General Adult Psychiatry

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. P M E ~ B Postgraduate Medical Education and Training Board

Approved by PMETB on 30 September 2005Specialty specific guidance in support of applications under Article 14 - General Adult Psychiatry

This document sets out the criteria that will be used to make an evaluation fo r applications under Article 14 (4). The documentalso details guidance on the standards and evidence that is required fo r applicants to demonstrate how they meet eachcriterion.Good Medical Practice

The evaluation criteria are based on the General Medical Council's Good Medical Practice.Specialists must be judgement-safe and competent in their field of specialist practice. They must be able to demonstrate the qualitiesand abilities to manage a clinical unit or team, ensuring high standards of professional care and effective working relationships withcolleagues across professional disciplines. Specialists should work within contemporary guidelines within the NHS. Specialists may takeon a leadership role within teams and organisations and will have the vision and foresight to develop new ways of working and thecommitment to see projects and teams through to the end. New Specialists will need to demonstrate the personal capacity and qualitiesto respond positively to feedback from colleagues and patients, to take and accept responsibility for clinical decisions, and to manageand respond to complaints from families of patients and fellow professionals in a professional manner. They will have the potential toteach and to support training programmes for trainees, departments and staff under their supervision

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be expected to demonstrate: Records of data for performance review Evidence of the methods, frequency andoutcomes of assessment e.g. Syllabi ofexaminations, assessmentsdocumentation and outcomes.Appropriate experience in: Record of assessment during training,documentation and outcomes.The assessment and management of Evidence that training was supervisedmental illness in working age adults by relevant psychiatric authorities e.g.Understanding issues regarding the Certification, log books/training records,implementation of mental health portfoliolegislation and the assessment of Evidence of subspecialty training e.gincapacity. psychotherapy log book Authenticated employment recordWorking in the context of listings for each post giving details ofmultiprofessional teams. type of post, workplace, size factorssuch as staff, patients, facilities,Experience and understanding of the specialties and dates.multi-agency health and social care Evidence of satisfactory completion ofenvironment in the context of developing posts authenticated by a designatedand delivering complex care packages in representative of the hospital. Evidenceaccordance with National service of satisfactory current appraisal/reframeworks/contemporary guidance for validation.mental health. Evidence of relevant recent ContinuingProfessional Development (CPOAn understanding and demonstrable certificates, or equivalent overseasadvocacy of the medical and social rights documentation required).patients. Structured ReportsTaking responsibility for effectiveconsultation including a detailed mental It is anticipated that successfulstate, cognitive and physical examination candidates would have at least five yearsand psychosocial assessment of the of general psychiatric training orpatient.

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Formulating a management plan,acknowledging the relevance of agerelated issues, catering for physical,psychiatric and social aspects ofpresentation.Providing clinical leadership in themanagement of complex cases involvingmultiple agencies, in accordance with thenational serviceframeworks/contemporary guidance formental health.Building therapeutic and supportiverelationships with both patients andcarers.Working in long term support of bothmentally and physically frail people incommunity and institutional settings.The prescribing and delivery of drugtreatments, electroconvulsive therapy andpsychosocial interventions in the contextof individual patients with complex mentaland physical illness.

experience of which a minimum of twoyears at a senior level (higher specialisttraining or equivalent)This experience should include workingin the context of multi-disciplinary teamsin community, out-patient and inpatientsettings, catering for acute and nonacute referrals.

Section 12 MHA approval orequivalent Evidence of supervised training inpsychotherapy, either completionof postgraduate course or seriesof supervised cases. Registration to practice as aspecialist Appraisal/revalidationdocumentation Other evidence offormative/summative assessment Demonstrating satisfactoryperformance at the level outlinedin the standards Multi-source feedback confirmingsatisfactory performance in the

areas and at the level outlined inthe standards. Evidence from\ case placeddiscussions across a range ofcomplex cases as demonstrationof clinical decision making skills. Other work olace basedPMETB General Adult Psychiatr y SSG Page 4 of 20 30 September 2005


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An understanding of the limitations oftheir competence. in clinical practice andtheir relationship with patients and knowwhere and when to ask for help, supportor supervision.

1.2 Have the self-awareness to 1Specialists in General Adult psychiatryacknowledge where the limits of will demonstrate in their practice:competence lie and when it isappropriate to refer to other seniorcolleagues for advice

The self-knowledge, confidence andpersonal high standards to acknowledgewhere an assessment may not becomprehensive and to recognise that theyneed to return to the patient, carers andmultiprofessional team for furtherinformation.

An awareness of the ways in which theirpersonal experiences, values andattitudes might affect their professionalpractice and know when to refer to a caseto another doctorThe principle that all decisions should bemade in the best interests of thepatient in their care.

from thecolleagues

assessments such as directlyobserved interactions orprocedures

Appraisal/revalidation documentation Other evidence of formative orsummative assessmentdemonstrating satisfactoryperformance at the level outlined inthe standards Multi-source feedback confirmingsatisfactory performance in the areasand at the level outlined in thestandards. Structured reportssupervisors and(nominated referees) Reflective entries in portfolio aroundspecific learning incidents.

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1.3 Have the potential (or ability) to take Spec ial ists in General Adult Psychiatry Success in MRCPsych or other testsresponsibility for clinical governance will demonstrate in their practice: of knowledge skills and attributesactivities, risk management and audit in Appraisal/revalidation documentationorder to improve the quality of service Knowledge about policy and practice Evidence of other formative orprovision relevant to clinical governance summative assessmentsdemonstrating satisfactoryParticipation in and responsibility for performance at the level outlined inclinical governance activities and the standards.encourage and support colleagues in Multi-source feedback confirmingtheir participation. satisfactory performance in the areasand at the level outlined in theAn awareness of local processes for standards.dealing with and learning from clinicalerrors and to be able to work within them Structured reports from supervisorsand colleagues (nominated referees)

Experience in the assessment andmanagement of patients considered to beat high risk of self harm, suicide or risk toothers.

Reflective entries in portfolioDescription of clinical governanceexperience, responsibilities andoutcomesDetails of clinical audit activity Evidence of post incident reviewspertaining to serious untowardincident reporting.

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2. Relationships with patientsSpecialists will demonstrate the capacity to build trust and to develop and maintain effective relationships with patients and their families.They will be good listeners and show respect and understanding for patients' perspectives on their illnesses or conditions. They mustdemonstrate a commitment to the principles and practice of consent and confidentiality.

Criterion

2.1 Specialists will need to developtrusting relationships with patients,carers and colleagues in alldisciplines. Recognise and respectpatients' diversity, including culturaland religious beliefs and practices.

Standards Suggested evidence

An understanding of the relevance of I advance directives.

An understanding of the importance ofsociological cultural and religious beliefsin the health and social care context.

Success in the MRCPsych or other test ofknowledge skills and attributesEvidence of Psychotherapeutic training;either appropriate postgraduatequalification or evidence of supervisedtraining.Appraisals/revalidationOther evidence of formative or summativeassessment demonstrating satisfactoryperformance in appropriate areas and tothe appropriate standard as described inthe document.Evidence from direct observation ofpatient and family consultationsExamples of written communications inportfolioPatient feedback data, formal andinformalEvidence from specific casesReflective entries in appraisal/revalidationportfolio.

Adult I .

An understanding and knowledge oflegislation regarding protecting the rightsof working age adults including the court , .of protection.

Emphasise through example the, importance of the person's autonomyand dignity, the rights of the individualand the relevance of involvement of thefamily and carers within the context ofassessment and management.

Specialists in Generalpsychiatry will demonstrate:

Effective and active listenina skills inPMETB General Adult Psychiatry SSG Page 7 of 20 30 September 2005


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consultations with individuals and theircarers, respecting their views andresponding appropriately.

The ability to develop a therapeuticrelationship and undertake appropriatepsychotherapeutic interventions withpatients, irrespective of age, physical ormental health.A commitment to ensure that spoken andwritten communication with lay peopleare written in non technical Englishdesigned to be understood by therecipient.Awareness that treatment and careaccommodates the cultural and religiousbeliefs of the individual and relevantcarers.Genuiness, empathy, courtesy andacceptance in terms of relationships withpatients as expressed throughknowledge, skills and experience inclinical practice and in their ability towork independently.

2.2 Specialists will follow the principlesand legal aspects of consent andconfidentiality. Working knowledge ofSpecialists in GeneralPsychiatry will demonstratepractice:

Adult Iin theirI

Success in the MRCPsych or other testof knowledge skills and attributesEvidence of PsychotherapeuticPMETB General Adult Psychiatry SSG Page 8 of 20 30 September 2005


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2. 3

the relevant legislative framework.

Specialists will be able to managedifficult and complex situations withpatients and their families, to advisethem appropriately and to managecomplaints effectively

Knowledge of key legal and ethicalguidelines to support their workespecially relating to consent totreatment and the right to refusetreatment by patients.An understanding of the rules relating toconfidentiality in the context of the multdisciplinary team, carers and other staffinvolved in the individual's care.Recognition of when the need to protecta vulnerable person outweighs the needto preserve confidentiality.

Recognition of when and why to shareinformation about an individual patientand how to ask for consent to share thisinformation and communicate concernsclearly.

Specialists in General adult I psychiatry will demonstrate in their practice:

Effective skills in working with patient,carers and extended networks in I planning and managing treatments,maximising the autonomy and selfmanagement skills of the individual.

training; either appropriatepostgraduate qualification or evidenceof supervised training.Appraisals/revalidationOther evidence of formative orsummative assessment demonstratingsatisfactory performance in appropriateareas and to the appropriate standardas described in the document.Evidence from direct observation ofpatient and family consultationsExamples of written communications inportfolioPatient feedback data, formal andinformalEvidence from specific casesReflective entries inappraisal/revalidation portfolio.

appraisals/revalidation documentationother evidence of formative or summativeassessment demonstrating satisfactoryperformance at the level outlined in thestandardsmulti-source feedback confirmingsatisfactory performance in the areas andat the level outlined in the standardsstructured reports from supervisors andPMETB General Adult Psychiatr y SSG Page 9 of 20 30 September 2005


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A keen awareness of their own personal,emotional reactions and the impact thatthese might have on patients, carers and Icolleagues.

The ability to work effectively with peoplewho may have different perspectives andunderstanding of mental illness cases

colleagues (nominated referees) evidence from case based discussion inthe areas and at the level outlined in thestandardsevidence from direct observation of patientand family consultationsevidence from specific(anonymised) reflective entries in appraisal/revalidationportfolio

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3. Maintaining Good Medical PracticeKeeping up to dateSpecialists set high standards in their clinical care and ensure that they remain fully competent to practise through their commitment tocontinuing professional development and the process of revalidation. They foster the skills and abilities of colleagues and encouragetheir professional development by identifying and ensuring their participation in further training and research opportunities. Specialistsare reflective practitioners and strive to improve standards in all aspects of their work. They demonstrate the ability to seek and respondconstructively to feedback.

Criterion

3.1 Specialists will take responsibilityfor and keep up-to-date in their ownrelevant professional and selfdevelopment, and facilitate that ofothers

Standards

Specialists in General AdultPsychiatry will demonstrate in theirpractice:That they are up to date in their practiceand promote evidence based medicinewhere possible.An understanding of the basic conceptsof research and ability to evaluateresearch effectively.A reflective approach to their practice,with an awareness of their level ofexpertise and limitations and theirdevelopment needs.A willingness to learn from others and acommitment to continuing professionaldevelopment, which would involve not

Suggested evidence

Success in MRCPsych or other test ofknowledge skills and attributes Appraisals/revalidation documentation Other evidence of formative or summativeassessment demonstrating satisfactoryperformance at the level outlined in thestandards Multi-source feedback confirming satisfactoryperformance in the areas and at the leveloutlined in the standards Structured reports from supervisors andcolleagues (nominated referees)

Personal learning/development plan Study leave record and other evidence ofcontinuing development Evidence of progression from formativeassessments Participation in teaching and lecturing Participation in departmental auditPMETB General Adult Psychiatry SSG Page 11 of 20 30 September 2005


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3.2 Specialists will acknowledge thatthe balance and quality of theirskills and expertise will change astheir careers progress and theyspecialise in certain areas of clinicalpractice

only seeking appropriate trainingopportunities but also respond tocomplaints and enquiries as usefullearning opportunities.

A willingness to accept mentoring as apositive contribution to their ownprofessional development.

Specialists in General AdultPsychiatry will demonstrate in theirpractice:The ability to apply affectively to theirpractice the knowledge andunderstanding acquired in their careerand the use of skills and strategies torespond effectively to challenges ofincreased responsibilityEffective skills in organisation,prioritisation and delegation and be ableto help others develop theseEffective professional networks thatthey have developed to support clinicalpractice and research activities.

Reflective entries in portfolio on evidence oflearning from formal training, attendance atcourses or from clinical practice

Appraisals/revalidation Other evidence of formative or summativeassessment demonstrating satisfactoryperformance in appropriate areas and to theappropriate standard as described in thedocument. Multi-source feedback confirming satisfactoryperformance in the areas and at the leveloutlined in the standards Structured reports from supervisors andcolleagues (nominated references) Reflective entries in appraisal/revalidationportfolio.



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4. Teaching and Training, appraising and assessingMaking assessments and providing referencesSpecialists are usually expected to teach and train students, trainees and colleagues and to appraise colleagues and assess their work.They will need to demonstrate effective communication skills in all of these activities, in the presentation and discussion of topics and intheir personal interactions. Specialists will be able to demonstrate an understanding of and a commitment to the principles and practiceof effective teaching and learning in clinical contexts. They must be able to take responsibility for the supervision of trainees and ensurethat effective arrangements are in place. They must demonstrate the ability to be open, honest and objective in appraisals and in writtenreferences for colleagues.

Criterion Standards Suggested evidence

to I Specia lists in General Adu l t . appraisals/revalidation documentation4.1 Specialists will be able Psychiatry will demonstrate in their other evidence of formative or summativedemonstrate the potential to teach practice: assessment demonstrating satisfactoryand train effectively at all levels of performance at the level outlined in theundergraduate and postgraduate A range of effective teaching and standardseducation where required learning skills on topics within their I multi-source feedback confirmingspecialty, in related clinical and satisfactory performance in the areas and atresearch areas and in a variety of the level outlined in the standardscontexts. structured reports from supervisors andcolleagues (nominated referees)evidence ofResponsibility for the training, super attending a suitable training coursevision and assessment of reflective entries in appraisal/revalidationundergraduates and trainees and other portfolioprofessionals such as nurses, therapistsand social workersThe ability to assess accurately thelevels of support and supervision thatare reauired bv different members of the



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team they supervise.

4.2 Specialists will demonstrate skillsand strategies in the process offeedback to colleagues and trainees,ensuring positive and constructiveoutcomes

Specialists in General AdultPsychiatry will demonstrate in theirpractice:

An understanding of the importance of apositive and constructive approach tomentoring, giving support, guidance andfeedback to trainees under theirsupervision.The ability to identify learning needs in awide range of professions and build onthis in their teaching.A reflective approach about theirexperiences in order to ensure positiveexperiences for trainees now under theirsupervision.

appraisals/revalidation documentation other evidence of formative or summativeassessment demonstrating satisfactoryperformance at the level outlined in thestandards multi-source feedback confirmingsatisfactory performance in the areas and atthe level outlined in the standards structured reports from supervisors andcolleagues (nominated referees) evidence of attending a suitable trainingcourse reflective entries in appraisal/revalidationportfolio

4.3 Specialists will be capable of judging Specialists in General Adult appraisals/revalidation documentationcompetence and professional Psychiatry will demonstrate in their other evidence of formative or summativeattributes in others practice: assessment demonstrating satisfactoryperformance at the level outlined in thePMETB General Adult Psychiat ry SSG Page 14 of 20 30 September 2005


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Honesty and integrity when contributingto peer reviews of colleagues teachingor researchRecognition of their own preferencesand an acceptance of differentapproaches of colleaguesThe ability to recognise and supportcolleagues who may be under pressure

standards multi-source feedback confirmingsatisfactory performance in the areas and atthe level outlined in the standards structured reports from supervisors andcolleagues (nominated referees) anonymised examples inappraisal/revalidation portfolio reflective entries in appraisal/revalidationportfolio

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5. Working with colleaguesWorking in teams and within organisationsSpecialists work as members of a number of teams and within organisations. They must be able to demonstrate an understanding of theroles of others and a respect for the knowledge, skills and experience they bring to a team and to an organisation. They will need todemonstrate strong interpersonal skills and an open and non-discriminatory approach to professional working relationships withcolleagues.


5.1 Strive for continuing improvement in allaspects of their work and that ofcolleagues while mindful of prioritiesand high standards

Specialists in General AdultPsychiatry will demonstrate in theirpractice:Knowledge of how to find, review andmaintain relevant knowledge in theirspecialty in order to maintain theirpracticethe ability to work with colleagues froma range of partner organizations bothstatutory and non-statutory including forexample social services, probationservices, NSF, MIND, Alzheimer'sAssociation.The ability to evaluate their ownperformance critically and a willingnessto be open about sharing and reviewingtheir practice with others

Appraisal/revalidation documentation Evidence of other formative or summativeassessments demonstrating satisfactoryperformance at the level outlined in thestandards. Multi-source feedback confirmingsatisfactory performance in the areas andat the level outlined in the standards. Structured reports from supervisors andcolleagues (nominated referees) Evidence of case based discussions in theareas and levels outlined in the standards Reflective entries in the portfolio

5.2 Have effective interpersonal skills I Specialists in General Adult I Appraisal/revalidation documentationPMETB General Adult Psychiatry SSG Page 16 of 20 30 September 2005


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5.3

which enable them to bring out thebest in colleagues, to resolve conflictswhen they arise and to develop andmaintain productive workingrelationships within the team.

Support teams that bring togetherdifferent professionals and disciplinesand other agencies, to provide highquality health care

Psychiatry will demonstrate in theirpractice:A commitment to ensure open and nondiscriminatory professional workingrelationships with colleagues and beaware of the need to prevent bullyingand harassment and demonstrateeffective administrative skills includingways to maximise support services.

The ability to take on differing andcomplementary roles within the differentcommunities of practice within whichthey work, in hospitals, in thecommunity and with social services andvoluntary agencies.

The ability to work effectively in multiagency teams, for example, with socialworkers and teachers, and havedeveloped an awareness of their ownrole within the team and the skills andexpertise of others.

Specialists in GeneralPsychiatry will demonstrate: Adult

Evidence of other formative or summativeassessments demonstrating satisfactoryperformance at the level outlined in thestandards.Multi-source feedback confirmingsatisfactory performance in the areas andat the level outlined in the standards.Structured reports from supervisors andcolleagues (nominated referees)

Appraisal/revalidation documentationEvidence of other formative or summativeassessments demonstrating satisfactoryperformance at the level outlined in thestandards.Multi-source feedback confirmingsatisfactory performance in the areas andat the level outlined in the standards.Structured reports from supervisors andcolleagues (nominated referees)Evidence based from case-baseddiscussions in the areas and at the levelsin the standards.

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6. Probity and HealthProtecting patients and the professionSpecialists are honest and trustworthy, recognising the privileges and responsibilities of their position. They ensure the standards ofGood Medical Practice as set out by the General Medical Council and other relevant Colleges/Faculties or professional bodies are met.


6.1 Always act in their personal and Specia lis ts in General Adult Appraisal/revalidation documentationprofessional lives to maintain public Psychiatry will demonstrate in their Evidence of other formative or summativetrust in the profession. practice: assessments demonstrating satisfactoryperformance at the level outlined in theAn understanding of national and local standards.regulatory bodies involved in standards Multi-source feedback confirming satisfactoryof professional and personal behaviour, performance in the areas and at the levelclinical practice and in education, outlined in the standards.training and assessment. Structured reports from supervisors andcolleagues (nominated referees)Probity in their personal and Current evidence of good standing and theprofessional life relevant regulatory body Probity statement Health statement

6.2 Act quickly and effectively if they Specialists in General Adult Appraisal/revalidation documentationhave a reason to believe that their Psychiatry will demonstrate in their Evidence of other formative or summativeown or a colleagues conduct, practice: assessments demonstrating satisfactoryperformance or health may put a performance at the level outlined in thepatient at risk Be honest and know the procedures to standards.follow where there is a concern about Multi-source feedback confirmina satisfactoryPMETB General Adult Psychiatry SSG Page 18 of 20 30 September 2005


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the professional practice of a colleaguewhich might be putting the health ofpatients at risk.Responsibility for their own health in sofar as it might affect the welfare ofpatients' safety.

performance in the areas and at theoutlined in the standards.Structured reports from supervisorscolleagues (nominated referees)

leveland

6.3 Undertake duties such as writingreports, giving evidence andcompleting and signing documentsin a timely I honest and conscientiouswith due respect for patients'confidentiality.

Specialists in General AdultPsychiatry will demonstrate in theirpractice:Know how to write reports concerningcapacity assessment for social servicesand the courts.Making accurate and comprehensivereports that will subsequently withstandscrutiny in a court of law or MentalHealth Act Appeal TribunalEffective skills in writtencommunications for a range ofaudiences, for patients and theirfamilies, colleagues and otherprofessional organisations.The ability to prepare a court report asa professional witness and develop theskills to present such material in court.

Appraisals/revalidation documentationOther evidence of formative or summativeassessment demonstrating satisfactoryperformance at the level of the outlinedstandards.Multi-source feedback confirming satisfactoryperformance in the areas and at the leveloutlined in the standards.Structured reports from supervisors andcolleagues (nominated referees)Examples of written communications inportfolioEvidence from case based discussion in theareas and at the level outlined in thestandards.

6.4 Through leadership encourage thedevelopment and practice of thesequalities in their colleaguesSpecialists in General AdultPsychiatry will demonstrate in theirpractice:

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The high standards expected of themby patients and carers, providing a rolemodel for other professionals inpromoting the mental health of olderpeople.

Structured reports from supervisors andcolleagues (nominated referees) Examples of written communications inportfolio Other evidence of formative or summativeassessment demonstrating satisfactoryperformance at the level of the outlinedstandards


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General Adult Psychiatry

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