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Forensic Psychiatry - FAQs

Frequently Asked Questions (FAQs)

This page has some specific questions about training which crop up fairly frequently. It is heavy on TLAs (three letter acronyms) and is really for existing trainees or those looking in detail at joining the scheme.

The lock out period for ARCPs

“Phew! I’m not locked out. I can still upload all of this the night before my ARCP!”

Don’t bother. There is no technical way that the online portfolio can be locked – no-one can prevent you from uploading information even minutes before the ARCP or even whilst the panel are looking at your portfolio (don’t laugh – we’ve seen it happen). What will happen from the summer of 2017 is that the panel will simply disregard all information highlighted by the system as being uploaded in the last 7 days or less. you have been warned!

Don’t leave it to chance – upload information as you gather it. Reports from 9 months ago don’t impress when they’re uploaded 2 weeks ago. This is particularly important when the panel is discussing a trainee for whom time management or prioritisation have been identified as problems. These are often exemplified by the portfolio, so make sure everything there is timely.

So you’re a Forensic Psychologist? That sounds interesting.

Forensic psychology is interesting, but we’re Forensic Psychiatrists. Psychiatry, unlike psychology, is a branch of medicine, so we are all medical doctors, specialising in Forensic Psychiatry, just as others specialise in Emergency Medicine or General Surgery.  We work with people from a range of other professions (often known as Allied Health Professionals (AHPs)) but we are definitely doctors first and foremost. We are registered with the General Medical Council and are Members of The Royal College of Psychiatrists, so use the postnominal MRCPsych professionally.

Forensic Psychologists are governed by the British Psychological Society. Psychiatrists and Psychologists often work closely together but do come from different backgrounds and each bring a distinct knowledge base and skill set to their work.

How can I get an easy DONCS assessment?

Offer to minute a meeting. Chairs often struggle to find time to fit this in – all offers will be gratefully received and the favour will be returned with a DONCS in your portfolio. You only have to ask…

How can I become a forensic psychiatrist?

howtopass.jpgAs this is a branch of medicine, you will have to be a doctor first. Have a look at MedSchoolBootCamp to learn more about that process.

Once you are a doctor, you will need to join the Royal College of Psychiatrists. This requires training and exams. Once you have passed the MRCPsych exams you are free to apply to join a Forensic Psychiatry training scheme. You may wish to consider the best forensic psychiatry training scheme, according to the GMC’s national trainees’ survey in 2015 and 2016.

 

The clinical exam (CASC) can be tricky

Is that like Cracker?

cracker.jpgNo – it isn’t like Cracker.

Cracker was a 1990s TV series about a criminal psychologist who helped the police to solve crimes. Forensic psychiatrists are doctors (see above) who assess and treat mentally disordered offenders. We treat people with mental disorders in order to get them better, like other doctors. We do not help the police to solve crimes. Many of our patients have been involved in criminal offending and we do often work with solicitors, barristers and the criminal Courts to provide expert advice on management of mentally disordered offenders. We don’t “profile” people – we assess and treat them.

How do you cope with all the blood?

There’s no blood. That’s Forensic Pathology – another branch of medicine involved with determining the cause of death using post mortem examinations. Our work involves expert knowledge of psychopathology, pharmacological and other treatments of a range of serious mental health problems, a sophisticated understanding of the legal and risk context and multidisciplinary team leadership. Clinical work involves careful and detailed interviewing. If there’s blood, you’re doing it wrong. 

What have I got to lose by joining the scheme?

For most people – nothing. Most of our ST4 trainees come from training posts – CT3 or similar (the old SHO posts). Doctors joining from these schemes have nothing to lose – their fixed term contracts are generally about to expire and if they don’t join a training scheme they will not have a job. If a CT3 doctor joins and becomes an ST4 trainee and doesn’t like the scheme (or fails to progress and is forced to leave the scheme) then they are not in a significantly worse position than when they started.

This situation is very different for Specialty Doctors (the old Staff Grade/Associate Specialist posts). Specialty Doctors are generally employed on long-term contracts and enjoy good job security. Many have been out of training for some time.  If a Specialty Doctor leaves a safe, long term post to join a scheme and it doesn’t work out, there is a risk that the doctor will then have no job to return to. The decision to join a training scheme requires careful thought, and is a gamble, particularly for Specialty Doctors.

We have welcomed many former Specialty Doctors to our training scheme in recent years and many have made a great success of their training and are now Consultant Forensic Psychiatrists. Other Specialty Doctors have been struck by how busy and demanding they have found a return to training. Some Specialty Doctors find that their current post allows time and flexibility to engage in a wide range of outside interests. ST training requires total commitment. Clearly, Less Than Full Time (LTFT) training is available, but this is no less demanding.

I’m a new ST4 starter – what do I do?

Firstly, email your new TPD at nicholas.taylor@nottshc.nhs.uk to introduce yourself and arrange a meeting or at least a telephone discussion about the scheme and, importantly, your first placement. Send a CV along as well – we get very little information about you before you start.

Secondly, have a read of some recommended books and some other recommended reading which will be helpful. Taylor and Gunn is the gold standard book, Forensic Mental Health was written by some of our very own supervisors and you must know how to Get Things Done if you are to be effective.

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The expensive Gold Standard textbook

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 A great place to start – written by our own trainers

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You should buy a copy of this book today and live your life by it

You might also want to consider joining some relevant organisations – the BMA, the British Association of Psychopharmacology and the Expert Witness Institute, for example.

When I finish my training, can I just start work as a Consultant?

No – there’s a lot more to it than that. One of the most important things to bear in mind is that, before you can act as a Responsible Clinician (RC) you have to become an Approved Clinician (AC). There are many courses nationally which provide appropriate training. Most East Midlands trainees attend a course in Rotherham, organised by Rotherham, Doncaster and South Humber NHS Foundation Trust (known as RDaSH). Contact Sue Waller on 01709 302677 or by email at sue.waller@rdash.nhs.uk to arrange this.

Without AC/RC approval, you cannot act as an RC, which is an essential component of Consultant jobs. You will also need to apply via the Royal College of Psychiatrists and the GMC to receive your Certificate of Completion of Training (CCT) and then to be entered onto the GMC’s specialist register.

Finally, you will need to find a job – not always easy in the current climate. On finishing training, after 3 years, you can use your “Grace Period” of an additional 6 months in a training post. This has been an automatic entitlement for years, but some reports suggest that trainees must apply for their Grace Periods, effective from April 2017. This has not been implemented widely as of May 2017, but you would be well advised to email your TPD and tell them that you want to use your Grace Period, a good 6 months in advance. There is a risk that you will suddenly find yourself out of a job otherwise…

I’m a final year trainee. Can I work as a locum Consultant?

Yes, but you might not want to. Final year trainees (ST6) can “act up” as Consultants for up to 3 months and have this time counted towards their training. This means it doesn’t extend the date of the Certificate of Completion of Training (CCT). This requires agreement of the Educational Supervisor and Training Programme Director, as well as an Associate Postgraduate Dean.

It is very likely that a training “acting up” in this way will also act as Responsible Clinician (RC) for the patients in their care. To act as an RC, you must complete training as an Approved Clinician (AC). This is a 2 day course, only available to final year trainees. A quick search of the web reveals dozens of Approved Clinician training courses across the UK. The first time you train as an AC, a full course (also known as an induction course) is necessary. To maintain your status as an AC every five years, a shorter refresher course is all that is required.

Most people find that attending a course in their own area or region is most helpful, as some of the case examples and case law that are discussed will probably be more relevant. Once a trainee has “acted up” for 3 months, they cannot act up again.

Locum (i.e. temporary) Consultant jobs are often available, and are usually taken after the CCT. Once a trainee takes a locum Consultant job, they must give up their training number (NTN) and cannot return to the training scheme. Again, AC/RC status is usually a mandatory requirement for locum Consultant jobs. Many people act up during their final year and then take a locum job post-CCT. This provides valuable experience and demonstrates to the trainee and to potential employers that the trainee has the ability to work as a Consultant.

Can I take a break during training?

Yes. The training lasts 3 years and a significant minority of trainees choose to take time out of training. These Out Of Programme (OOP) periods are known as OOPs and take various forms:

  • OOP for Research (OOPR)
  • OOP for Training (OOPT)
  • OOP for Experience (OOPE)

OOPRs and OOPTs count towards training and do not result in a delay before CCT. For this reason, there are extensive quality assurance procedures (and a lot of paperwork) around OOPRs and OOPTs.

OOPRs are useful for trainees who are heavily involved in research who need a dedicated period of time to write up a dissertation or analyse data.

OOPTs are rare – perhaps reasonably so. The training scheme is designed to deliver the best training. It should be unusual to have to leave the scheme to gain further training experiences.

Trainees need to plan ahead for OOPTs – at least 3 months’ notice is required.

OOPEs are different. Trainees who want a complete break from training can request an OOPE. This does extend training and the time can be used for anything – a career break, travel, etc. Clearly, trainees are not paid during OOPEs and there are no requirements about what people do during their OOPE time.

One of our trainees took an OOPE to spend time in South America, delivering psychotherapy in a women’s prison in Bolivia. Another trainee used an OOPE as a career break and decided to leave the training scheme.

What is Form R?

Form R is effectively a link between Annual Reviews of Competency Progression (ARCPs) – the annual reviews of trainees’ progression – and medical revalidation – the national scheme requiring doctors to revalidate every 5 years. ARCPs are thorough reviews and inform decisions about revalidation, and the Form R is used to link these two processed together. Form Rs were introduced in 2013 and many trainees were slightly mystified about them at first. They are sent to trainees shortly before the ARCPs and trainees must complete then and send them to the Local Education and Training Board (LETB).

This will be checked at the ARCP and if a Form R has not been completed, trainees are generally awarded an Outcome 5 and given time to fill it in.The simple message is “Fill in your Form R” for all your ARCPs.

How can I make my portfolio look good for the ARCP?

The most common problem at ARCPs is when uploaded PDFs appear on the screen the wrong way round. There’s relatively little time to fiddle around during ARCPs and we can’t rotate the view of PDFs in the portfolio easily, on the PC provided by health Education East Midlands (HEEM).

Yes – you can download PDFs and rotate them in Acrobat Reader, but please make it easy for the panel. Look at your own documents in your own portfolio – get them the right way up!

Be aware that, as of late 2016, there is a lock-out or lock-down period before ARCPs, to prevent late uploading of documents. You will be unable to add anything further to your portfolio in the last week before your ARCP. This will stop the embarrassing uploads (new items every 3 minutes in the small hours on the morning of the ARCP) and the frankly absurd when trainees upload information during the actual 20 minute ARCP (“Are we looking at the information present in the portfolio at the start of this ARCP or at the end?”) Outcome 5s await late uploaders!

A word on mini-PATs

The mini-PAT offers a chance to reflect on your view of your strengths and weaknesses. Some trainees fill in “4” for their entire self-assessment. Please try to be more reflective than this and indicate your real strengths and weaknesses. More importantly, you MUST have enough returns on your mini-PAT for it to be valid.

The worst way to manage a mini-PAT is to send out relatively few requests, get an inadequate number of returns then have to start a new mini-PAT round. This will cause a delay and, critically, irritate all the people who will be feeding back. It is recommended that you submit the maximum number of requests initially. This will ensure that everything goes smoothly. This has been a problem for a number of years and continues to be an easily made mistake in early 2017.

When do I need an Educational Supervisor’s report?

You should have a full report from your Educational Supervisor (ES) for every ARCP that you have. All ES reports are full reports – there are no draft or interim reports. If you are unlucky enough to have an ARCP more frequently than annually, you still need an ES report. For people training on a less than full time (LTFT) basis, ARCPs will still happen at the very least annually. They will therefore cover a period of training of less than 12 months whole time equivalent (WTE). You still need an ES report for all of these ARCPs. The only exception is if you are on long term leave (maternity leave or sick leave). You may be unable to meet your ES to complete the report. otherwise – get an ES report for every ARCP.

What can and can’t locum Consultants do with regard to supervision?

They can’t act as Educational Supervisors, but can act as Clinical Supervisors if:

  • They are contracted for at least 3 months
  • The Clinical Supervisor role is in their contract
  • They have undertaken training for this role
  • They are appraised in relation to this role
What is this Tribunal Guidance that everyone’s talking about?

Where can I find a copy? It’s here.

The commonest criticism of Tribunal reports is that they are not signed and dated – make sure that the copy sent to the Tribunal Office has your signature on it. Some Tribunals insist that the date is written in your own hand next to your signature – play it safe and get the process off to a smooth start.

Where can I find guidance about training? Where is “the rulebook”?

Sadly, much existing guidance is out of date and references organisations that no longer exist. PMETB, Deanery Regional Action Teams, the Forensic Psychiatry SAC (FPSAC), and many others have long since ceased to function by live on in the guidance we are supposed to follow. A good place to start is The Gold Guide, last updated in 2016.

Does a Clinical Supervisor have to be a Forensic Psychiatrist?

Surprisingly, no. The Forensic Faculty (of the Royal College of Psychiatrists) does not have a requirement that a Clinical Supervisor must have a CCST or CCT in Forensic Psychiatry. This allows, for example, Consultants with a CCT in LD psychiatry, who are working in a Forensic Service, to act as Clinical Supervisors for Forensic trainees.

I’ve finally finished my training and got my final ARCP Outcome 6. I have a Consultant job in a different Trust and I want to leave. Who do I tell?
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Get some training and practice before your interview – it’s a big deal

Congratulations! For our East Midlands trainees, please tell:

  • Your employer – i.e. Medical Staffing
  • The Trusts’s Medical Education Manager – Elaine Hayes
  • Your Clinical Supervisor
  • Your Educational Supervisor
  • Your Training Programme Director
  • The relevant person in HEEM – sukhminder.sanghera@nhs.net

It’s important to get this right, as there are all manner of consequences for pay, references and other areas which you may be unaware of.

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