Psychiatric Bulletin (2006) 30: 229-231. doi: 10.1192/pb.30.6.229
© 2006 The Royal College of Psychiatrists
Psychiatric Bulletin (2006) 30: 229-231
© 2006 The Royal College of Psychiatrists
The International Fellowship Scheme for consultant psychiatrists: trainees’ perspective
Sanju George, Specialist Registrar in General Adult Psychiatry
Sandwell OutreachTeam, 6-6A Simpson Street, Oldbury, Birmingham B69 4AL,
e-mail:
sanju.george{at}talk21.com
Bill Calthorpe, Specialist Registrar in General Adult Psychiatry
Queen Elizabeth Psychiatric Hospital, Birmingham
Sudhir Khandelwal, Consultant in General Adult Psychiatry
Glenfield Hospital, Leicester
Declaration of interest
S.K is a consultant psychiatrist from India who came to England under the
NHS International Fellowship Scheme. S.G. and B.C. are SpRs training in the
UK.
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Introduction
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The NHS International Fellowship Scheme for consultants offers overseas
consultants, in specialties including psychiatry, an opportunity to work in
the UK (Goldberg, 2003). This
was launched by the Department of Health in 2002 and so far over 100
consultant psychiatrists have been recruited. However, there are several
aspects of the project that are unclear. How long will this recruitment
continue? Are there any arrangements in place to encourage overseas
consultants to return to their home country at the end of their fellowship?
Are they eligible to train senior house officers (SHOs) and specialist
registrars (SpRs)? Will the recruitment under the scheme have an impact on job
opportunities for SpRs currently training in the UK? Why is membership of the
Royal College of Psychiatrists being granted to the newly recruited
consultants without an examination? These and many more concerns have arisen
in the wake of this scheme. In this article, we evaluate the scheme, discuss
its implications and suggest possible ways forward.
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Benefits of the scheme
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This scheme has a range of potential benefits. It will help to fill the
vacant consultant posts in the National Health Service (NHS). Careful and
selective recruitment of highly skilled and truly committed consultants can
make a real difference to mental health service delivery.
The overseas consultants and potentially their home countries have as much
to gain as the NHS. The scheme offers them an opportunity to work ‘in a
different health system, acquire new skills, get wider work experience, pursue
research interests and develop their teaching skills’
(Mellor, 2003). Individual NHS
trusts are also providing many, less well-publicised, voluntary services in
their home countries, in areas such as mental health and women’s health
(Mellor, 2003).
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Induction, mentoring and continuing professional development
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Most trusts have programmes to help overseas consultants familiarise
themselves with the healthcare system and life in the UK in general. The trust
which employs the consultants arranges for them to attend an induction
programme, which includes an introduction to life in the UK, clinical aspects
of the job and a discussion of cultural issues which may be unfamiliar. Most
trusts also arrange training in the Mental Health Act 1983 and assist in
obtaining Section 12(2) approval. However, there is a need to evaluate current
induction programmes to explore whether they are uniform and fulfil both
professional and pastoral needs.
A trust should also, in consultation with the consultant, appoint a medical
colleague to act as mentor. If the post involves research, a research mentor
should also be assigned. The mentor should discuss with the consultant their
needs for continuing professional development (CPD) and opportunities for
study leave and further training. A trust should also identify a member of
staff to ensure pastoral support during the transition period. This should
include an introduction to social and professional networks for the doctors
and their families.
The Royal College of Psychiatrists has a significant role to play in
providing advice on opportunities for CPD and in ensuring a supportive and
comfortable working environment for the new consultants.
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Trainees’ concerns
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A number of experts have expressed ethical and moral concerns about
recruitment of consultant psychiatrists from low- and middle-income countries
(Mellor, 2003;
Patel, 2003;
Ndetei et al, 2004).
In addition, how does this scheme affect the training and career opportunities
of UK trainees? There are two major issues that should be considered.
First, although the posts are advertised as nontraining appointments, this
is not always the case. Many overseas consultants are being appointed to
training posts and are closely involved in the training of SHOs and SpRs.
There are several aspects of psychiatric training in the UK (e.g. preparing
trainees for the MRCPsych examinations) that only experienced trainers can
adequately cover. Fortunately, overseas consultants are usually highly skilled
and have a wealth of clinical and research experience and, in general, it is
only the form and not the content of postgraduate psychiatric training that
tends to vary across countries. However, there is a clear case for a longer
period before these consultants become trainers. There is also a need for
tighter monitoring of the training process. The College has a key role to play
in teaching these consultants to be good trainers (e.g. by organising training
workshops). Once in the role of trainer, the consultants should undergo the
same periodical review as existing UK psychiatrists.
Second, there is the issue of conferring the MRCPsych qualification on
overseas consultants after a relatively short period of time. It is perceived,
particularly by trainees, that some consultants recruited from overseas are
granted Membership far too readily, thus causing resentment in those who have
worked hard to obtain the qualification. The decision to confer Membership
should only take place following extensive discussions with all the
stakeholders. It could be argued that conferring some alternative
qualification would be more appropriate. However, by conferring Membership the
College could ensure CPD through College meetings and workshops, etc.
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Ways forward
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It is evident that there are no easy solutions to some of the pitfalls of
the scheme. We therefore suggest some measures that might improve the
effectiveness of the recruitment scheme.
Prior to recruitment
First, the scheme should be more selective and should assess the commitment
and motivation of prospective recruits to ensure that they are coming to the
UK for the right reasons. Second, there needs to be agreement on the number of
consultants to be recruited and over what period of time. The number should be
balanced against the number of specialist registrars who are likely to
complete their training and qualify for consultant posts. Third, it needs to
be ensured that a strictly ethical recruitment policy is followed by all NHS
trusts and this should be closely monitored with tighter regulations in place
to guarantee adherence. Finally, the scheme needs to be encouraged within the
context of ‘exchange programmes’ and better support and advice
should be available to the overseas consultants should they wish to return to
their home countries.
After recruitment
Trusts need to provide more thorough induction programmes and adequate peer
support and mentoring. There should also be a post-induction review to
determine how well recruits are settling into their new roles, and whether
they are experiencing any cultural or professional problems.
A much wider debate, including trainees, should discuss the eligibility of
overseas consultants to become trainers and members of the College. The
College should extend CPD opportunities to the recruits and support them in
becoming good trainers for SHOs and SpRs.
Long-term solutions
Although the scheme represents a short-term solution to the problem of
unfilled UK consultant posts in psychiatry, other long-term approaches should
not be overlooked. These include increasing the intake into UK medical
schools, encouraging more medical students into psychiatry and increasing the
number of SHO and SpR training posts in psychiatry. In addition, current
government initiatives such as Modernising Medical Careers will allow greater
opportunities to experience psychiatry in Foundation Years 1 and 2.
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Conclusion
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In principle, the NHS International Fellowship Scheme has broad-ranging
moral, logistic and training implications. There needs to be a much wider
debate of the specific details of the programme and more intense monitoring of
its effectiveness. Recognising and rectifying any failings early on will
prevent it from becoming a chronic dysfunctional programme, delivering little
benefit and compromising low- and middle-income countries.
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References
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GOLDBERG, D. (2003) The NHS International Fellowship
Scheme for Consultant Psychiatrists. Newsletter of the Faculty of
General and Community Psychiatry,
6, 5
–6.MELLOR, D. (2003) Commentary: recruitment is ethical.
BMJ, 327, 928
.[Free Full Text]
NDETEI, D., KARIM, S. & MUBBAHAR, M. (2004)
Recruitment of consultant psychiatrists from low- and middle-income countries.
International Psychiatry,
6, 15
–18.
PATEL, V. (2003) Recruiting doctors from poor
countries: the great brain robbery. BMJ,
327, 926
–928.[Free Full Text]
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Introduction
Benefits of the scheme