRADUATE TEACHING PROGRAMME

FIRST SEMESTER 2015-2016

INTRODUCTION

Welcome to the first semester of the 2015-2016 year of the Postgraduate Teaching programme in Psychiatry. This will run on Wednesdays and Thursdays between 16.09.2015 – 16.12.2015. The teaching programme has the following components:

Postgraduate Lecture and Seminar Course

Course Organisers: Dr Alison Haddow and Dr Allen Shand

This course was developed jointly by Grampian, Tayside and Highland Mental Health Services. The course has two main elements, Special Study Days (SSDs) and Clinical Seminars.

Special Study Days: These will be common to trainees in Grampian, Tayside and Highland. They will consist of lectures and seminars covering all the main clinical areas in psychiatry. We have attempted to draw on the best expertise in our own services and also to bring in outside speakers of national repute. We hope that speakers will present an overview of recent research and current developments in their subject. SSDs usually start at 10:00 or 10.30 am. The SSDs on Basic Principles are repeated annually to bring them into synchronisation with the College examination calendar. Although it may be of benefit to trainees to attend on consecutive years, this is not mandatory.

Clinical Seminars: The format of these is flexible and we have encouraged tutors to take a creative approach to this teaching. The seminars might include case presentations. The major purpose of these sessions is to guide trainees in the task of identifying areas in which learning is required.

Venues: Aberdeen Special Study Days will be held in Seminar Room A, Block A, ClerkseatBuilding, RoyalCornhillHospital. Clinical Seminars will take place in Seminar Room B, with video link to Inverness. Dundee teaching will be held at the Carseview Centre, Medipark, Tom McDonald Avenue, NinewellsHospital, Dundee.

Feedback forms will be issued to you after each teaching session. Would you please complete these and give them to whoever has led the SSD or seminar. If you have any concerns about the course, please do not hesitate to contact Dr. Haddow (01224 557507) or Dr Shand (01224 557536).

Mental State Meetings

Co-ordinator: Dr Naglaa Massoud

Venue: Seminar Room A, RoyalCornhillHospital

These are held on Wednesdays from 09:00 am to 10:20 am during term-time. The purposes of these meetings are to enhance interview skills and case presentation and, in particular, the development of an accurate and articulate report of mental state. All trainees are expected to attend. The meetings will be of particular value to trainees who are preparing to sit the clinical components of the MRCPsych examination.

The ability to do a case presentation with confidence is an important professional skill and one that can be developed by attendance at the Mental State Meetings.

We are exploring how to improve the exam-relevance of the Mental State Meetings and would welcome suggestions on this. The Mental State Meetings are also relevant to workplace based assessments.

Evidence-based Case Conference and Journals Club

Co-ordinator: Dr Elizabeth Willox

Venue: Seminar Room A, RoyalCornhillHospital

This is held on Wednesdays from 11.30 until 1.00 pm. These sessions begin with presentation of a research paper of relevance to the patient to be discussed. This will be done by a trainee psychiatrist. There is then a full case presentation. This is done in turn by consultant teams who are expected to select a patient who is of particular interest or one who has presented unusual problems of diagnosis or management.

Multidisciplinary Journals Club

Co-ordinator: Dr Jenny Bryden and Dr Gemma Fleming

Venue: Seminar Room A, RoyalCornhillHospital

This is held on Thursdays between 12:30 and 1:30 pm. The purpose of this part of the Teaching Programme is to present research papers of clinical relevance and to foster critical discussion of research. Lunch is usually provided. A consultant will chair each meeting. Two trainees have been allocated to each slot. Papers have been allocated in advance for these sessions. We hope that this will allow presentation of high quality papers covering a range of areas of interest. The Chair and speakers should meet in advance to go over the papers and to discuss issues such as content and presentation style.

Psychotherapy Supervision

Co-ordinator: Dr Marina McLoughlin

Each trainee is allocated to a supervision group according to his/her level of experience. See programme for times and venues.

Aberdeen trainees are invited to the Psychotherapy department’s in house seminar programme.These are held on Monday mornings at 11am.Interestedindividuals who can commit to regular attendance should email Dr McLoughlin beforehand. ()

Psychotherapy training for CT1-CT3 (NHS Grampian)

All Core Trainees in Psychiatry need to provide evidence of the competencies in psychological treatments in order to progress from CT3. The basic minimum is to undertake, under supervision, two psychological therapy cases in two modalities between years CT1 and CT3. One of these cases should be a brief treatment (12-20 sessions) and the other a longer term treatment (24 sessions or longer).

It is the aim of the Psychotherapy Department to support our trainees in acquiring the necessary competencies and progressing in their training however it is the trainee’s responsibility to make sure they are getting the necessary experience.

Balint Group (Department of Psychotherapy)

The process of developing competencies in psychotherapeutic approaches starts with the Case-Based Discussion (Balint) group. This group is an ongoing opportunity for developing clinical practice by thinking psychologically about everyday work experiences. The College expects evidence of attending a minimum of 30 case-based discussion groups. The Balint group is mandatory to training, runs for 1 year (the duration of CT1) on once/week basis irrespective of term times and fulfils current College recommendations. Core trainees receive a completed CBD form after 6 months and after 12 months of attending the group. Trainees will need the evidence of attending the Case-Based Discussion group for their ARCP and to apply for the CASC.

“The essence of the group’s work is a speculation and empathy exercise in what it may be like to be the doctor and what it may be like to be the patientin the relationship that has been presented for the group to consider. The result for the presenter (and only a little less directly for the group members) is a different perspective on this patient, on the sources of difficulty for the doctor, and finally on alternate (and hopefully more effective) ways for the doctor and patient to be in a healing relationship.”

Balint 1957

Recommended reading:

• see Appendix 1

Personal psychotherapy is not obligatory but may be beneficial to enhance the tolerance of distress, anger and mixed emotions about professional situations and to develop insight. The decision to have personal therapy rests with the trainee and the Department of Psychotherapy does not participate in arranging such therapy.

At the beginning of CT2 year trainees are allocated either to CBT or Psychodynamic Psychotherapy supervision groups. In Child and Adolescent or YPD posts there may also be an opportunity for conducting therapy but this experience and the necessary supervision with an accredited supervisor would need to be organised directly within that post. Once the first two cases have been completed, Core Trainees also have an opportunity to undertake a case of IPT.

Psychodynamic Psychotherapy supervision (Department of Psychotherapy)

The Department of Psychotherapy organises supervision for Psychodynamic Psychotherapy cases. Patients suitable for psychotherapy by a trainee would be assessed by one of the therapists within the Psychotherapy Department. Supervision is mandatory and is on once weekly group basis. Usually a trainee would attend supervision for a few weeks prior to taking on a suitable patient. The two completed SAPE forms and a Psychotherapy ACE form would provide the necessary evidence of completion of therapy.

Recommended reading:

• P. Hughes, D. Riordan “Dynamic Psychotherapy Explained”, Radcliffe Publishing 2006, 2nd ed.
• P. Casement “On learning from the patient”, Routledge 1985
• J. Wilson “Starting out in Psychodynamic Psychotherapy”, Psychiatric Bulletin (2001), 25, pp.72-74

Trainees who are interested and able to attend on a regular basis are also invited to come to Psychotherapy Department in-house educational seminars. These seminars are held once/month on Mondays 11.00 – 12.00 noon.

Cognitive-Behavioural Therapy (CBT) supervision (EDS, Fulton Clinic)

The Department of Psychotherapy organises supervision for CBT. Suitable cases can be taken from the caseload of the team where the trainee works. However, it is important that the trainee does not take on patients for therapy from their own caseload. All cases need to be discussed with Mrs Sally Hill, CBT supervisor, prior to the assessment being carried out. The trainee assesses the patient for CBT under Mrs Hill’s supervision. Supervision is mandatory and is on once weekly group basis. The two completed SAPE forms and a Psychotherapy ACE form would provide the necessary evidence of completion of therapy.

Recommended reading:

• K. Hawton, P. M. Salkovskis, J. Kirk, D. M. Clark “Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide” Oxford University Press 1996
• “Overcoming” series of books for various psychiatric problems
• Websites –

Interpersonal Therapy (IPT) supervision (Eden Unit, RCH)

Those Core trainees, who have completed their first two cases, may be interested to see a patient for IPT.

The Department of Psychotherapy coordinates supervision for IPT. Suitable cases can be taken from the caseload of the team where the trainee works. However, it is important that the trainee does not take on patients for therapy from their own caseload. All cases need to be discussed with Dr Jane Morris, IPT supervisor, prior to the assessment being carried out. The trainee assesses the patient for IPT under Dr Morris’s supervision. Supervision is mandatory and is on once weekly group basis on Wednesdays at 16.00. The two completed SAPE forms and a Psychotherapy ACE form would provide the necessary evidence of completion of therapy.

Psychotherapy assessments process:

All trainees, irrespective of the modality of the therapy cases they do, need to complete assessment forms that would provide the evidence of the Psychotherapy competencies for ARCP.

These forms are SAPE (Supervisor’s Assessment of Psychotherapy Expertise) and Psychotherapy ACE (Assessment of Clinical Expertise).

SAPE forms are completed by trainee’s supervisor and Psychotherapy ACE forms are completed by Dr M. McLoughlin, Psychotherapy Tutor.

For each psychotherapy case a trainee needs to write a short formulation (the current understanding of the patient’s difficulties) mid-way through therapy. This formulation is then discussed with the supervisor and the first SAPE is completed at this point. At the end of treatment the final formulation is written and another SAPE is completed. Thereafter a trainee would need to arrange an appointment with Dr Marina McLoughlin in order to complete a Psychotherapy ACE.

The two SAPE forms are used to inform the completion of the Psychotherapy ACE and Psychotherapy ACE provides the Psychotherapy competencies evidence for the ARCP process.

Appendix 1

Balint in a Nutshell

An Introduction by Heather Suckling

History of the Balint Group

The name is that of Michael Balint a Hungarian psychoanalyst.

His main work was as a psychoanalyst at the Tavistock Clinic, in London. He started groups for GPs in the 1950s to study the doctor-patient relationship; he described them as “Training-cum-research” groups. He worked closely, and ran groups with his third wife, Enid – a Social Worker and Marriage Guidance Counsellor. Her influence on medical training is probably as great as his.

What is a “traditional” Balint Group?

It consists of 6-12 doctors with 1-2 leaders and it meets regularly.

Meetings usually last for 1-2 hours and the group continues for 1 or more years.

The method is that of case presentation without notes.

What happens in a Balint group?

The leader asks “Who has a case?”

The presenter who volunteers tells the story of a consultation; this is not a standard case presentation, but a description of what happened between the doctor and the patient. It need not be long, complicated or exciting but something that is continuing to occupy the presenter’s mind. It may be puzzling, or has left the presenter feeling angry, frustrated, irritated or sad.

The group discusses the relationship between the doctor and patient and tries to understand what is happening that evokes these feelings. The feelings which the patient evokes are significant and may be reflected in the presenter or in the group. This facilitates the understanding of the patient.

All discussions within the group are confidential.

What can a Balint group do?

It provides an opportunity for doctors to reflect on their work. It can provide an outlet for anxieties and frustrations generated by their work. It can arouse a doctors’ interest in patients whom they have previously found upsetting, annoying or “difficult”. It can open minds to other possibilities, both of diagnosis and day to day management. The group provides support and improves communication with patients and other professionals. It can improve job satisfaction, the patient’s perception of care and help to prevent burn-out.

What does a Balint group not do?

It does not tell the doctors “how to do” their work.

It does not provide easy answers.

It will not solve all doctors’ problems with patients.

Who was Michael Balint?

He was born in Budapest in 1896, the son of a GP.

He became interested in psychoanalysis after first hearing Freud speak in 1918 and when he met his first wife, Alice, who was an analyst.

He obtained his Doctorate in medicine in 1920 and initially worked as a biochemist.

Later he undertook psychoanalytic training, his analyst was Sandor Ferenczi. Balint worked as a psychoanalyst in Budapest during the Fascist regime, but in 1939 came to Manchester (UK) as a refugee.

In 1945 he was appointed as a Psychoanalyst at the Tavistock Clinic.

In the early 1950s he began his work with GPs- the Balint Group was born.

In 1957 “The Doctor, his Patient and the Illness”, his seminal work, was published.

The founders of the Royal College of General Practitioners were profoundly influenced by Balint’s ideas; they formed the basis of modern postgraduate training for general practice.

He used the term “patient-centred medicine” in his description of the group he ran at

University College hospital for medical students in 1969

“Perhaps the essence of Balint Groups has always been to share experiences and enable people to observe and rethink aspects of their relationships with patients and their work as doctors.”

Enid Balint (1992) ‘The Doctor, the Patient and the Group’

HCS Jan 2006 (amended Feb.2007)

Attendance (applies to CT1-3 only)

Attendance at some elements of the teaching has been disappointing in recent years. We have therefore decided to introduce individual attendance sheets. A copy of this is at the end of this programme. You should take this to teaching sessions and request that the chair or tutor signs this. If you are unable to attend you should write the reason for this in the space for this signature. This is an important document which you will be expected to produce when you meet the tutor for routine assessments and you should take great care of it. We would advise you to make a regular electronic copy to protect against the eventuality of it being mislaid.

Grampian Philosophy, Psychiatry and Psychology Interest Group

Co-ordinator: Dr. John Callender

This is not part of the formal teaching programme but may be of interest to you. The group meets on Thursdays at 4.45 pm approximately once every three months. The meetings attract a mixed audience of clinicians, philosophers, neuroscientists and others. If you wish to be informed of meetings, you should ask Diane Sandison (57600 or ) to put your name on our mailing list.

SPECIAL STUDY DAYS/CLINICAL SEMINARS - SEMESTER I - FOR GRAMPIAN SHO’s

Special Study Day

TBC

Special Study Day

Clinical Seminar

Special Study Day

ABERDEEN

ABERDEEN

ABERDEEN

ABERDEEN

Special Study Day

Special Study Day – 16thSeptember 2015