Cross specialty training would improve outlook for academic psychiatry, says report

BMJ 2013; 346 doi: (Published 29 March 2013) Cite this as: BMJ 2013;346:f2080
  1. Zosia Kmietowicz
  1. 1BMJ

Training of psychiatrists needs to be more flexible to encourage doctors to take up the specialty and pursue a career in academia, a report has said.

Without a fresh approach to training, the advances being made in science were less likely to be translated into developments in diagnosis and management, because doctors were not choosing to teach future generation of psychiatrists, said Nick Craddock, professor of psychiatry at Cardiff University’s department of psychological medicine and neurology.

He was speaking at the launch of the report from the Academy of Medical Sciences, Strengthening Academic Psychiatry in the UK.1

The number of posts in academic psychiatry in the United Kingdom has fallen by 27% since 2000. And although mental ill health accounts for some 15% of the disease burden in developed countries, spending on mental health research makes up just 5% of the total UK health research budget.

Part of the problem was that psychiatry was not “projected sufficiently well enough,” said Simon Wessely, vice dean in academic psychiatry at the Institute of Psychiatry in London.

Much UK academic activity was funded by the NHS, and, with demands for efficiency savings, managers saw academia as an area that they could cut without attracting unfavourable headlines, he said.

Training places in psychiatry also continued to be undersubscribed. In 2011 only 83% of the 478 first year training posts in psychiatry in England were filled, rising only slightly to 85% in 2012, far less than the proportion in other major specialties.

Trainees often wrongly believed that nothing could be done for psychiatric patients, said Wessely. And stigmatisation of patients with psychiatric problems meant that they were seen as difficult and challenging, but psychiatry offered a very rewarding career with high rates of satisfaction, he added.

One of the report’s recommendations is to remove “unhelpful and constraining boundaries between psychiatry and related specialties” by developing integrated training programmes. This would allow psychiatrists in training to undertake modules in neurology, paediatrics, immunology, and other related disciplines and bring these skills to patients and other doctors if they chose to take up teaching posts.

Craddock said, “It is a fantastic time in the science of the brain. We have a fabulous opportunity to bring together a lot of disciplines to understand psychiatric illness, develop diagnosis and management, and take forward these skills to deliver better care and train doctors to deliver better care.”

He added that the current system of specialty training was delivered with the short term requirements of the NHS in mind. “This does not marry up very well to the requirements of academic medicine,” said Craddock.

This was different from the situation in the United States, where doctors’ training was run by universities with a greater focus on the individual doctor’s training needs rather than the needs of the health system, he added.

The report also calls for improving research capacity in academic psychiatric and ensuring that trainees in the specialty can carry out doctoral research in optimal settings. At the moment many trainees may do their clinical training at some distance from their research base—a situation that the Academic Faculty of the Royal College of Psychiatry has described as “deeply concerning.”


Cite this as: BMJ 2013;346:f2080