Psychiatric Bulletin (2001) 25: 471-472. doi: 10.1192/pb.25.12.471
© 2001 The Royal College of Psychiatrists
Psychiatric Bulletin (2001) 25: 471-472
© 2001 The Royal College of Psychiatrists
Trainees' attitudes to single and dual training in old age psychiatry
Ruth Allen, Consultant Old Age Psychiatrist
Royal Free Hospital, Pond Street, London NW3 2QG; tel: 020 7830
2400
Rob Butler, Locum Consultant Old Age Psychiatrist
St Margaret's Hospital, Epping, Essex
Correspondence: e-mail:
ruthallen 100{at}hotmail.com
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Abstract
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AIMS AND METHODS
To undertake a nationwide survey to find out the attitudes of old age
specialist registrars (SpRs) towards single and dual training. A questionnaire
was sent to all old age SpRs in the UK.
RESULTS
Two-thirds of SpRs were undergoing dual training. Most trainees favoured a
flexible system that offers the choice of single or dual accreditation. Many
trainees had concerns about single accreditation. Schemes vary in whether they
encourage one type of training or another.
CLINICAL IMPLICATIONS
Training schemes appear to vary unacceptably in their attitudes to
training. There needs to be a more consistent approach nationally. Clearer
guidance from the College may help.
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Introduction
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Old age psychiatry became a separate speciality within the NHS in 1989 and
is now well established (Jolley,
1999). Specialist registrars (SpRs) holding national training
numbers in old age psychiatry may pursue a single certificate of completion of
specialist training (CCST) or dual training with general adult psychiatry.
Dual training involves 2 years in each speciality while single old age
training involves a 3-year training period with at least 2 years spent in old
age psychiatry (Royal College of
Psychiatrists, 1998).
At the College's Old Age Faculty SpR meetings, concerns have been expressed
that trainees are not clear about the advantages and disadvantages of single
and dual training. Some trainees express concerns that single certification
may in some circumstances limit their flexibility as consultants, or offer
second class status. Furthermore, training schemes are perceived to have very
different attitudes to training. Some SpRs said their schemes routinely
encouraged trainees to undertake single training, while others said their
schemes routinely encouraged dual training.
Dual training has implications for workplace issues. Orrell
(1998) has pointed out that
dual accreditation lengthens training and consequently reduces the output of
trained old age psychiatrists (who are in short supply). For this reason, it
has been suggested that dual accreditation is not justified and should not be
offered to the vast majority (Shaw,
2000). Others have argued that the present system encourages a
thriving speciality (Godber,
1999).
The present system seems confused and lacks clarity. For these reasons we
surveyed senior and specialist registrars to find out their attitudes to
single and dual training.
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Method
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A questionnaire was designed and sent to all trainees in the country. The
old age psychiatry regional representatives were contacted and asked to
provide a list of training schemes and scheme organisers in their region. A
list of trainees in old age psychiatry was compiled by writing to the scheme
organisers requesting a list of trainees on their scheme registered for single
old age or dual training. Where there was no response or the regional
representatives were unsure, SpRs in that region were asked for the
information. A 
2 test was used to measure whether the reported
attitudes of the training schemes were associated with the number of single
and dual trainees on that scheme.
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Results
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The response rate was 153/213 (72%). Of these 78% were SpRs, 17% were
senior registrars and 5% lecturers. Eighty-seven per cent were full-time and
13% were flexible trainees; 67% of the sample were registered for dual
accreditation and 33% for single accreditation. Of those doing single training
15% said their SpR training would include no general adult training.
Seventy-six per cent of trainees aimed to be old age psychiatrists, 3% general
adult psychiatrists and 21% were undecided. The trainees' responses to the
questions asked are shown in Table
1.
Trainees also had the opportunity to list the main factor(s) influencing
their decision to opt for single or dual training. Their responses were
grouped together under broad categories. Out of 102 trainees registered for
dual accreditation, 44 cited greater flexibility and increasing their options
as the reason for their choice. Nineteen welcomed the wider training
experience and 17 wanted a longer training and, of these, six mentioned a
desire to delay the responsibilities of becoming a consultant. Fourteen were
undecided about ultimate career; 10 were concerned about needing experience to
provide general adult consultant on-call cover; eight were concerned that in
the future the College or trusts may discriminate against those with only a
single CCST; six made reference to old age psychiatry not being recognised in
other countries where they might want to practise; and three raised the issue
of private practice. Two trainees were uncertain as to which was the better
option.
Twelve of the 51 trainees pursuing single training selected this option
because they were clear that this was their career aim. Nine had no interest
or saw no relevance in further general adult training. Seven preferred the
shorter training time and six trainees pointed out how long part-time dual
training would take. One person felt pressured by their rotation, and another
felt that old age psychiatry was under threat and planned to leave his/her
rotation to pursue dual training elsewhere. Three mentioned concerns about
being part of an adult on-call rota and two acknowledged the lack of
flexibility in single training. One person called for clarification from the
College that those with a single CCST would not be disadvantaged when looking
for consultant jobs.
Trainees in schemes that encourage single accreditation were more likely to
be registered for single accreditation (P=0.001)
(Table 2).
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Discussion
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The majority of trainees did not want either a 3-year unified scheme or for
all trainees to become dually accredited. This survey shows that most trainees
want a flexible system that offers them the choice of single or dual training
in old age psychiatry. Many SpRs commented that the decision on single or dual
training should be left to the individual trainee. Substantial numbers of
trainees expressed concerns about the way NHS trusts and the College may view
single accreditation. These factors appeared to influence their choice,
although nearly half of those dual registered would leave early to take up a
consultant post they really wanted. Generally trainees seemed to have reasons
for their choice of single or dual training, with only a few feeling unsure or
pressured by others. Some trainees reported needing to have a second interview
to register for dual, while for others this was not necessary. Trainees
describe wide variation between schemes in terms of whether they routinely
encourage single or dual training. This form of ‘postcode’
training is unacceptable. There needs to be a more consistent approach across
training schemes. There should be clearer guidance from the College as to the
advantages and disadvantages of the types of training. This could also address
the concerns that many trainees have about the status of single training. If
reassured, more trainees may choose single accreditation. This may lead to
more trained old age psychiatrists filling posts currently vacant.
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Acknowledgments
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We thank Dr Marudkar and Dr Orrell for their comments on the questionnaire
design and the first draft of the paper, respectively.
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References
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GODBER, C. (1999) Beware dual certification (letter).
Old Age Psychiatrist,
14, 7.
JOLLEY, D. J. (1999) Care of older people with mental
illness. Psychiatric Bulletin,
23,
117-120.[Free Full Text]
ORRELL, M. (1998) Guest editorial. Old Age
Psychiatrist, 13,
2.
ROYAL COLLEGE OF PSYCHIATRISTS (1998)
Higher Specialist Training Handbook. Occasional Paper
OP43. London: Royal College of Psychiatrists.
SHAW, S. (2000) Dual accreditation — what's the
point? Old Age Psychiatrist,
18, 2.
Top
Abstract
Introduction
