Psychiatric Bulletin (2007) 31: 230-232. doi: 10.1192/pb.bp.106.012286
© 2007 The Royal College of Psychiatrists
First experience of recruiting to the new specialist training programme
Megan Munro, Consultant Psychiatrist
Stein Centre, St Catherine’s Hospital, Birkenhead, Wirral CH42 0LQ,
email
Megan.Munro{at}cwpnt.nhs.uk
Michael Wesson, Consultant Psychiatrist
The Hesketh Centre, Southport
Mark Theophanous, Consultant Psychiatrist
The Stewart Unit, Peasley Cross Wing, Merseyside
Declaration of interest
The authors are honorary joint coordinators of the Mersey Regional
Rotational Training Scheme.
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Introduction
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In 2002 Unfinished Business, a report and consultation paper by
Sir Liam Donaldson, Chief Medical Officer for England, put forward proposals
for the reform of the senior house officer (SHO) grade, including the
formation of the new early years foundation posts
(Donaldson, 2002). In 2004
Modernising Medical Careers - The Next Steps
(Department of Health, 2004)
outlined specialty and general practitioner (GP) training programmes building
on the foundation programme. As a result all medical training will be changing
to a competency-based model from August 2007. This will encompass run-through
training from specialist training years 1 (ST1) to 6 (ST6). Some regions and
specialties have been chosen as pilot sites for specialist training year 1
commencing August 2006.
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Mersey Deanery pilot
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The Mersey Deanery has embraced the changes with enthusiasm and was a pilot
site for foundation year 2 (F2) trainees in 2004, which included psychiatric
placements. Psychiatry is one of the specialties that has agreed to take part
in the ST1 pilot.
The Merseyside regional rotational training scheme has 93 trainees at SHO
level spread over a large geographical area. Organisation of the scheme is
carried out by three scheme coordinators, one from each of the largest local
trusts, with input from local college tutors and specialties via the Basic
Specialist Training and Education Committee (STEC). They are supported
administratively by the medical staffing department of the single employing
trust. Until now the scheme has been run much along the lines of most training
schemes, with competitive interview, contracts being renewed on satisfactory
progress and an expectation that trainees will progress quickly through years
1 to 3 and obtain their Membership of the Royal College of Psychiatrists
before taking up higher postgraduate training.
For the new specialist training scheme it was considered that a more robust
form of selection would be required if the right individuals were to be found
for the 6-year specialist training now proposed. A new recruitment and
selection process was set up by the scheme organisers with help and advice
from Mersey Deanery. It consisted of an application process, a shortlisting
procedure and a competitive interview.
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Application process
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Advertisements appeared on the Mersey Deanery website
(http://www.merseydeanery.nhs.uk)
along with a person specification and in the BMJ. Applicants were
required to download the application form and send in four paper copies. Human
resources staff initially screened the applications for valid General Medical
Council (GMC) registration.
The application form was in 11 sections:
- personal details
- GMC registration
- professional qualifications and experience, including prizes
- present employment
- previous appointments
- clinical care - knowledge and skills including evidence of F2 training
- audit - a description of an audit project carried out by the candidate
- evidence-based medicine/research/presentations and publications - intended
to demonstrate the candidate’s understanding of these
- interpersonal skills and team work
- personal skills/personal statement/other interests
- referees
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Shortlisting
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Nominations were invited from local trusts for current educational
supervisors to sit on the shortlisting and interview panels. Representation
was sought from the academic department and specialties, and from
carers’ and users’ groups. General adult psychiatry, old age
psychiatry, psychotherapy, learning disabilities, child and adolescent mental
health services, the local academic unit, and carers and users were all
represented.
Fifteen panel members were identified and met on 2 days to shortlist from
186 eligible applications. The group split into 3 smaller groups of 5, each
group reviewing 62 applications. The 3 scheme coordinators had devised, with
wider consultation, a scoring sheet for evaluating the applications, allowing
for a score out of 50 to be awarded. The scheme coordinators moved among
groups in order to try to maintain some consistency in scoring. Each candidate
was awarded a score by the group and this was entered on a spreadsheet by one
of the administration staff.
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Interview schedule
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Although having a psychiatric bias, the interviews should not have been
beyond the capabilities of any doctor who had undertaken house officer or
foundation year training. It consisted of three parts, a traditional
interview, a presentation and a practical skills assessment. Prior to the
interview candidates’ documents were checked by staff from medical
staffing.
Traditional interview
The interview section of the assessment involved four interviewers,
including a patient representative, and lasted for 20 min. The interview was
structured with four questions, the final question being subdivided into three
parts. The questions were based on the F2 curriculum. All candidates were
asked the same set of questions in the same order. They included questions
about the applicants’ reasons for choosing psychiatry as a career, their
understanding of the process and purpose of audit, the role of alcohol in
psychiatric and psychological morbidity and a clinical vignette to promote a
discussion about mental capacity.
Presentation
Candidates were given the topic on arrival and allowed 30 min for
preparation. No presentation aids (e.g. overhead projector or power point)
were provided, however, candidates were advised they could make notes for use
during the presentation, which was to be of no more than 5 min. The topic for
the presentation was ‘Discuss the reasons why some people develop mental
disorders and others do not’.
The idea behind this station was to test not only the candidate’s
knowledge but also their ability to think on their feet and test their
performance under pressure.
Practical skills
This took the form of an objective structured clinical examination (OSCE),
lasting up to 10 min, where actor patients were employed. The case scenario
was that of a potentially suicidal patient and the task was to assess the
current risk of suicide.
Scoring system
For each of the stations a comprehensive scoring sheet had been prepared.
This was broken down into component parts for each station. The interview
attracted a maximum score of 30 points, the presentation could score up to 20
points and the practical skills scenario also had a maximum score of 20
points. Each interviewer scored their station separately and was asked to make
notes for subsequent analysis and to aid feedback (sample score sheets are
available from the authors on request).
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Selection process
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The selection procedure took place over 2 days. Each candidate followed the
same pattern of presentation, interview and practical skills for which 40 min
had been allocated. There were two interview stations and one each of the
other stations; starting times were staggered. The timetable was devised by
medical staffing personnel who also acted as invigilators and timekeepers. The
15 individuals who had been involved in the shortlisting process were split
among the four stations. In order to try to maintain consistency, the same
interviewers were based on the same stations on both days and the content of
the interviews remained the same.
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Results
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From 186 eligible applications, 64 candidates were shortlisted and 51 of
these attended for interview. Shortlisting scores ranged from 1 to 40, and
those with a score of 
22 were shortlisted. The mean score for those
shortlisted was 28.9, and for those who were not the mean score was 13.6.
Scores during the selection procedure ranged from 21.5 to 56.5 out of 70.
The 24 successful candidates scored 42 and over. There were seven reserve
candidates scoring between 39 and 41.5. The mean score of successful
candidates was 46.7 and that for unsuccessful candidates was 33.8.
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Discussion
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Disadvantages of this type of selection process are that it is
time-consuming and costly in terms of manpower; 12 consultant psychiatrists
and three service users/carers were involved over 4 days. There were also 4
half-days of actor/patient time. The organisation and administration of the
procedure took up many hours of human resources staff time.
In spite of the apparent drawbacks, the positive features were the
cooperation between the scheme coordinators, other interviewers and human
resources staff, which led to the interviews running smoothly and with no
timing problems. Feedback from the users’/carers’ group about the
process has generally been positive. The venue, an empty ward in a district
general hospital, worked particularly well as it was possible to make use of
bays as interview stations and side-rooms as a waiting area, documents
checking station and presentation preparation areas.
Each candidate was asked the same questions in the same order at interview
and carried out identical tasks in the presentation and practical skills
station. It was hoped that this format would ensure consistency and reduce
interviewer bias. However, we acknowledge limitations in the selection
process, particularly as a single OSCE is not considered to be a reliable
measure of clinical skills. This was our first experience of deviating from a
traditional interview procedure and the format had to be devised within a
limited timescale. Consideration will be given to a different procedure in
future.
All scoring sheets were retained and unsuccessful candidates were invited
to request feedback; six individuals took up the offer. The use of a
comprehensive scoring system made this easier and more meaningful.
Next year all recruits to psychiatry will be joining the new specialist
training schemes. We hope this paper will help to inform the process of
recruitment and selection and provide other scheme organisers with points to
help them devise their own procedures.
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Acknowledgments
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We thank Emma Hulme, Dawn McLoughlin and Christine Withey of the Human
Resource Department, Merseycare NHS Trust.
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References
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DEPARTMENT OF HEALTH (2004) Modernising
Medical Careers:The Next Steps. The Future Shape of Foundation, Specialist and
General Practice Training Programmes. Department of
Health.DONALDSON, L. (2002) Unfinished Business:
Proposals for Reform of the Senior House Officer Grade - A Paper for
Consultation. Department of Health.
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Introduction
Mersey Deanery pilot