HENW (North Western) MRCPsych Course

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HENW (North Western) MRCPsych CourseTheory to
Practice
Dr Latha HackettCourse Director NW School of
PsychiatryEmail latha.hackett_at_cmft.nhs.uk
Sam Abbott Medical Education Manager NW School
of PsychiatryEmail sam.abbott_at_mhsc.nhs.uk
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Background

• The process
• The course Academic programme, LEPP
• Training of Educational Supervisor
• Evaluation
• Challenges
• Future plans

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Health Education North West

• Brought together two former Deaneries, North
  Western Mersey
• Oversees postgraduate medical education
  training with responsibility for over 7,000
  trainees
• Process of aligning activity
• Currently still two Schools of Psychiatry
• Psychiatry trainees in the NW - 120 Core
  trainees, similar No of HST

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The NW School of Psychiatry
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Background to MRCPsych Course

• Historically delivered via Manchester University
• 30 day MRCPsych course
• Delivered over 2 year period
• Has been running for more than three decades
• In the last three years the course moved towards
  blended learning, distant learning, face to face
  and periods of private study
• Summer 2013 - 3,500 per trainee per year, due
  to increase for 2014...
• Termination of contract by the Deanery in 2013
• Point of no return, hence opportunity for a new
  NHS developed and locally delivered programme

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From September 2014

• No University run course for CT1s
• CT2 trainees to continue on the University
  course. Last cohort completed in the of summer
  2015
• No extra money
• NHS had to provide the training
• New NHS run course for CT1 had to start September
  2014

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Setting up the Course

• Commenced in Post 1.4.14 - 1 day a week
  secondment
• Studied core curriculum, examination, Wessex NHS
  run course, Mersey University course Manchester
  University course - April 2014
• Phase 1 completed by July 2014
• Phase 2 commenced September 2014

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Consultation May June 2014

• CT/STs currently on the course or who had
  recently completed the University MRCPsych
• Site tutors as a group, some individually, School
  Operational Board, DMEs across the patch of 9
  Trusts
• MHSC, GMW, Pennine Care, Lancashire Care,
  Cumbria, CMFT, 5BP, Macclesfield and Calderstones
• One half day (tutors/CTPD) and 1 full day
  (included all interested parties)

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Consultation Findings

• Considerable variations in training provided by
  different LEPs
• Some really excellent models of training e.g. 555
  presentation
• In some LEPs there was variation between own
  sites
• Psychotherapy training - Met the College
  requirement 30 sessions of Balint group, one long
  case and one short case in two different
  modalities. Again delivery varied across LEPs
• No consistency parity in training
• Though every body was keen trying their best
  and there was a lot of enthusiasm for training on
  all sites

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Disconnection Variation

• Between
• Learning in the Placement
• Educational Supervisor supervision
• LEP Programme
• University run course
• Psychotherapy
• MRCPsych examination

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Outcome

• Curriculum Development
• Subgroup established in June 2014
  (recommendation, major educational role)
• LEP Programme/Handbooks/Website operational by
  August 2014
• Delivery
• LEP programme to commence September 2014
• Academic course to commence September 2014 for
  CT1
• Evaluation

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New Course Principles

• Psychiatrists are medically qualified doctors
  with a specialism in Psychiatry
• Adult learning principles
• Achievement of core skills for core trainees
• Training close to patients, learning from
  patients, learning from ES, in MDT, in the LEP
  Programme
• What cannot be done locally in placements done
  centrally e.g. academic day, exam preparation
• Good practice on sites incorporated - 555,
  psychotherapy
• Training offered on different sites are now
  comparable measurable

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New Course Aims To

• Reconnect the four training strands
• Educational Supervisor supervision
• LEP run weekly sessions
• Academic course at the Medical Education, School
  of Psychiatry (replaced the University run
  course)
• Psychotherapy
• And link them to
• MRCPsych examination
• Achieving
• Consistency/parity across sites and increase
  depth of knowledge to address differences in
  training provision across LEPs

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Some Parallels To

• PBL for Medical students in Manchester
• Run on different sites with the same PBL format
  with PBL trained Doctors
• Have handbooks prepared by a committee that PBL
  tutors follow handbook for tutors and handbook
  for students
• Students do have some lectures centrally e.g.
  statistics during their Project Option etc etc
• Discussion with Manchester Medical School lead
  for PBL re how the University reviewed its PBL
  teaching

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Module Leads Site Leads

• General Adult Dr Brijesh Desai, Lancs Care
  recommended by TPD
• Old Age Dr Gareth Thomas, Lancs Care, MEF,
  recommended by TPD
• Child Adolescent Psychiatry Dr Neelo Aslam,
  CMFT (TPD)
• Intellectual Disability Dr Nasim Chaudhry, GMW,
  Dr Sol Mustafa Pennine recommended by DMEs
• Forensic Drs Vicky Sullivan Hany El-Metaal,
  GMW by STP
• Substance Misuse Dr Patrick Horgan, GMW - by
  STP Psychotherapy Dr Adam Dierckx, MMHSC, by STP

• GMW Dr Raghu Paranthaman
• Pennine Care Dr N Fernando MHSC- Dr Adam
  Dierckx
• Lancashire Care Drs Brijesh Desai/Gareth Thomas
• Cumbria - Dr Andrew Morgan, Tutor
• 5BP Dr Joe Johnson, Tutor
• Acute Trusts - trainees based in acute Trusts
  (CAMHS) tend to join local mental health trusts

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Supported by

• School of Psychiatry Postgraduate Collaborative
  managed by Samantha Abbott
• With the enormous help of administrators, Janene
  Chesters, Laura Griffiths and Angela McMahon
• Operational Group meets 2-4 times a year
• 2014 - July 14, August 14, October 14
• 2015 January 2015, July 2015,
• 2016 - January 2016

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Theory to Practice
Educational Supervisor/ Supervision - weekly an
hour
Local Educational Provider (LEP) (44) 30
sessions a year
Academic Programme Ct1-12 days Ct2 12 days
Psychological modalities 30 Balint gps Long
case Short case in 2 diff modalities
Attain core competencies MRCPsych Exam
(Progress Test Written Clinical)
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North Western Course ESLEPPsychotherapyAcadem
ic programme Exam Practice

• Local Education Provider Programme LEPP
• Every LEP was providing weekly Journal club and
  case presentations (44 sessions annually)
• Many were already providing, weekly, half day
  sessions for the whole year
• The main difference from the old course was to
  strengthen this bit of the training
• We recommended that all LEPs provide mandatory
  15, half day sessions every six months with the
  content recommended

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North Western MRCPsych Course

• LEP programme
• Modular, two year rolling - 4 x 6 months
• Each 6 month block has 15 half day sessions
• Each block has General Adult, Old Age,
  Specialties CAP, ID, Substance Misuse,
  Forensic, one across ages
• LEPs had to meet, FY,GP, CT training needs
• Psychological modalities 30 (25) sessions of
  Balint group, one long case and one short case in
  two different modalities preparation of
  trainees for providing therapy
• Academic Programme (2 years) 12 days a year
  for CT1 and 12 days a year for CT2 and no
  programme for CT3

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North Western Course

• Supported centrally from the School of
  Psychiatry, Module Leads and Course Director,
  producing
• Handbooks for GA for 6 months, OA, CAP, ID,
  Forensic, Substance Misuse completed August
  2014
• Trainee and ES handbook
• Dedicated password protected on-line materials
• Journal papers sent out 2-4 weeks in advance
• Expert Led Sessions Prepared lectures were
  available
• Feedback Reflective notes

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SchoolofPsychiatry.net
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August February annually

• Induction
• Communication skills training verbal, non
  verbal and written skills
• Once the Academic programme and LEP programme is
  established we will jointly look at
  Communication skills training to share good
  practice achieve best practice

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63 CT1/2 on the course to date
Trust Attending LEP Sessions at
5BP Leigh
Calderstones Preston
Central Manchester University Hospital Trainees join GMW MMHSCT sessions
Cumbria Carlisle
Greater Manchester West Prestwich (GMW)
Lancashire Care Blackburn Blackpool Preston
Manchester Mental Health Social Care Trust NMGH (MMHSCT)
Pennine Care Bury Rochdale Oldham Tameside Stockport
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September/March- Programme starts LEP
academic programme

• Local Education Provider Programme commenced
  with the same modules across all areas
• Mandatory 15 half days (4 hours)
• Clear guidance on what must be covered during the
  6 months
• Modules could be delivered in any order as long
  as all were covered during that 6 month period
• LEP still has 7 sessions available to cover
  topics of their choice e.g. audit/communication
  skills etc etc
• Open to all trainees in psychiatry FY, GP,
  CT1-3
• FYs/GPs can do joint presentations with CTs

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LEP Component

• General Adult 6 (7) sessions
• Old Age - 2 sessions
• Child and Adolescent 2 sessions
• Intellectual Disability 1 session
• Forensic 1 session
• Substance Misuse 1 session
• Every 6 months a theme across ages e.g.
  Psychosis across the ages

• 2 hours on MCQs, exam practice etc during the
  whole 6 months
• Total 15 sessions of 4 hours each every 6 months
• Total LEP (2 years) - 60 sessions in 24 months
  25-GA, 8 OA, 8 CAP, 4 ID, 4-Foren, 4 Substance
  misuse, 3 to Psychotherapy. 4 sessions themed
  across ages e.g.. Psychosis, Depression, eating
  disorder, Mental Illness in the family

Centrally developed handbook for LEP advice on
Journal club papers, Clear learning outcomes,
Link with Competencies (ILO), Cases for case
presentation and ES handbook Centrally developed
handbook for LEP advice on Journal club papers,
Clear learning outcomes, Link with Competencies
(ILO), Cases for case presentation and ES handbook
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Topics for LEP Programme

• General adult topics - Topics for LEP GA (25
  sessions) Psychosis (4 sessions), Depression (4
  sessions), Bipolar 4, Personality disorder 3,
  Anxiety disorders/GAD/Phobic/Panic -2,
• Suicide and self harm 2, MHA/MCA, PTSD
• Organic, General Hospital, OCD 1 each
• Papers, RCT, Meta-analysis/Systematic review,
  Economic study, Genetics
• Old age (8) Assessment, Alzheimers dis, Other
  Neurodegenerative disor, Delirium, Mood
  disorders, Psychosis, anxiety disorders,
  Medico-legal aspects
• CAP (8) Assessment, ADHD, ASD,
  Anxiety/Depression, Attachment disorder, eating
  disorders, ID in CAP, Legal aspects

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Topics for LEP Programme - 2

• Psychotherapy 3 Psychotherapy services etc,
  Emotionally unstable personality disorder, 1 more
• ID (4) Assessment, Mental disorders, Behavioural
  issues, Offenders
• Forensic (4) Psychiatry and CJS, Link bet Crime
  and mental disorder 1 2, Psychiatry in court
• Substance Misuse (4) Diag and treat of Alcohol
  problems, D T problems with substance misuse
  other than alcohol, D T of dual diagnosis,
  Recovery concepts, psychosocial treatments and
  service developments
• Across the ages 4 sessions. Psychosis across
  the ages, Depression, eating disorders, mental
  illness and Family/Carers

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MRCPsych Academic Modules

• Covers aspects that cannot be covered in the LEP
  course or in Placement
• 12 days a year X 2 year course
• 6 September-January 2015 6 days
• 6 Feb- July 2015 6 days
• September December 2015 6 days
• March-June 2016 6 days
• Run at the School of Psychiatry on Thursdays
• Exam syllabus to follow

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Academic course 2014-2016

• First 6 months
• 2 days in September, October November ( 6 days)
• Topics covered Introduction to the MRCPsych
  including the new exams, Classification, Critical
  appraisal, Philosophy of psychiatry 1 day
• Basic Psychology, Neurosciences 1 day each
• Human development 1 day
• Psychopharmacology 2 days
• Every session they had MCQs

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Academic course cont

• II six months
• Feb-July 2015 4 days for Psychotherapy, 1 day
  each for GA and OA
• III six months
• September 2015-Jan 2016 2 GA , 2 OA (Physical
  health), 1 stats research methodology, 1 each
  for Neuropsych
• IV six months
• March July 2016 , 1 GA, CAP, ID, Foren, Sub
  misuse 1 for exam
• Total for 24 months 24 days
• Run as seminars/Workshop, a few lectures
• Consultant CPD Consultants welcome to attend

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Typical Academic Day Programme
930 Expert session - Anorexia Nervosa
1100 Coffee
1115 Expert session - Bulimia Nervosa other eating disorders
1215 Lunch
1300 Group work through 3 x 30 minute case vignettes Each case 15 minute group work then 15 minute discussion. Examples include assessment and treatment of complications, medicolegal frameworks for urgent treatment, strategies for relapse prevention)
1500 Coffee
15.15 MCQ workshop
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Exam Preparation

• Every LEP session trainees have MCQ/EMI practice
• Every academic programme MCQs
• 3 hours exam Written practice every year (July
  2015)
• Yearly Progress Test 11/12/15/16 June 2015
• Sat by ALL CT Trainees

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Exam Feedback to Trainees
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Educational Supervisors

• Pivotal in training of trainees, hence have to
  be well supported
• Know the curriculum and know what the exam is
  about
• Clear about competencies and training
  requirements of core trainees in their placement
• Educational supervision to achieve consistency
  across the region - clinical and educational
  supervisor
• ES being able to link the trainees learning
  LEP, MRCPsych, Psychotherapy etc in educational
  supervision
• Points for us to consider how we do this in
  LEPs, across LEPs by pooling of resources across
  LEPs, this will start this Summer

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Feedback

• Weekly feedback from LEP programme
• Feedback from the Academic Teaching Programme
  after each session
• Generally extremely positive
• Few recommendations
• Some cancellations
• 3 slots cancelled 1 JC on one site, 2 555
  (all 3 different sites) (Sites are 5113 11
  sites (2))

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Academic Day Feedback
How would you Rate these Sessions?
Did they meet your expectations?
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Encouraged Trainees to Prepare
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Sessions were Lively Stimulating
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Trainee Feedback
Exam focussed this is how these sessions
SHOULD be!!!
Activities related to exams and ARCP
has encouraged me to read more
Fascinating!
has sparked an interest!
Very stimulating discussions by speakers
interested in the topic themselves
MCQ enough time was given for us to discuss in
groups
The entire session was made simple and kept me
interested
there was a lot relevant to exams
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LEP Programme

• Greater Manchester West LEP Experience
• Raghu Paranthaman
• MRCPsych Tutor
• GMW NHS Trust

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Overview

• Background
• Setting up of course
• Practical aspects of running the course
• Feedback for the first year

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MRCPsych - Theory to Practice
Educational Supervisor/ Supervised training
weekly an hour
Psychological modalities 30 Balint gps Long
case Short case in 2 diff modalities
Local Educational Provider (LEP) 30 sessions a
year 4 hours each
Academic Programme Ct1-12 days Ct2 12 days
MRCPsych Exam(MCQ practice, Progress test)
Slide coutresy of Dr. Latha Hackett
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Local Educational Programme(Trust )

• Two year rolling modular programme - 4 x6 months
  block
• Same modules across all trusts in the region
• Minimum of 15 half days every 6 months
• Each block will have General Adult, Old age,
  Specialties CAMHS, LD, Substance misuse,
  Forensic

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GMW NHS Trust

• Provides mental health services to Bolton,
  Salford and Trafford residents in Greater
  Manchester
• Provides a number of specialist (substance
  misuse, adolescent inpatient, forensic) services
  for a wider geographical area
• Trainees are mainly based in 4 sites

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Trainees in GMW
CT GPST ST FY
Salford 9 2 8 6
Bolton 6 2 3 6
Trafford 7 1 2 4
Prestwich 10 0 7 0
Total 32 5 20 14
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Setting up of Course

• Lead appointed - June14
• Support from Lynda Hurst, Medical Education
  Manager
• Meeting with tutors-variability in teaching
  across sites, feasibility of delivering 4 hour
  programme in each site
• Attendance in directorate consultant meetings
• Centralised Programme set up (start from
  Sep14)-race against time!
• Support from a higher and a core trainee from
  second semester

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GMW MRCPsych Programme

• Started Sep14
• Two semesters have been completed
• Initially only for trainees in the 3
  districts(Bolton, Salford Trafford)
• Trainees in specialist placements joined in
  Feb15
• One centralised teaching for all junior doctors
  in our trust

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MRCPsych Teaching

• Wednesday afternoons (1PM till 4.30 PM) Trust
  HQ, Prestwich site
• Protected teaching time for all trainees
• Light sandwich lunch provided
• Course has evolved
• Expanded from 15 sessions to 20 sessions per
  semester
• CASC training and audit presentations- successful
  with excellent feedback
• Sessions have been made shorter with more breaks

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MRCPsych Teaching

• 20 weeks from March to July and September to
  January
• Each week will have a theme , eg Depression
• First 15 weeks
• Part of school of Psychiatry MRCPsych course
• 70 attendance mandatory for Psychiatry CT1s and
  CT2s
• Last 5 weeks
• Extra Forensic CAMHS sessions, CASC training
  Audit presentations

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Example Programme Depression

1300 1345 Depression
1400 1445 Case presentation
1500 1515 555 presentation (on a depression topic eg psychological therapies)
1515 1615 Expert led session(on a depression topic eg Treatment of depression)
1615 1630 MCQ
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Slot Allocations

• All CTs do at least 1 presentation
• Extra slots allocated to CT1s/CT2s and then
  CT3s
• No trainee does more than 2 presentations
• Trainees do case conference in the speciality
  they are working in. Same for journal clubs as
  far as possible.
•  Other trainees(FY doctors, GP trainees and BBT)
  are not allocated slots
• All STs chair a session

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MRCPsych teaching

• College(Site) tutors act as co-ordinating
  tutors for 5 sessions each every 6 months (4
  tutors x 5 sessions 20)
• Agreement reached with the Consultant body that
  each consultant would aim to attend a minimum of
  4 MRCPsych teaching sessions every year
• Consultants deliver all the Expert led sessions

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Teaching

• There are guidelines for case conferences,
  journal clubs and chairing sessions
• All the information is embedded in a word
  document- journal papers , 555 topics, guidelines

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Attendance- Second Semester

• Average- 32 per session
• Range - 22 to 43
• Consultants- 8 per session

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Feedback- First Semester

• Were the overall aims and objectives for the day
  met?

• N172

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Feedback- Second Semester

• How would you rate this training session overall?

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Feedback Free text comments

• Well organised and I have really learned a lot
• Really useful and thought provoking
• Interesting, Interactive, Concise, Crisp
• Excellent Excellent session
• Range of topics covered

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Challenges

• Venue
• Cancellations- affects training of all trainees
• IT issues
• Lunch/range of refreshments provided
• Local teaching(in each district) missed by some

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Formal Evaluation

• Focus groups of trainees (GT DM)
• Feed back from Tutors, ES, Consultants of the day
  Spring/Summer
• Advice obtained from Education Psychologist and
  Senior Lecturer in EP at Manchester University

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The Challenges - 2014

• There were a few sleepless nights.
• Main challenge was fear of change and
  uncertainty, we get good feedback from
  trainees, what we do is very good, why should we
  change?
• For me - having a Belief, to Listen, Develop,
  Change Support convince people it will work
• Some rather difficult views, thankfully in the
  minority
• The very tight timescale April to July 2014 to
  organise, convince providers and deliver

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Positives

• All trainees access same teaching regardless of
  Trust.
• Expert resources pooled across the NW
• Holding one event rather than 3 in some trusts
  saves time and money
• Consultants across the NW contributed to the
  development/delivery not just a few academics at
  the University
• closer links to the exam
• ESs feel more connected to the MRCPsych training
• Presentations are much closer linked to the
  curriculum/exams/syllabus than the University
  course which often felt detached as commented
  by a university course trainee

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Positives cont

• ESs feel more connected to the MRCPsych training
• Presentations are much closer linked to the
  curriculum/exams/syllabus - University course
  often felt detached as commented by a
  university course trainee
• School much more involved with trainee
  development/progress - therefore rapid access to
  TPD/HoS or Trusts when required to resolve issues
  - health issues, excessive on call etc, patterns
  emerge

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Challenges

• Trainees feedback - Being on call and missing
  some of these sessions want these sessions to
  be protected as this is their study leave
• MCQs not being done in LEPP routinely
• General adult LEP 24 sessions over two years.
  To do the expert led sessions on time, though we
  have got better at this. Agreeing to do it and
  not arriving on time
• Academic programme Psychosexual and eating
  disorders
• Some speakers wanting to be paid
• Across the ages topics need re-thinking
• More admin time was funded in year two, still not
  enough
• Up keep of the website
• Feedback forms had to be re-designed
• Small number of trainees in some sites
• Not all expertise available in some sites e.g.
  forensic
• New challenges that need to be looked at e.g.
  Communication workshops etc
• Working together will really help these
  challenges

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Comments from a DME

• Trainees say meets educational needs better
• Trainees spend more time in the clinical
  placement learning on the job!
• Teaching more organised and planned
• Excellent resources available on the school
  website
• We learn from each other

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Comment from a Consultant

• Good CPD, Id Forgotten most of what I thought I
  should have known, good to go back, read up and
  update

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The next 12 months...

• Re-Visit med ed committees, Meet ESs, observe
  LEPP
• Progress test both Written and Clinical exam
  annually before RCPsyc exam
• Review Communication skills/Simulation training
  in placements Started August 2015
• Training the ES in curriculum and examination (on
  line module under preparation) and CASC level
  training
• CT1and CT2 course is running from September 2015
• Review the whole course again in Spring 2016
  Consultation with all Trainees, Educational
  supervisors, Tutors, TPDs, DME
• Format will remain same but up to date journal
  clubs etc

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The next 12 months...

• Quality Assure
• To link with the TrOn trainee online (RCPsych)
  -Trainees can evidence for Portfolio
  Triangulation, FY do it
• Communication/Simulation training look at the
  practice across the patch and provide guidance on
  good practice
• MRCPsych website
• On line lectures, links to guidelines, news
  letters
• Regional training day for all, every two years.
  Updates on every branch of Psychiatry
  Local/National/International speakers, hosted by
  the NW School of Psychiatry ...American
  Congress- North of England Psychiatry Congress
• NW School of Psychiatry Debates Maudsley style
  debates two or three times a year
• In conjunction with the Medical School, Royal
  College of Psychiatrists, School of Psychiatry
  etc

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Quote

• Change is hard at first,
• Messy in the middle
• And
• Gorgeous in the endRobin Sharma

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My experience

• Human beings, generally are not made for change
• But.
• Most of us can be Persuaded
• Some of us are Malleable
• A few of us, have to be worked around

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Acknowledgements

• Wessex School of Psychiatry
• Professor Damien Longson
• Samantha Abbott and Team NW School of Psychiatry
• Subgroup leads, Trust leads, Tutors
• NW Directors of Medical Education
• New Consultants, especially Dr Gareth Thomas
  Dr Neelo Aslam Dr Brijesh Desai
• Trainees, especially Drs Alex Petcu, Rachel
  Thomasson, Ngozi Atulomah, Sally Makin, STs in
  CAP
• Steve Glover, CMFT Librarian

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Webshots
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Tutor Resouces
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Thank you for your timeAny Questions?