"REGULATIONS FOR BASIC AND HIGHER SPECIALIST TRAINING INTRODUCTION The College of Psychiatrists of  (referred to in this document as the College) is responsible for all aspects of postgraduate training in Psychiatry. Its aim is to provide the best possible training at both basic and higher specialist levels in Psychiatry. Satisfactory completion of specialist training confers eligibility for inclusion on the Specialist Division of the Medical Register. The Medical Council recognises four psychiatric specialties: Psychiatry*, Psychiatry of Old Age, Child & Adolescent Psychiatry and Psychiatry of Learning Disability. * Throughout this document the term ‘Psychiatry’ refers to the specialty Psychiatry as recognised by the Medical Council’s Specialist Register and which in practice is General Adult Psychiatry. This document provides the regulations for Basic and Higher Specialist Training and should be read in conjunction with the Curriculum for Basic and Higher Specialist Training. Section 1 deals with the structure of training and the regulations for the award of Certificate of Completion of Basic Specialist Training (CCBST) and Certificate of Completion of Higher Specialist Training (CCHST). Section 2 deals with the Regulations for the Basic and Higher Training Schemes. Section 3 deals with the Continuous Assessment process Section 4 deals with the Examination This document, in conjunction with the Curriculum for Basic and Higher Specialist Training 2012, replaces the BST Blueprint (July 2011) and the Higher Specialist Training Handbook (January 2010). The development of regulations for Basic and Higher Specialist Training will include regular reviews and updates. Any member of the College of Psychiatrists of Ireland who wishes to suggest a change should submit that proposed change to the relevant Faculty and/or College committee. In turn, that Faculty/College Committee will make a recommendation on the proposed change to the Dean of Education. This edition would not have been possible without the support of the College staff and the commitment of the College membership who voluntarily contribute to the many Committees and Sub-committees that produced the above documents. 5 SECTION 1: CERTIFICATES OF COMPLETION OF BASIC SPECIALIST TRAINING (CCBST) AND HIGHER SPECIALIST TRAINING (CCHST) Basic Specialist Training (BST) Schemes and Deaneries are regional and the Higher Specialist Training (HST) Scheme is national. Higher Specialist Trainees are also known as Senior Registrars (SRs). BASIC TRAINING SCHEMES IN PSYCHIATRY Selection for training requires that the applicant is eligible for entry to the Trainee Specialist Division of the Medical Register maintained by the Medical Council of Ireland. Entry is by a centralised interview organised by the Postgraduate Training Department of the College of Psychiatrists of Ireland. The Training Department also monitors the quality of training available, approves applications for new BST posts and Educational Supervisors and regularly assesses the Schemes / Deaneries. The award of a Certificate of Completion of Basic Specialist Training (CCBST) requires that Trainees demonstrate attainment of all the learning outcomes listed in the curriculum and complete a specified period of experience. Attainment of outcomes will be demonstrated by Workplace Based Assessments (WPBAs), completion of the Portfolio and Supervisors’ Reports. An Annual Review of Progress (ARP) Panel must approve progression through and completion of training. In addition Trainees must pass the College BST Clinical Examination. This exam must be passed within two years of completion of BST, meaning that Trainees must complete all parts of the exam within 2 years of completing their continuous workplace based assessments in a bona fide, registered BST post. This also applies to those who undertake flexible training. The BST programme runs for 4 years and therefore will consist of eight, six-month clinical attachments. Learning outcomes for all specialties [General Adult, Psychiatry of Old Age, Psychiatry of Learning Disability and Child & Adolescent Psychiatry] and subspecialties (Forensic Psychiatry, Liaison Psychiatry, Social & Rehabilitation Psychiatry, Psychotherapy and Addiction Psychiatry) must be attained. Where this is not provided by clinical attachment the learning outcomes must be addressed by the Scheme / Deanery through other methods (e.g. a combination of courses, workshops, seminars, specialist clinic attendance, e-learning, etc.). In practice it will not be possible to achieve outcomes in some specialties without a clinical attachment. The College does not intend to be prescriptive in relation to which clinical attachment may or may not be provided in each year of BST (excluding FY which must have placements that can meet the specific learning outcomes for that year). The Schemes / Deaneries in collaboration with the College must assess and demonstrate the suitability (e.g. in terms of provision of experience relevant to the learning outcomes and level of supervision) of individual clinical attachments for BST. If a Trainee has previous training experience and can demonstrate learning outcome attainment, Basic Specialist Training may be accelerated by one year (generally in two steps of 6 months each), subject to the approval of an ARP Panel. 6 HIGHER SPECIALIST TRAINING SCHEME Entry to HST requires the award of a CCBST (or equivalent from another jurisdiction). However, progression from BST to HST is not automatic but is by competitive interview. Separate interviews are held for the Adult and Child & Adolescent Psychiatry Schemes. BST Trainees appointed prior to July 2011 who wish to progress to HST must have completed at least three years’ training in Psychiatry prior to commencing higher training and must have passed the MRCPsych Examination (or equivalent from another jurisdiction). For Trainees entering BST from July 2011 onwards, the entry criteria for HST will be the award of the Certificate of Completion of BST (CCBST), which will be based on attainment of learning outcomes, passing the College BST Clinical Examination and satisfactory progression at each Annual Review of Progress. “Gap Years” between BST and HST: Trainees may attain experience in lecturing and research without the need to take “gap years” between BST and HST. This has been achieved by: 1. Incorporating research/lecturing years into HST: (a) 8 Adult and 1 Child & Adolescent HST special lecturer posts have been fully integrated into the National Higher Training Schemes. (b) The College’s process for the approval of additional research/lecturer posts to allow accrual of credit for CCHST is fully implemented. Prospective application and subsequent review by Annual Review of Progress (ARP) process is mandatory. 2. For all new entrants to BST from July 2011 onwards eligibility for entry to HST will be based on the ARP process rather than by interview. The interview process will remain in place for 3 reasons: (i) To determine candidate suitability for the fully integrated research/lecturer posts. (ii) Ranking of applicants (to be used in the case of competition for specific placements). (iii) Ranking of applicants in the event that the number of eligible candidates exceeds the number of available posts. This means that from July 2015 onwards BST and HST will be streamlined as Trainees awarded a CCBST by the College of Psychiatrists of Ireland will be automatically deemed eligible for HST. Final year BST Trainees must confirm that they wish to continue to HST and must attend an interview. If the number of eligible Trainees exceeds the number of available HST placements, entry to HST will be competitive and restricted to those Trainees awarded a CCBST by the College of Psychiatrists of Ireland. Trainees entering HST through this streamlined process can attain experience in lecturing or research as described in the paragraph below entitled “The Place of Research in Higher Training”. Open recruitment to the National Higher Training Schemes will only take place where the number of posts exceeds the number of Trainees awarded a CCBST by the College of Psychiatrists of Ireland. The Postgraduate Training Department of the College of Psychiatrists of Ireland is the body with overall responsibility for the organisation and administration of the HST Schemes. It monitors the quality of training available, approves applications for new Senior Registrar (SR) posts, Educational Supervisors and research posts and regularly assesses the Schemes. 7 In order to gain a CCHST the Trainee will have achieved the learning outcomes for Higher Specialist Training detailed in the accompanying curriculum document (as assessed by Annual Review of Progress panels) and will have completed a specified period of experience in the relevant clinical placements (as described below). Applicants for CCHST who have trained in other jurisdictions must provide evidence of equivalent experience. PSYCHIATRY (GENERAL ADULT) The training period for this CCHST will be three years. Two years are to be spent in General Adult Psychiatry clinical attachments. A third year may be spent in General Adult Psychiatry, psychiatric research or one of the other Adult specialties or subspecialties. If this year is spent in one of the subspecialties of Adult Psychiatry (Forensic, Liaison, Social & Rehabilitation, or Addiction) then the College will recognise this special experience by a formal record of the subspecialty learning outcomes achieved in the Annual Review of Progress Panel Report. PSYCHIATRY OF OLD AGE The training period for this CCHST will be three years. Two years are to be spent in Psychiatry of Old Age clinical attachments. A third year may be spent in psychiatric research or one of the other Adult specialties or subspecialties. If this year is spent in one of the subspecialties of Adult Psychiatry (Forensic, Liaison, Social & Rehabilitation or Addiction Psychiatry) then the College will recognise this special experience with a formal record of the subspecialty learning outcomes achieved in the Annual Review of Progress Panel Report. All Trainees in Psychiatry of Old Age must attain the learning outcomes for Psychiatry (General Adult) such that they can manage clinical situations when a General Adult Psychiatrist may not be available. PSYCHIATRY OF LEARNING DISABILITY The training period for this CCHST will be three years. Two years are to be spent in Psychiatry of Learning Disability clinical attachments. A third year may be spent in psychiatric research or another appropriate psychiatric specialty or subspecialty. The College will recognise this special experience with a formal record of the subspecialty learning outcomes achieved in the Annual Review of Progress Panel Report. All Trainees in Psychiatry of Learning Disability must attain the learning outcomes for Psychiatry (General Adult) such that they can manage clinical situations when a General Adult Psychiatrist may not be available. CHILD & ADOLESCENT PSYCHIATRY The training programme for award of a CCHST in this specialty lasts for three years, all of which must be spent solely in Child & Adolescent Psychiatry clinical attachments. Experience gained in other specialties during this period will not count towards training for a CCHST in Child & Adolescent Psychiatry. However the College will recognise additional special experience with a formal record of the subspecialty learning outcomes achieved in the Annual Review of Progress Panel Report. 8 DUAL CERTIFICATION Trainees have the option of seeking dual certification. While the minimum duration of higher training for award of a single CCHST is three years there is considerable overlap between some of the psychiatric specialties so that a full six year training period is not required for dual certification. Training should be agreed prospectively and the dual CCHST will be awarded on completion of the full programme of training. There is considerable overlap between the core knowledge and skills required for a CCHST in the adult Psychiatry specialties. The degree of this commonality varies between specialties. Accordingly, programmes for dual certification involving adult Psychiatry will be as follows. I. PSYCHIATRY (GENERAL ADULT) AND PSYCHIATRY OF OLD AGE The basic skills of assessment and management of psychiatric disorders and treatment, including psychological and physical approaches, are common to these specialist areas with some variation in emphasis according to the patient group. Thus, training will be of four years duration, comprising of: o One year of training in Psychiatry (General Adult) o One year of training in Psychiatry of Old Age o Two years gaining clinical experience common to both specialties (in practice one year of common training will be spent in Psychiatry of Old Age and one year in Psychiatry (General Adult)) One year of training for a dual CCHST in Psychiatry (General Adult) and Psychiatry of Old Age may be spent in research, provided it is undertaken with a balance of clinical experience per specialty. Note that to gain a dual CCHST in Psychiatry (General Adult) and Psychiatry of Old Age the ARP panel must be satisfied that the equivalent of two years’ experience in General Adult Psychiatry clinical attachments has been achieved. II. PSYCHIATRY (GENERAL ADULT) AND PSYCHIATRY OF LEARNING DISABILITY There is overlap in training between these two specialties. Thus the training programme will last four years and comprise of: o One year of training in Psychiatry (General Adult) o One year of training in Psychiatry of Learning Disability o Two years gaining clinical experience common to both specialties, in settings which are also common to both specialties (in practice, one year of common training will be spent in Psychiatry of Learning Disability and one year in Psychiatry (General Adult)) Note that to gain a dual CCHST in Psychiatry (General Adult) and Psychiatry of Learning Disability the ARP panel must be satisfied that the equivalent of two years’ experience in General Adult Psychiatry clinical attachments has been achieved. 9 III. PSYCHIATRY OF OLD AGE AND PSYCHIATRY OF LEARNING DISABILITY Dual CCHSTs are not currently available in these two specialties of Psychiatry. However, it is possible that a programme could be devised to meet the training needs of this combination if requested. Alternatively, a Trainee may meet the requirements for one of these specialties and gain additional higher training experience in the other which does not meet the criteria for a CCHST in that specialty. In these circumstances the College will recognise this special experience with a formal record of the specialty learning outcomes achieved in the Annual Review of Progress Panel Report. DUAL CERTIFICATION - OTHER PROGRAMMES There are areas of commonality between a number of pairs of psychiatric specialties, for which joint training programmes may be developed, as detailed below. I. CHILD & ADOLESCENT PSYCHIATRY AND PSYCHIATRY OF LEARNING DISABILITY Dual CCHSTs are not currently available in these two specialties of Psychiatry. However, it is possible that a programme could be devised to meet the training needs of this combination if requested. Alternatively, a Trainee may meet the requirements for one of these specialties and gain additional higher training experience in the other which does not meet the criteria for a CCHST in that specialty. In these circumstances the College will recognise this special experience with a formal record of the specialty learning outcomes achieved in the Annual Review of Progress Panel Report. II. PSYCHIATRY (GENERAL ADULT) AND CHILD & ADOLESCENT PSYCHIATRY Dual CCHSTs are not currently available in these two specialties of Psychiatry. However, it is possible that a programme could be devised to meet the training needs of this combination if requested. Alternatively, a Trainee may meet the requirements for one of these specialties and gain additional higher training experience in the other which does not meet the criteria for a CCHST in that specialty. In these circumstances the College will recognise this special experience with a formal record of the specialty learning outcomes achieved in the Annual Review of Progress Panel Report. PRACTICE IN SUBSPECIALTIES CCHSTs are available in four specialties: Psychiatry (General Adult), Child & Adolescent Psychiatry, Psychiatry of Learning Disability and Psychiatry of Old Age. Trainees may wish to prepare themselves for careers in subspecialties within Psychiatry for which CCHSTs are not available. As the need arises, the College will make recommendations as to appropriate training and supervision for subspecialties e.g. the College recommends that a doctor practising as an Addictions Psychiatrist, Liaison Psychiatrist, or Social & Rehabilitation Psychiatrist, in addition to meeting the criteria for CCHST in Psychiatry (General Adult), should have one year of higher training in the relevant psychiatric placement. A Forensic Psychiatrist, in addition to meeting the criteria for CCHST in Psychiatry (General Adult), should have three years higher training in Forensic Psychiatry placements. A Consultant Psychiatrist with a special interest in psychotherapy should have specialist training in Psychiatry or Child & Adolescent Psychiatry, have a postgraduate qualification in psychotherapy and be accredited by a national awarding organisation such as the Irish Council for Psychotherapy or other European equivalent. 10 THE PLACE OF RESEARCH IN HIGHER TRAINING One year spent in relevant research may count towards training for a CCHST in Psychiatry, Psychiatry of Old Age, Psychiatry of Learning Disability, or Child & Adolescent Psychiatry. No research may be considered to contribute to higher training unless prospective educational approval has been obtained from the College and the post has an appropriate clinical component (Minimum 2 clinical sessions and a maximum of 4). The clinical component must be supervised by a Consultant who is on the Specialist Register, is PCS compliant, and has been approved as an Educational Supervisor by the College. The specialty designation of the approved year depends on the content of both research and clinical time. Trainees must maintain the portfolio and attend the ARP panel. In addition, if the year of research experience is gained prior to appointment to HST, recognition will not be effective until a substantive Senior Registrar post is obtained. In all cases the ARP panels must be satisfied that all the learning outcomes required for award of the CCHST have been achieved. As noted above, one year of training for a dual CCHST in Psychiatry (General Adult) and Psychiatry of Old Age may be spent in research, provided it is undertaken with a balance of clinical experience per specialty. Where a Trainee is undertaking any other combination of dual training it is unlikely that sufficient clinical experience could be gained if a year was devoted to full-time research. It is therefore anticipated that, with this single exception, programmes of higher training leading to dual certification will not include a research year. With prospective approval a Trainee can collect evidence for the portfolio for two years but only if then directly appointed to the HST Scheme. The Trainee will then have the portfolio assessed by the ARP panel and can be credited with a maximum of 1 year of higher training (i.e. must subsequently complete a minimum of two more years on the Scheme). However if a Trainee has done 3 sessions / week for two years in a core specialty then the Trainee could gain credit for a full year experience in that core specialty and could therefore do one core year and one sub-specialty year in the remainder of higher training. In order to utilise this process the Trainee must maintain the portfolio throughout the period with prospective approval. The ARP panel will only assess material that is contemporaneously recorded. SPECIAL LECTURER POSTS IN PSYCHIATRY There is a common interview for both lecturer and Senior Registrar posts. At application, candidates will be asked to state whether they are applying for the lecturer posts, the Senior Registrar posts or both. Rotation to lecturer posts will be for a maximum of 2 years duration. Subsequently, candidates will then move into the Senior Registrar Scheme. Established Senior Registrars may also move into lecturer posts provided they have been previously appointed by the lecturer panel. The lecturer posts will be accredited according to the clinical component of the post. Criteria for completion of Higher Specialist Training may include 2 years as lecturer and 1 year in a specialty or subspecialty. Note that to gain a CCHST in Psychiatry (General Adult) the ARP panels must be satisfied that the equivalent of two years’ experience in General Adult Psychiatry clinical attachments has been achieved. 11 Lecturers will have both an academic and a clinical component to their post. When lecturers are appointed, they will retain their academic post for a two year term and will be supervised by one of the Professors of Psychiatry. Lecturers will rotate their clinical post every year and will have a different clinical supervisor. A detailed timetable for each lecturer post is submitted to the College specifying the nature of both the academic and clinical components. This will ensure that the clinical component of each post has an appropriate Senior Registrar level of clinical responsibility and the clinical component of the post will determine the accreditation. Lecturer posts must have a minimum of 4 clinical sessions, with the balance of the week devoted to teaching and research. There must be an on-call commitment of at least one in ten, with a weekly timetabled hour for educational supervision. Supervisors must be members of the College, be on the Specialist Register and be PCS compliant. The salary scale must be that which applies to Senior Registrars. Trainees must maintain the portfolio and prove progression of training at an ARP. The Educational Supervisor (responsible for weekly individual supervision sessions, mid-point, end-point, and other supervisor reports) may be the supervisor for either the academic or the clinical component but there must be a different Educational Supervisor for each of the two years. 12 SECTION 2: REGULATIONS FOR BASIC AND HIGHER TRAINING SCHEMES A. REGULATIONS RELEVANT TO BST & HST EDUCATIONAL SUPERVISORS Educational supervision must be provided by the Consultant designated as the Supervising Consultant and should not be delegated to other staff except when the Consultant is on leave. No Consultant should be responsible for the educational supervision of more than one higher and more than two basic specialist Trainees. All Educational Supervisors must be members of the College of Psychiatrists of Ireland, be on the Specialist Register, and be PCS compliant. Educational supervision should take place with Trainees individually rather than in pairs or in groups, although group supervision may be provided in addition. TRAINING CENTRE TUTOR The Tutor must be a permanently appointed Consultant, be a member of the College of Psychiatrists of Ireland, be on the Specialist Register, and be PCS compliant. Responsibilities include: liaison with the Vice-Dean (see below) with regard to Trainee placements, Trainee assessments, monitoring of quality of training and career advice to Trainees. Where difficulties arise during a particular clinical placement, the Trainee should raise these in the first instance with the Supervising Consultant. The Tutor may have a valuable role in helping to resolve such difficulties. The Tutor will be able to build up a picture of the quality of training in each placement. This information should be used for improving those aspects of the Scheme that are found to be inadequate or unsatisfactory. FLEXIBLE (PART-TIME) TRAINING Provision should be made for Trainees who wish to train on a part-time basis. Flexible training requires the agreement of the employer and the Vice-Dean or Dean of Education. Flexible Trainees are required to undergo the same whole time equivalent length of training as full-time Trainees and may therefore spend a longer period in each attachment. The following rules and training guidelines apply to part-time / flexible training at BST level; 1. Part-time training is generally to be considered as at least 0.5 WTE of a full-time NCHD’s working week (= 39 hours ÷ 2 = 19.5 hours per week). 2. Part-time Trainees must be able to meet the same amount and variety of learning outcomes as a full-time Trainee. 3. Trainees undertaking part-time training must have exposure to a full range of clinical activities including on-call, case presentations, journal club, reflective practice groups etc. 4. Part-time Trainees must be provided with weekly educational supervision by the Supervising Consultant. Each weekly meeting does not have to last one full hour but part-time Trainees must have access to the same amount of educational supervision over one year as a full-time Trainee has within 6 months. 13 5. Part-time Trainees must stay in the same post with the same Supervising Consultant for one full year (2 x 6 month placements). 6. The structure and provision of training (i.e. 5 x mornings, week on/week off, 3 days / 2 days) must be clearly specified in the Training Placement Plan at the start of each placement. 7. Ideally part-time Trainees should attend the in-house teaching programme every 2 weeks but a Trainee must not go a whole 6 months (one placement) without attending in-house teaching. 8. Part-time BST Trainees will have their documentation reviewed and meet with an ARP panel at the same frequency as full-time Trainees to monitor progress and to enable the Trainee to provide feedback on the post. At this point, a part-time Trainee may choose to apply for acceleration as he / she may not require double time in training if they are attaining the necessary learning outcomes above the expected rate. 9. At the time of the ARP each year, the Trainee must indicate if they plan to continue training on a part-time / flexible basis for the year ahead. 10. It is the responsibility of the Trainee to negotiate part-time/flexible working arrangements with the relevant employing authority/ HR personnel. The College’s concern is ensuring that the Trainee receives appropriate training and it was agreed that it is a role of the Vice-Dean to identify posts that are suitable for training within their respective Deanery and if necessary, match 2 part-time Trainees to one post. The following rules and training guidelines apply to part-time / flexible training at HST level; 1. Part-time training is generally to be considered as at least 0.5 WTE of a full-time NCHD working week (= 39 hours ÷ 2 = 19.5 hours per week). 2. Part-time SRs must be able to meet the same amount and variety of learning outcomes as a full-time SR. 3. SRs can change Educational Supervisor after 1 full year in post, dependent on their individual training needs. The allocation of part-time / flexible SRs to posts will be discussed by the HST Mentors and Dean of Education at the pre-rotation allocation meeting with the Dean bearing the ultimate decision. 4. SRs undertaking part-time training must have exposure to a full range of clinical activities including on-call, case presentations, journal club, reflective practice groups etc. 5. The structure and provision of training (including a timetable for research) must be clearly specified in the Training Placement Plan at the start of each placement. 6. The SRs Initial Research Proposal must clearly specify how research time is going to be spread over the 2 years (or for the duration of the project). 7. Part-time SRs must be provided with weekly educational supervision by the Supervising Consultant. Each weekly meeting does not have to last one full hour but part-time SRs must have access to the same amount of educational supervision over two years as a full-time SR has in one year. 14 PROTECTED EDUCATIONAL TIME Educational leave may be granted by the appropriate employing authority for educational activities approved by the College. There will be four categories of protected educational time: A. Scheduled and protected time off-site attending training or undertaking study as required by the College B. On site regular weekly / fortnightly scheduled educational and training activities including conferences, grand rounds, etc. C. Time to allow Trainees to observe and subject to Consultant approval, participate under supervision in certain planned procedures. D. Research – including that taking place during paid non-clinical training days * Throughout this section the term “/ week that the Trainee is at work” means per week that the Trainee is in employment and not on leave. For BST this means: Category A 18 days / year for blended learning courses (9 days attendance at the face-to-face course and 9 days for completing e-modules, course reading, quizzes) This leaves up to 18 days / year (from 36 days educational leave) to attend exams, study prior to an exam, or to attend approved scientific meetings. Category B 3 hours / week of in-house activities split evenly across the clinical and professional domains of the curriculum. Category C 1 hour / week: Protected one-to-one supervision with the Educational Supervisor 1 hour / week: Protected clinical skills training (should result in completed WPBA) 12 hours over BST (3 hours / year) Psychotherapy supervision 40 hours over BST (10 hours / year) Reflective practice Categories B & C combined = 5 hours / week that the Trainee is at work* plus 52 hours across 4 years (i.e. 13 hours / year). Category D does not apply to BST. 15 For the HST – Child & Adolescent Scheme this means: Category A 20 days / year for blended learning courses (16 days attendance at the face-to-face course and 4 days for completing e-modules, course reading, quizzes) This leaves up to 16 days / year (from 36 days educational leave) to attend exams, study prior to an exam, or to attend approved scientific meetings. Category B 10 days / year of in-house activities to include: 1 hour / week: Protected one-to-one supervision with the Educational Supervisor; Case Conferences & Journal Clubs. Category C 10 days / year of clinical skills (e.g. psychotherapy / mental health tribunals / ECT). Category D 1 day / week for specific research project (planning, implementation, publishing). In summary, this amounts to 1.5 days / week that the Trainee is at work for categories B, C, and D combined (max. 492 hours per year) (and a further half-day / week worked to attend courses under category A). For the HST – Adult Scheme this means: Category A 8 days / year for blended learning courses (6 days attendance at the face-to-face course and 2 days for completing e-modules, course reading, quizzes) This leaves up to 20 days for College approved training in non-clinical skills and 8 days /year to attend exams, study prior to an exam, or to attend approved scientific meetings Category B 20 days / year of in-house activities to include: 1 hour / week: Protected one-to-one supervision with the Educational Supervisor; Case Conferences & Journal Clubs OR Category C 20 days / year of clinical skills to include: 1 hour / week: Protected one-to-one supervision with the Educational Supervisor and specialised clinical skills (e.g. Psychotherapy / mental health tribunals / ECT) Category D 1 day / week for specific research project (planning, implementation, publishing) In summary, this amounts to 1.5 days / week at work for categories B, C, and D combined (max. 492 hours per year) with the College courses under category A (and up to a further half-day / week worked to attend College approved non-clinical training activities – also under category A). Note that 16 the one-to-one supervision with the Educational Supervisor is mandatory but otherwise the use of categories B and C is flexible (to a combined maximum of 10 days / year). The previous term of ‘special interest session’ will cease to be used. ON CALL At BST Trainees must participate in the local on-call rota in an equitable manner which should be evenly spread over the 4 years of BST with an absolute minimum of 90 sessions (or pro-rata for a 3 year BST training) as part of the employment contract. For the HST Adult Scheme a minimum of 70 sessions and for the HST Child & Adolescent Scheme 40 sessions of on-call on the senior on-call roster must be completed during higher training. A Supervising Consultant must be available to the SR when on-call. Each approved post must offer a minimum of 25 sessions of on-call per 12-month placement. Payment of on-call is at NCHD rates. MATERNITY AND/OR SICK LEAVE All periods of maternity leave and / or sick leave must be notified to the Scheme Co-ordinator (BST), Vice-Dean (BST) or Dean of Education (HST). Notice of the intention to take maternity leave must be given to the Scheme Co-ordinator (BST), Vice-Dean (BST) or Dean of Education (HST) as soon as possible. Trainees who take maternity or sick leave must attain the learning outcomes to progress in training. The ARP panel will make a recommendation as to the requirement for additional training time, if any. TIME OUT FROM PROGRAMME A BST Trainee may apply to the Scheme Co-ordinator or Vice-Dean for time out from the training programme. This may be for 6 or 12 months and during that time the doctor will no longer be eligible to be on the Trainee Specialist Division of the Medical Register maintained by the Medical Council of Ireland and may not collect materials for the continuous assessment portfolio. On return to training the remaining duration of training will be as specified at the last Annual Review of Progress Report. If the doctor does not return to training after a maximum of 12 months he/she must reapply to enter training. This application will be to the Scheme Co-ordinator or Vice-Dean who will convene and chair the interview board. The College of Psychiatrists of Ireland application forms and interview policies must be used and copies of all documentation must be forwarded to the Dean of Education prior to the doctor’s return to the training programme. On return to training the remaining duration of training will be as specified at the last Annual Review of Progress Report. 17 INDUCTION PROGRAMME All Trainees must participate in a structured induction programme at the time of taking up their duties. The form and content of induction programmes will vary according to local needs but must include the following elements as a minimum: o Physical tour of facilities o Management of on-site emergencies o Procedure for emergency referrals/admissions o Mental Health Act 2001 o Hospital information and patient information management systems o Health and Safety Issues o Non Violent Crisis Intervention o ECT administration (in sites where ECT occurs) o Basic Life Support Training o Personnel issues (contract, on-call rota, etc.) SAFETY All training sites must provide safe working conditions for Trainees in all facilities including those in general hospitals and in the community. Safety issues must be highlighted in the initial induction programme and the Trainees’ Induction Handbook must incorporate a section on safety including information on accessing local policies and procedures. Assessment rooms used by Trainees for assessment of acutely disturbed patients (in inpatient units, assessment suites, emergency departments and community facilities) should be safe, including a door opening outwards with an unobstructed visualization panel, and must not contain objects that could be used as potential weapons or barricades. Trainees must be provided with personal alarms which are regularly tested and fully monitored. Doctors, on-call at night, must be provided with mobile telephones if they are required to travel between sites. Non Violent Crisis Intervention training must occur at commencement of training and annually thereafter. Attendance at such training must be recorded in the portfolio. Each training Scheme should have a mechanism for monitoring violent incidents involving Trainees; these records may be examined by visiting College accreditation teams. Each site should have a clear policy for the management of Trainees involved in untoward incidents, including immediate reporting of the incident and subsequent counselling and support, if needed. Information about this should be incorporated in the Induction Handbook. 18 EMPLOYMENT CONDITIONS 1. Contracts All Trainees must be issued with appropriate contracts. A formal job description and timetable must be available for each training post and must be updated regularly. In addition and separate to the employment contract, the Trainee will sign a learning agreement with the College. 2. Educational leave Trainees should be made aware of their entitlement to study leave and the local arrangements for applying for this. Trainees’ clinical duties must not conflict with their ability to attend recognised training activities. 3. Travel expenses Trainees should be reimbursed necessary travel expenses in accordance with national rates and regulations. 4. Office accommodation & secretarial support All Trainees must have access to an office where they can carry out administrative duties without unnecessary interruption. Ideally such offices should be within the clinical workplace and may also serve as consulting rooms. Trainees must have access to adequate secretarial support to allow them to discharge their duties effectively. POSTGRADUATE FACILITIES 1. Library All Trainees must have access to a library which provides a comprehensive service under the direction of a qualified librarian. There must be an adequate range of up-to-date books and journals and facilities for inter library loans, photocopying and on-line literature searching (including out of hours). The library should include a minimum of ten psychiatric journals as well as access to general medical journals (e.g. BMJ, The Lancet). Adequate library facilities must be provided at each site where training is provided though the exact configuration will depend on local need. Satellite libraries should contain standard psychiatric texts and at least three psychiatric journals as well as photocopying facilities and telephone, fax and computer links with the nearest staffed library. 2. Lecture & Seminar Rooms Each training centre must have one lecture room large enough to accommodate all the psychiatric medical staff, together with non-medical staff and doctors from other specialities, who may attend postgraduate meetings. The lecture room should be equipped with appropriate audio-visual equipment. Seminar rooms may be less formal in character and should be able to accommodate 12-15 people. Where such rooms are used on a multidisciplinary basis, psychiatric Trainees must have sufficient access to allow adequate training. Video facilities should be available for interview skills training if required. 19 ACCREDITATION OF TRAINING SCHEMES Accreditation includes feedback from ARP panels and visits by accreditation teams appointed by the College. The Accreditation Team Report may include mandatory requirements and recommendations. Continuing accreditation (of Educational Supervisors, clinical sites, Deaneries, and Schemes) is subject to the mandatory requirements being addressed. Where the quality of training is in doubt, an early revisit may be recommended. When serious deficiencies are identified, the continuation of training accreditation may be at risk either for one or more specific posts or the Deanery / Scheme as a whole. Where accreditation has been withdrawn from a post, reaccreditation will only be granted when the College is satisfied that effective remedial action has been taken. When an entire training Deanery / Scheme loses accreditation, re-accreditation will require a further formal accreditation visit. B. REGULATIONS SPECIFIC TO HST DEAN OF EDUCATION The Dean of Education is the HST Co-ordinator. Guidelines for the Dean of Education in the allocation of HST posts: 1. First consideration should be the Trainee’s training need(s). This should include recommendations made by an Annual Review of Progress Panel and consideration of Trainee’s preference for dual or single specialisation. 2. Trainee preferences. Trainees should be asked prior to allocations to rank their 6 preferred posts. 3. For Trainees entering HST from July 2014 the ranking of HST posts via the accreditation process will be combined with the above two points. 4. Trainees should have experience in a range of demographic settings (to include urban, rural, and areas of deprivation), where possible. 5. Trainees should have experience in a range of services (as defined by a different ECD / employer / region), where possible. 6. If there is to be a period of paid leave that is known prior to allocation then priority is to be given Trainee needs and preferences rather than those of the service. 7. Posts for the remaining duration of the Trainee’s rotation will be allocated but flexibility will be provided if there is a change to the Trainee’s training needs or to the availability of training posts (e.g. new post approved or a post withdrawn). 8. Trainees will have an opportunity to provide a change to their preferences in December of each year. This will allow a Trainee already on the Scheme to submit a new preference prior to recruitment of new entrants for the following year but for a post that has not already been allocated to another Trainee on the Scheme. 9. Where none of the above considerations allow for a decision between two Trainees who wish for the same placement the Dean of Education may refer to interview ranking scores at entry to the Scheme. 20 10. For operational reasons the Dean of Education may have to make changes to placements at short notice. 11. For HST Adult Scheme: Placements must provide for a minimum of 70 sessions on the senior on-call roster. 12. For HST Adult Scheme: Trainees seeking a CCST in Adult Psychiatry must have at least 24 months experience in general adult Psychiatry. 13. For HST Adult Scheme: Trainees seeking dual certificates of completion of specialist training should, where possible, alternate placements between the two specialties (This may not be possible when a rotation includes a 2-year academic post). 14. For HST Child & Adolescent Scheme: Placements must provide for a minimum of 40 sessions on the senior on-call roster. 15. For HST Child & Adolescent Scheme: Trainees must have at least 6 months experience in an in-patient setting and at least 18 months in ‘generic’ Child & Adolescent mental health services. HST MENTORS HST Mentors are provided for each of the HST Schemes. Their roles include: career advice, an advocacy role (e.g. with Trainees and Educational Supervisors or with Trainees and the Dean of Education), advice to Dean of Education on rotations, on-going review of each Trainee’s portfolio for early identification of problems (in conjunction with Educational Supervisor), feedback to Accreditation Sub-Committee on quality issues, and assistance in preparation of Scheme accreditation. RESEARCH AND PROTECTED EDUCATIONAL TIME For Higher Trainees protected time is provided for under Categories A, B, C, & D (see above). This leave is not automatic and is dependent on the Annual Training Plan and the Initial Research records, which are compiled by the Trainee, Educational Supervisor and research or other supervisor at the beginning of a training post. The aims of the protected educational time must be specified and the outcomes recorded in the Trainee’s portfolio, which must be presented to the ARP panel. Approval of training for the award of a CCHST requires that the aims are appropriate to that CCHST and that the outcomes have been achieved. ACTING UP SRs may act up (provide short-term Consultant cover) for their Educational Supervisors only. Acting up must be compliant with guidelines from the Medical Council of Ireland. Agreement of the employing authority must be sought and received before acting up. Senior Registrars are permitted to spend a period of time acting-up in any year of HST (that is permitted by the Medical Council of Ireland) as part of their formal training programme but not within the first three months of first year. Each period spent acting-up can be for a maximum of 3 weeks at one time with a maximum of 6 weeks per year in total. 21 Senior Registrars must be paid at the appropriate Consultant grade for the duration of the period. Periods spent acting-up are agreed in consultation and at the discretion of the Educational Supervisor and granted on an individual case-by-case basis in line with the training needs of the individual Trainee. Each period of acting-up must be followed up with a formal supervision session with the Educational Supervisor to report and feedback on the training experience. OUT OF PROGRAMME TRAINING This generally applies to a Trainee on a Higher Training Scheme who is granted a period in another jurisdiction during which the Trainee must continue to collect evidence for the portfolio. This requires that the Educational Supervisor for the Out of Programme post completes the College of Psychiatrists of Ireland Educational Approval form. This form will be assessed by the Dean of Education, HST Mentors, and a nominee of the relevant Faculty if none of the above are a Consultant in the specialty relevant to the post. Generally, the remaining 2 years on the Scheme will be in the core specialty. C. REGULATIONS SPECIFIC TO BST THE VICE-DEAN For those who commence psychiatric training from July 2014 onwards, Basic Specialist Training (BST) will be delivered via nine Deaneries each with a number of Training Centres. The Vice-Dean will be the link between the Deanery via the Dean of Education to the Postgraduate Training Committee (PTC). With the Dean of Education the Vice-Deans will be responsible for the organisation of BST. Roles will include: Deanery development, recruitment and retention of Trainees, quality of training, advice to Trainees, and Trainee placements (arrange Foundation Year Placements to the training centres in the Deanery according to PTC policy & with the Dean of Education, other Vice-Deans, Scheme Co-ordinators, Tutors, and Specialty Tutors arrange for pre-defined BST rotations for years BST1-3). TRAINING CENTRE TUTOR The Tutor must be a permanently appointed Consultant, be a member of the College of Psychiatrists of Ireland, be on the Specialist Register, and be PCS compliant. Responsibilities include: liaison with the Vice-Dean with regard to Trainee placements, Trainee assessments, monitoring of quality of training and career advice to Trainees. Where difficulties arise during a particular clinical placement, the Trainee should raise these in the first instance with the Supervising Consultant. The Tutor may have a valuable role in helping to resolve such difficulties. The Tutor will be able to build up a picture of the quality of training in each placement. This information should be used for improving those aspects of the Scheme, Deanery that are found to be inadequate or unsatisfactory. 22 ALLOCATION TO DEANERY On entry to Basic Specialist Training each Trainee will be allocated to a Deanery based on their preference and performance at interview. It is not ordinarily possible for a Trainee to switch between Deaneries during training. If a Trainee, who is progressing satisfactorily, wishes to move to an alternative Deanery, the following protocol will apply. The Trainee must resign from the current Deanery and re-apply and be interviewed through the centralised recruitment process at the next scheduled intake. The Trainee will not be considered a new entrant to training and therefore will not be competing for a training post. However, they will be competing with other applicants at that intake for posts in specific Deaneries (i.e. this process will not guarantee transfer to a different Deanery but will guarantee an offer of a training post in one or more Deaneries. Accredited training from their former Deanery will count. 23 SECTION 3: ANNUAL REVIEW OF PROGRESS INTRODUCTION The Annual Review of Progress (ARP) is an important function of the Postgraduate Training Department of the College of Psychiatrists of Ireland. The College has the responsibility for the provision and quality assurance of training and for the assessment of Trainees. The College decides whether a Trainee is eligible for receipt of certificates of completion of Basic Specialist Training and of Higher Specialist Training. The ARP panel examines evidence submitted to the College by Trainees and generates reports, which can lead to provision of certificates of completion of training, continuation of training or termination of training. The ARP has replaced the previous form of assessment at Basic Specialist Training (BST), which was based on time served in training and passing the membership Examination of the Royal College of Psychiatrists (MRCPsych) and at Higher Specialist Training (HST), which was based on time served in training and reports by Supervising Consultants. The ARP can also be used as a method to assess candidates from other recognised speciality training Schemes (either in Ireland or abroad) for the purpose of recognition of training appropriate to Psychiatry. The ARP provides a yearly record of training attainments and is used to support the application for Certificates of Completion of Basic and Higher Specialist training (CCBST and CCHST). The CCHST is required to allow a Trainee to be placed on the Medical Council Specialist Register in one or more of the four recognised specialties of Psychiatry. To progress in training, Trainees must demonstrate that they are acquiring the necessary learning outcomes at the appropriate rate. The ARP is a review of the evidence produced by the Trainee to demonstrate satisfactory progression. The ARP enables identification of a Trainee in difficulty, so that appropriate remedial measures can be put in place at an early stage. One of the key functions of the ARP is to review the Trainee’s educational evidence. Preparation for the ARP occurs throughout the year. The method to gather evidence both appropriately and efficiently is by using the Trainee portfolio. A portfolio is a collection of evidence that training (and more importantly learning) has occurred. WPBA (workplace based assessment) forms and other portfolio items can be downloaded from the College website. The College is moving towards the creation of an electronic portfolio. Attainment of learning outcomes is demonstrated in the portfolio by WPBAs and by a variety of other methods. WPBAs need to occur at regular intervals throughout the year and not be left until the period immediately before the ARP. In advance of the ARP the College will send a reminder to each Trainee including a form containing a learning outcomes attainment grid and a portfolio checklist. The College requires that every Trainee completes and returns the learning outcomes attainment grid by the given deadline. The purpose of this form is to summarise the information contained within the portfolio and, along with the portfolio evidence submitted throughout the year by the Trainee, it allows the ARP panel members to make a determination as to whether or not a Trainee’s progress is satisfactory. During each placement, as part of the Trainee portfolio, the Supervising Consultant will also be required to complete a number of formal meeting records with the Trainee (initial, midpoint and endpoint) which will also help shape 24 the ARP panel’s opinion on a Trainee’s progression through training. It is the responsibility of the Trainee to ensure that all documentation is periodically sent in to the College using the dedicated email address: portfolio@irishpsychiatry.ie. If evidence is incomplete or lacking then the ARP panel will not be able to support a Trainee’s progression until such evidence is provided. COMPOSITION OF THE ARP PANEL Each ARP panel will be composed of at least three members who have completed ARP panel training provided by the College. For BST ARP assessments, one of the panel members may be a Higher Specialist Trainee currently on the Higher Training Scheme in Psychiatry. All other panel members must be approved Educational Supervisors or retired Consultants who have been involved in the supervision of Trainees within the previous five years. All ARP panel members must have an up-todate certificate of ARP panel training provided by the College. Each panel will elect a chairperson who will ensure that the correct procedure is carried out during the entire ARP process and that all necessary forms are completed and returned to the College. Panel members must not include anyone who may have a conflict of interest, such as the Trainee’s current or immediately previous clinical supervisor or BST Tutor. FUNCTIONS OF THE ARP PANEL The Annual Review of Progress (ARP) plays a central role in the Trainee appraisal process. On behalf of the Postgraduate Training Committee (PTC), the panels will have the ability to recommend progression of the Trainee to the next stage of training, to ask for more evidence regarding the Trainee’s performance, to stall such progress and recommend or insist on remedial training or to recommend termination of training. By its nature the ARP process is summative. The quality of the evidence submitted to the panel is of vital importance. It will consist mainly of reports from clinical and Educational Supervisors and Tutors, workplace based assessment forms and evidence of attainment of a wider experiential nature. The panel members will hear feedback from Trainees on their respective training experience(s). There is a policy to deal with negative feedback about Trainers or training sites. The panel members will give Trainees feedback on their submitted evidence. 25 THE ARP PROCESS Trainees will be notified in advance of the panel meeting which will be convened by the College. Trainees must take full responsibility for the submission of their portfolios and other supporting documentation in advance of the meeting. The College will not send reminders to Trainees with regard to submission. Material submitted after the specified deadline will not be reviewed by the ARP panel. This may result in a Trainee being given an unsatisfactory outcome due to insufficient evidence. The panel will systematically consider the evidence presented with respect to the curriculum and make a decision on a Trainee’s progress. The panel has two objectives: 1. To consider the adequacy of the evidence provided by the Trainee. 2. Provided the documentation is adequate, to make a judgment about the Trainee’s suitability to progress to the next stage of training or to confirm that training has been satisfactorily completed. The panel’s judgment will typically be based on 4 types of evidence: 1. Attainment of learning outcomes (as evidenced by workplace based assessments and other documented assessments of performance). 2. Judgments in the form of structured reports from the Educational Supervisor (or the Tutor) regarding the Trainee’s overall performance. 3. Further experiential activities required by the College curriculum (e.g. reflective practice group participation, documented supervision sessions, approved course attendance, completion of e-learning modules, Examination success etc.). 4. Experiential activities beyond the requirements of the College curriculum (published research, conference presentation etc.). The ARP panel will examine the submitted learning outcomes attainment grid and the Trainee portfolio to complete the ARP Panel Report Form. Only written evidence or communication will be used by the ARP panel to make a decision on a Trainee’s progression. Whilst a Trainee’s supervisors and Tutors may be phoned in relation to a specific query about submitted evidence, ARP panel decisions will be based on documented evidence. 26 OUTCOMES There are six possible outcomes which fall into three categories (a) progress, (b) Unsatisfactory / insufficient evidence and (c) completion of training. Progress 1. The Trainee is progressing through training with the attainment of all learning outcomes as expected. 2. The Trainee is progressing through training; however, some learning outcomes have not been attained. Additional training time is not required. The Trainee may be required to meet with the panel. The Trainee will have to submit evidence of attainment of unmet outcomes at the ARP of the following year, along with outcomes for the next year of training. Unsatisfactory or insufficient evidence 3. Inadequate progress is being made by the Trainee and further training time will be required. The Trainee must meet with the panel. 4. The Trainee will be released from the training programme with or without attainment of specified learning outcomes. The Trainee must meet with the panel. 5. Where the documentary evidence submitted is so incomplete or otherwise inadequate that a panel cannot reach a judgement, no decision will be taken about the performance or progress of the Trainee. The failure to produce timely, adequate evidence for the panel will result in this outcome and will require the Trainee to explain to the College (and panel) in writing the reasons for the deficiencies in the documentation submitted to date. This incomplete evidence outcome will remain as a part of the Trainee’s record but once the relevant evidence has been submitted then a new outcome will be added according to the evidence evaluated by the assessment panel. Evidence must be sent, or an explanation outlining the reasons for the lack of evidence must be made in writing, to the Dean of Education, the College of Psychiatrists, within ten working days of being notified of the panel’s initial decision to award a Trainee an Outcome 5- incomplete evidence. Failure to respond to this request within the specified time frame will result in Outcome 4- the Trainee being asked to leave the training Scheme. Therefore an Outcome 5 should be considered a serious outcome given as an alternative to an Outcome 4. Submitted evidence will be reviewed by the initial ARP panel members (if possible). Recommended for completion of training 6. The Trainee has attained all the specified learning outcomes and will be recommended as having completed the training programme and for award of a CCBST or CCHST. 27 MEETING WITH THE TRAINEE The following Trainees will meet an ARP panel:  All FY Trainees  All final year BST (B3) Trainees  All final year HST Trainees  All other Trainees whose outcome is other than an outcome 1 or 2  Trainees with an outcome 2 where a meeting is required to explain the decision  Trainees who have received an outcome 1 and wish to accelerate training The panel will, after reviewing the submitted evidence and finding that the outcome is other than outcome 1 or 2 meet the Trainee to give feedback and an outline of what is expected to address the necessary concerns in relation to training. This will lead to the identification of unmet learning outcomes. Trainees who wish to accelerate training will meet with the panel to discuss the feasibility and advisability of this. It is not envisaged that the ARP panel will routinely revise a decision (made on submitted evidence) after a meeting with a Trainee. In exceptional circumstances, however, this might be appropriate. The panel will clearly state the reasons for the change in decision in the ARP report. APPLICATION TO THE ARP PANEL FOR RECOGNITION OF PREVIOUS TRAINING OR FOR ACCELERATED TRAINING If a Trainee has previous training experience and can demonstrate learning outcome attainment, Basic Specialist Training may be accelerated by a maximum of one year, subject to approval by an ARP panel. On application to the BST programme, a Trainee who wishes to accelerate training may apply to have their portfolio assessed by an ARP panel prior to commencement of BST. The Trainee must submit evidence of having met relevant learning outcomes during a period of training (i.e. on the register of specialist Trainees kept by the Medical Council or equivalent from another jurisdiction). That period of training must have provided the Trainee with experience relevant to Psychiatry. In practice this is most likely to have been met by General Practice Trainees who have had a Psychiatry clinical attachment. Subject to approval by the ARP panel, training may be accelerated as follows: The Trainee will be given an Outcome 3 (further time required) and invited to another ARP after 6 months (rather than 12 months). In practice this means that the Trainee will remain in Foundation Year but be offered an end of Foundation Year ARP 6 months ahead of time. If making satisfactory progress at the ARP 6 months later the Trainee will then progress to BST 1. That panel may also decide that the Trainee will be invited to a further ARP after another 6 months to assess the BST 1 learning outcomes. If appropriate the Trainee could then be given a further Outcome 1 and progress to BST 2. The Trainee would then have had training accelerated by one year. If a Trainee (on the register of specialist Trainees maintained by the Medical Council or equivalent from another jurisdiction) at application to the training programme wishes to accelerate training but he / she is unable to submit evidence (i.e. portfolio) of having met relevant learning outcomes, he / she will not be in a position to be assessed by an ARP panel prior to commencement of BST. The 28 Trainee may be offered an ARP review after 6 months rather than 12 months at which time if making satisfactory progress the panel may decide that the Trainee can progress to BST 1. The Trainee would then have had training accelerated by 6 months. Any Trainee who is given an Outcome 1 by an ARP Panel may discuss with the panel the possibility of acceleration. The Trainee must request a meeting with the panel within two days of receiving notification by e-mail of the outcome. If the panel deems it appropriate, on the basis of evidence in the portfolio, it may decide that the interval to the next ARP review would be 6 months rather than 1 year. If the Trainee receives an Outcome 1or 2 at the subsequent ARP review he / she would accelerate by 6 months. This process may occur on a maximum of two occasions during BST. A Trainee who is in Foundation Year will automatically have an ARP interview. At other stages of BST, a Trainee who has been given an Outcome 1 will have an ARP interview if one is requested within two days of notification of the decision. ACCELERATION / DECELERATION OF TRAINING – SUMMARY If a Trainee has previous training experience and can demonstrate learning outcome attainment, Basic Specialist Training may be accelerated by a maximum of one year, subject to approval by an ARP panel. This may be implemented in two steps of 6 month accelerations. Any other Trainee who, at ARP, has met all learning outcomes for the year may be granted an ARP for the following year of training after six months. In total, throughout a programme of training, an individual Trainee will have no more than 12 months additional training, apart from exceptional circumstances. Trainees can accelerate only twice during a BST training programme, just as they can decelerate (Outcome 3: further time required) only twice. Therefore a BST Trainee can spend a minimum of 3 years and a maximum of 5 years in training. PART - TIME TRAINING AND LEAVE FROM TRAINING A Trainee who is in part-time training or who has had a period of leave (other than annual leave) will be required to complete the ARP process 12 months from entry to the programme/last ARP review. If the Trainee has not returned from leave at that time then they will be required to complete an ARP review at the next available opportunity upon their return. At that point the Trainee may not have completed a year of training but will be assessed for two reasons. Firstly, the ARP process, in addition to assessment of the Trainee, provides an opportunity for feedback on training. Hence, for timely feedback it is important that every Trainee is given the opportunity to comment on the provision of training at least once per year. Secondly, it is important to ensure that the structure of part-time training/leave does not prevent the Trainee from gaining mandatory experience(s) and to address such problems in time. (For example, a part-time training based on working mornings only might result in the Trainee missing all reflective practice group sessions if they are always held in the afternoon. After 24 months of half-time training such a Trainee would have had 12 months of training but might not be able to progress having not had the opportunity to attend the reflective practice group). Note that a Trainee who is in part-time training or who has had a period of leave and has not completed a year of training at the time of the ARP cannot be given an Outcome 1 or 2 (unless training is accelerated – see above). The Trainee who is making satisfactory progress will be given an Outcome 3 – further time required. The decision form will specify that this decision is based on satisfactory progress at an early ARP and is not due to unsatisfactory progress. 29 APPLICATION TO ARP FOR RECOGNITION OF EXPERIENCE POST BST AND PRIOR TO HST There are two options for those eligible for HST to seek recognition of experience post BST and prior to starting the HST programme. The experience must be in either a research or lectureship post. The Trainee must apply prospectively to the College and, if the proposal is accepted, complete a portfolio throughout the post (based on the learning outcomes for a year of HST). If subsequently appointed to the HST Scheme, the Trainee may submit this portfolio to the ARP immediately prior to the first HST post. If given an Outcome 1 or 2, the Trainee may be able to complete the HST year 3 ARP after a further 2 (rather than 3) years. ARP AT THE COMPLETION OF A STAGE OF TRAINING All HST Trainees & BST Trainees with a January completion date Generally ARP reviews take place in May and October/November of each year. As training placements are completed in either January or July, end-point supervisor reports for the most recent placement will not be available at the time of the ARP review. Therefore, all ARP outcome reports are contingent upon a satisfactory end-point supervisor’s report. In the case of Trainees who are continuing in training this will be reviewed at the subsequent ARP. In the case of Trainees who are completing a stage of training the award of an Outcome 6 will be contingent upon items specified in the ARP report. At a minimum this will include a satisfactory endpoint supervisor’s report but may include additional reports or evidence. All such evidence must be submitted for review by the Dean of Education within 10 working days of completion of the final placement. BST Trainees with a July completion date In order to be eligible for Higher Specialist Training the Trainee must have completed the Exam process and have an Outcome 6 from the BST3 ARP. The application process for Higher Training takes place between December and February. Therefore to facilitate seamless training for Trainees who are due to complete BST in July, an additional ARP review will take place in January annually. Only BST3 Trainees who have (i) been successful in the Exam process and (ii) who are due to complete training in July and (iii) intend to apply for a College of Psychiatristry of Ireland Higher Training programme at the next intake, will be eligible for this review. An Outcome 6 at this review will allow the Trainee to apply for HST with a start date in July (which is the Trainee’s scheduled date of BST completion). As the Trainee will have a further 6 months of BST training following the ARP review it is to be expected that there will be a number of learning outcomes to be obtained in that final placement. The Outcome 6 report will detail all outstanding requirements and these together with the end-point supervisor’s report must be submitted for review by the Dean of Education by the last working day of May. The confirmation of a place on the Higher Training Scheme will be contingent on successful completion of this process. If the panel decide that there is not enough evidence in the portfolio to award an Outcome 6, the Trainee will have another ARP in May and will not be eligible to apply for HST that year. 30 REVIEWS AND APPEALS Trainees, their Supervising Consultants and, at BST, their Tutors and Vice-Deans will be e-mailed the outcome of the panel members’ review of the evidence. The timelines given below for reviews and appeals commence on the day the e-mail communicating the outcome is sent. A review or an appeal may be requested before the scheduled meeting with the panel (See section on Meeting with the Trainee, above, for details of Trainees who must meet the ARP panel). This meeting will proceed, regardless of whether a review has been requested. The annual review panel will explain to the Trainee the evidential basis on which the decision to assign a particular outcome was made and it will be documented on the ARP Report form. The Trainee may decide to withdraw the request for a review or an appeal after the meeting. Review of Outcome 2: Progress with need to develop (within time) Outcome 2 usually involves closer than normal monitoring, supervision and feedback on progress to ensure that the specific learning outcomes, which have been identified for further development, are obtained, but does not require that the indicative date for completion of the training programme will change. A Trainee who disagrees with the decision has a right to ask for it to be reconsidered. Requests for such reconsideration (review) must be made in writing to the Dean of Education, The College of Psychiatrists of Ireland, 5 Herbert Street, Dublin 2 within ten working days of being notified of the panel’s decision. The Dean of Education will then arrange an interview for the Trainee (as far as practicable with all the parties of the annual review panel) which should take place within fifteen working days of receipt of such a request from a Trainee. Trainees may provide additional evidence at this stage. The Trainee will have the opportunity to discuss this with the panel and to see all the documents on which the decision about the outcome was based. Additional evidence must be submitted to the College at least 3 days before the review meeting. The panel that is reviewing the Outcome 2 recommendation should have administrative support from the College so that its proceedings can be documented. An account of the proceedings should be given to the Trainee and also retained by the College. A decision of the panel following such a review is final and there is normally no further appeal process. Appeals Process for Outcome 3: Need to develop (further time required) and Outcome 4: Trainee asked to leave training Scheme Trainees will have the right of appeal if they receive a decision which results in a recommendation for an extension of the indicative time to complete the training programme (Outcome 3) or to leave the training programme with identified learning outcomes that have been achieved, but without completion of the programme (Outcome 4). Appeals should be made in writing to the Dean of Education, The College of Psychiatrists of Ireland, 5 Herbert Street, Dublin 2, within ten working days of the Trainee being notified of the panel’s decision. The appeal procedure has two steps: 31 Step 1: Discussion Step 1 provides the opportunity for discussion between a Trainee, Supervising Consultant(s) / BST Tutors / BST Vice-Dean / HST Mentor and, in so far as possible, the original ARP panel members to resolve matters. A college representative may also be in attendance to document and record the outcomes of the meeting. The purpose of this stage is to reach a common understanding of a Trainee’s problems and to decide on the best course of action. The Trainee may submit additional evidence for review by the panel. This must reach the College at least three days before the Step 1 discussion. Where, following the Step 1 process, Trainees accept that learning outcomes have not been attained, thereby resulting in an extension to the planned training programme, an action plan should be developed for the attainment of learning outcomes that have not been met. In addition, a revised indicative date for completion of training should be set. This should not normally be greater than an aggregated period of one year from the original indicative date of the end of training. Step 2: Formal Appeal Hearing A Trainee, who does not accept the outcome of Step 1, should inform the Dean of Education, The College of Psychiatrists of Ireland, 5 Herbert Street, Dublin 2 within ten working days of receiving it. The Dean of Education will then arrange a formal appeal hearing (Step 2), which should normally take place within fifteen working days of receipt of a request for an appeal, where practicable. Members of the original annual review panel must not take part in the appeal process. Trainees may support their appeals with further written evidence, which must reach the College at least 3 days before the appeal hearing. All documentation that will be considered by the appeal panel must be made available to the Trainee. If the annual review panel has recommended the Trainee should be withdrawn from the training programme, the Dean of Education should always assume that a Step 2 hearing will follow and take the necessary steps to arrange it. An appeal hearing in these circumstances should proceed unless the Trainee formally withdraws, in writing, from the programme at this stage. The Dean of Education should always confirm the position in writing with the Trainee where the Trainee declines an appeal hearing. The Dean of Education will convene an independent appeal panel to consider the evidence and to form a judgement. It should consider representations and evidence from both the Trainee and from those who are closely involved with his / her training, such as the Supervising Consultant and / or BST Tutor. The appeal panel should normally include the Dean of Education or a nominated representative as chair, and two senior Trainers, one of whom should be from a different specialty. The membership of the panel should not include any of those involved in the discussions under Step 1 nor should it include any members of the original annual review panel. A representative from the College must be present to advise the chair and to record the proceedings of the appeal. Trainees also have a right to be represented at the appeal, to address it and to submit written evidence beforehand. They may choose to be accompanied, for example, by a friend, colleague or a 32 representative of their professional body but this should not normally be a legal representative or family member. However, if a Trainee wishes to be accompanied by a lawyer, the appeal panel chair should normally agree to the request in advance. Legal representatives should be reminded that appeal hearings are not courts of law and that the panel governs its own procedure, including the questioning to be allowed of others by the legal representatives. Trainees should be notified in writing of the outcome of the appeal hearing. The appeal process described above is the final internal avenue of appeal. The review or appeal panels may decide at any stage that Outcomes 2, 3 or 4 are not justified. If so, the facts of the case will be recorded and retained by the Dean of Education but the outcome should be amended to indicate only the agreed position following review or appeal. This revised documentation should be forwarded to those indicated. It may be that the outcome of appeals under Step 1 and 2 is to alter an earlier recommendation while still maintaining the view that progress has been unsatisfactory. For example, a decision to withdraw a Trainee from a programme may be replaced by a requirement for an extension of training time in order to gain the required learning outcomes. In such cases, the outcome documentation should show only the position following the decision of the appeal panel. Where lack of progress may result in the extension or termination of a contract of employment, the employer should be kept informed of each step in the appeal process. Where, following the appeal process, Trainees accept that learning outcomes have not been achieved, thereby resulting in an extension to the planned training programme, an action plan should be developed, for the attainment of learning outcomes that have not been met. In addition, a revised indicative date for completion of training should be set. COMMUNICATION OF ARP PANEL DECISIONS The outcome from the ARP must be recorded on the ARP Panel Report Form. After the panel reviews the evidence the Trainee will receive a copy of the outcome by e-mail. The outcome will also be communicated to the Supervising Consultant and at BST, the Tutor. When all meetings have concluded the ARP report will be sent to the Trainee and to the following: 1. Trainee’s Supervising Consultant 2. Tutor and Scheme coordinator/vice dean (for FY and other BST Trainees) 3. HST Mentor (for HST Trainees) 4. Trainee’s employment body 5. In the case of Outcome 4, the Medical Council 33 POLICY FOR DEALING WITH NEGATIVE FEEDBACK ARISING FROM FORMAL ASSESSMENTS CARRIED OUT BY THE CPSYCHI There are 3 types of negative feedback that might be reported during a formal assessment by the CPsychI (for example to an Annual Review of Progress (ARP) Panel: 1. Allegations of substandard training 2. Allegations of professional misconduct in relation to patients/patient safety 3. Allegations of professional misconduct not related to patient safety but including bullying, sexism, ageism etc. that in HSE would come under remit of the Dignity at Work policy (Note many Trainees are employed not by HSE but other organisations). The purpose of formal assessments such as ARPs is to assess Trainees and training and NOT to address the above issues. ARPs should not be considered the most appropriate or most convenient forum for addressing such issues. Instead they should be addressed locally and actions should not be delayed until the next ARP meeting. However, if they are raised at an ARP the following pathways should be used: Type 1 allegations may be ‘against’ Educational Supervisors, tutors, the site, or the Scheme (or the College) Types 2 & 3 may be against the Trainee, Educational Supervisors, tutors, or other health professionals that the Trainee has had interaction with. As a general principle, only comments about the Trainee should be included in an ARP final report. Comments about any other individual or organisation should be addressed by another mechanism but the Trainee should be assured that they will be addressed. 1. Allegations of substandard training Step 1 – ARP reports to the Dean of Education Step 2 – The Dean of Education writes to subject of allegation for response Step 3 – If the allegation is not disputed the information is shared with the accreditation process, Tutor, and Scheme Co-ordinator. If the allegation is disputed the parties should be invited to a meeting facilitated by a Consultant approved by the College [e.g. by an independent Consultant agreed by both and chosen from a list of volunteers for such a role]. If any part of the allegation is upheld this information would then be shared with accreditation process, Tutor, and Scheme Coordinator / Vice-Dean. Step 4 – The Dean of Education will report annually to PTC (and thereby) Council on statistics but not named individuals. This process would not necessarily be used for ARPs only. For example, if written information submitted to the College as part of a Trainee’s portfolio raises such allegations then action should be taken and not postponed to the next ARP. 34 SECTION 4: BST CLINICAL EXAM A. INTRODUCTION PURPOSE OF THE EXAMINATION The purpose of the Examination is to ensure that a national standard is both set and met in the assessment of curriculum based competencies set for basic specialist Trainees in Psychiatry. In turn, this will ensure uniformity of practice and consistent levels of attainment of the standards such that they may be used as an entry criterion for higher specialist training. Background The College of Psychiatrists of Ireland commenced a revised programme for Basic Specialist Training (BST) in July 2011. This programme is outcomes-focused, monitoring and validating Trainee progression by incorporation of structured continuous assessment, which is both formative and summative. The components of the assessment programme include workplace based assessment (WPBA), structured supervision sessions, regular progress meetings, structured course participation, maintenance of a training portfolio, self-directed learning activities and an annual review of progress (ARP). With the exception of the ARP, assessment is carried out in the Trainee’s workplace by the Trainee’s Educational Supervisor, local tutor or another Consultant level Trainer or occasionally by a Senior Registrar colleague. The College Examination Whilst the emphasis on assessment of outcomes in the workplace (by WPBA, frequent local evaluation and periodic certification) is important, there is a requirement for a national Examination to allow Trainees to be formally assessed by independent practitioners who are external to their training. It is important that Trainees are not solely assessed by, and rely solely on, the opinions of their local educators. The College has therefore decided to develop an Examination that is fair, reliable, informative and defensible. Furthermore the Examination will be integrated with the local continuous summative assessment process. A national (College) Examination will add to the reliability and validity of an assessment matrix which includes local assessment of competence and performance and therefore it is prudent to combine locally based appraisal/assessment with central Examinations. In summary, the use of a centrally organised assessment enables a national standard to be set which ensures both uniformity of practice and consistency in levels of competency. In addition it helps identify underperforming Trainees and contribute important additional evidence using a national reference as a benchmark. A college Examination, therefore, would allow progression in training to become dependent on assessment against a nationally agreed benchmark and not a local standard which by its very nature would be variable. Hence the overall purpose of the Examination is to ensure that a national standard is both set and met to ensure both uniformity of practice and consistency in levels of attainment of curriculum outcomes. 35 HOW EXAMINATION CONTENT IS DETERMINED The Examination must validate the outcomes set by the curriculum. Therefore, Examination content must be determined with reference to the curriculum. This has been greatly facilitated by the development of the new BST curriculum, which is an outcomes based document. This has resulted in sets of outcomes for each phase of training, within both clinical and professional domains. Trainees are expected to have achieved these outcomes and the Examination is therefore an objective benchmark which all Trainees must achieve to progress towards basic training completion and as a foundation to progress towards higher training. The Examination content is determined by the creation of an Examination blueprint, utilising the BST curriculum as the framework against which outcomes are determined for assessment. A methodology will be selected for how each learning outcome will be assessed (see appendix 1). For example, a learning outcome may be assessed by the ARP process, by an Objective Structured Clinical Examination, a Clinical Formulation and Management Examination or by a combination of these (see below). This will be determined by the Exam Sub-Committee of the Post-graduate Training Committee of the College (PTC), chaired by the Dean of Education. In summary, to achieve alignment between assessment and curriculum outcomes a blueprinting process will be performed. This will allow an Examination to be developed to assess explicitly stated outcomes utilising appropriate assessment types. Test method selection A variety of test methods have been selected to ensure that the widest ranges of outcomes, both theoretical and practical are assessed. Assessment must be reliable, valid, feasible, cost-effective, acceptable and also provide feedback to candidates being assessed. These attributes are collectively termed “assessment utility”. Review of Examination instruments and methods used in Psychiatry in other major jurisdictions revealed that the multiple choice question paper (MCQ), short answer question (SAQ), critical appraisal paper and structured oral Examination (OSCE) are both widely and effectively utilised in assessing Trainees. No single assessment instrument can assess every single outcome satisfactorily. The College Examination will be developed in two phases. In Phase 1 Trainees will continue to be required to complete the written components of the Royal College of Psychiatrists MRCPsych Exam. In addition, they will be required to complete the College of Psychiatrists of Ireland Clinical Exam. In Phase 2 the College of Psychiatrists of Ireland written exam will be developed and implemented. By the conclusion of these two phases the College Examination will therefore have been developed incorporating all the above components in a structured and integrated fashion. STANDARD SETTING & MAINTENANCE The Postgraduate Training Committee (PTC) will have overall responsibility for the creation, setting and on-going review of the College Examination. The PTC will be assisted by the Exam Subcommittee of the PTC, chaired by the Dean of Education and will consist of accredited Trainers (including senior clinical academic Psychiatrists) with demonstrated knowledge and expertise in Trainee supervision and assessment. 36 The content expert group will have access to educational expertise (a statistician with knowledge of the education literature), both within the College and through appointment of an external Examiner panel. The group will utilise the assessment blueprint to develop the required Examination formats outlined previously. The group will be responsible for Examination test item development, proofing, and standard setting. A standard is set for each component using an absolute standard. This means that there is no pre-determined number of candidates who pass or fail. Candidates pass or fail according to their own performance and not on how well they perform in relation to the other candidates. Standard setting will occur using the Angoff method. This method utilises Examiners (selected from College Educational Supervisors or tutors, etc.) who are asked to review each element in the clinical exam. Each element is independently assessed in relation to an external standard set by the Examiners. These estimates are discussed and averaged across assessors to reflect the standard for each question. The standard for each element is averaged across an exam to provide a pass mark. The group will also be responsible for oversight of the delivery of the test, and post-test analysis of results, in particular, determination of final cut-off score and test scores of candidates. SELECTION, TRAINING & MONITORING OF EXAMINERS All postgraduate training is supervised by accredited Trainers. Trainers are required to be on the Specialist Register of the Irish Medical Council, members of the Irish College and be compliant with the professional competence Scheme (PCS). Trainers will have undertaken a train-the-Trainer programme and prospective Examiners, an Examiner training programme (a specific training part to standardise scoring). Periodic refresher training for both Trainers and Examiners will be put in place. For Examiners this will be mandatory every 3 years. It is from within this pool that Examiners will be selected, both to develop and standard set/maintain the Examination, and also to deliver the clinical component of the Examination. Examiners will be provided with a list of the Trainees being examined prior to the exam and will be required to declare any conflict of interest. Examiners should not examine a candidate for whom they have been an Educational Supervisor or if the candidate(s) is known to them (e.g. relative, friend). It will be permissible for an Examiner to examine a candidate which they have previously reviewed as part of the Annual Review of Progress (ARP) process. Performance of Examiners will be routinely monitored during the clinical exam by external Examiners and post-assessment feedback meetings for Examiners will take place to share experience and allow dialogue to occur between Examiners. Examiners who do not maintain a suitable standard, as determined by the College Exam Sub-committee of the PTC, will be offered retraining or will be required to relinquish their role in future Examinations. CANDIDATE FEEDBACK & APPEALS PROCEDURE Feedback is given to candidates on an on-going basis during the formative component of their continual assessment process. The College Examination will also allow structured feedback to be given to candidates on their performance. 37 In particular, the OSCE should permit focused feedback on performance to be given to candidates due to the nature of the marking constructs used for the OSCE assessment. The College is currently developing its appeals procedure for candidates and this will be developed in line with international best practice. CLINICAL EXAMINATION FORMAT In order to be eligible to sit the Clinical Examination, candidates are required to have received an outcome 1 or 2 at the BST1 Annual Review of Progress (ARP) and must be registered BST Trainees in Psychiatry or have received a BST3 ARP Outcome 6 within the previous 2 years. In Phase 1 candidates for both the Clinical Formulation and Management Examination (CFME) and the Objective Structured Clinical Examination (OSCE) will be required to have obtained a pass in all written papers of the MRCPsych prior to sitting the College of Psychiatrists of Ireland Clinical Examination. The first offering of the clinical component took place in June 2014 and will run biannually (summer and winter) thereon in. The CFME will occur in tandem with the OSCE Examination at a single national centre. (A) CFME (Clinical Formulation and Management Examination): The CFME will take the format that involves all candidates watching the same video (of an interaction between a Psychiatrist and a patient) in one test centre with each candidate then being interviewed by a panel of two Examiners. The focus of the Examination will be the development of, and discussion surrounding, formulation and clinical management. In the interview the Trainee is asked to present and assess the case making an appropriate diagnosis and to formulate a management plan. This will be repeated once with a second video and a different set of Examiners. Each of the videos will be for 20 minutes followed by a 20 minute interview. The CFME may assess any of the 4 recognised Psychiatry specialties (General Adult Psychiatry, Child & Adolescent Psychiatry, Learning Disability Psychiatry and Old Age Psychiatry) or a sub-specialty (Addictions, Forensic, Liaison, Psychotherapy, and Social & Rehabilitation). Candidates will be provided with a formatted sheet for notes for personal use, not to be marked but to be retained by the College in case of appeals. Examiners will have been trained in advance of the roll out of this Examination and will assess candidates utilising a structured answer template and a Likert Scale or Global Rating Scale (GRS). All opening questions will be standardised before the assessment and Examiners will be permitted to interact and probe candidates during the interview. Two Examiners will be required per interview with a number of extra Examiners/Invigilators available on site if and when required to step in. (B) OSCE (Objective Structured Clinical Examination): The purpose of the OSCE is to provide a valid and reliable assessment of knowledge and clinical skills. The OSCE will include both patient and clinical data focused material. 38 The Exam sub-committee of the PTC will develop an OSCE blueprint and will determine the pass mark based initially on the Angoff Method and subsequently utilising the Borderline Group Method. The pass mark will not only set a threshold for each station or a number of stations that must be ‘passed’ but, in addition, core domains will be assessed across a number of stations such that the candidates will be required to pass each of these core domains. These will cover at least the following 4; (i) Communication Skills, (ii) Physical Examination and Health, (iii) Prescribing Skills and (iv) Risk Assessment. The blueprint, marking schema, and detailed Examination outline will be made available to candidates in advance of the Examination. OSCE stations may be both unlinked and linked (paired stations) and will utilise actors, suitable patients or consist of data interpretation. The entire scope of practice will be assessed. Examiners, therefore, would not be restricted to Psychiatry and patients/carers or allied specialities could also be represented, for example general practice, neurology, geriatric medicine and paediatrics. One Examiner will be required per station with a number of extra Examiners/invigilators ‘floating’ between stations and available on site if and when required to step in. In order to pass the Clinical Examination candidates must be successful at both the CFME and OSCE components. At the first attempt candidates must be examined in both components. Candidates who are unsuccessful at only one component (CFME or OSCE) are only required to be examined on that component at subsequent attempts. CLINICAL EXAMINATION PROCESS Preparation Examiners will arrive in time to prepare for the BST Clinical Examination. This includes attending an Examiners briefing meeting, checking the questions, being confident with questions and answers, and, being completely familiar with any relevant OSCE station. The start time of the exam may be delayed to ensure that this occurs. Examiners will be given a copy of the College’s Examiners Regulations document to review well in advance of the day of the Examination. Allocation of Candidates If an OSCE Examiner finds that he / she knows a candidate, or, the candidate considers that the Examiner knows him / her an alternative station, alternative Examiner, or Observer may be used. In the case of the CFME the Candidate or Examiner must inform a member of the Postgraduate Training Department immediately. The Candidate should inform a member of the Postgraduate Training Department, with reasons; if he/she considers that an Examiner’s impartiality is prejudiced. It will be permissible for an Examiner to examine a Candidate which they have previously reviewed as part of the Annual Review of Progress (ARP) process. If an Observer knows the Candidate the Observer should move to another station in the OSCE. Beginning the CFME Examiners introduce themselves to the candidate and may very briefly explain the format of the CFME. The Examiners must check and record the candidate’s number. Questioning begins only when the stopwatch has been started/ bell sounds to ensure that each candidate is examined for the same period of time. 39 Examiners should start the Examination with a question that is neutral in tone and difficulty. The aim is to avoid candidates being discouraged at the start of the CFME by an unreasonably difficult or aggressive question. Questioning in the CFME The Examiner must ensure that every candidate is provided with the appropriate opportunity to demonstrate knowledge. The Examiner has a list of standard questions and a list of topics that should be addressed within each question. These are used to suggest the general areas of questioning. However the CFME is not absolutely rigid in structure. It is not necessary for Examiners to stick to the order of these topics precisely. They can thus respond flexibly and appropriately to the responses of the candidate. However, the presence of the topic list ensures that approximately the same subject matter is examined by all CFME Examiner panels. The areas listed are all included in the syllabus. The question list also helps guide the Examiners, ensuring that the topics asked are within the College’s published curriculum. B. CANDIDATE REGULATIONS INTRODUCTION The overall purpose of the Examination is to ensure that a national standard is both set and met to ensure both uniformity of practice and consistency in levels of attainment of curriculum outcomes. The Examination will occur biannually (summer and winter). This will ensure that Trainees will have 4 attempts to pass the Examination whilst in training posts. All components of the exam must be completed within 2 years of successful completion of the Annual Review of Progress (ARP) for BST year 3. In Phase 1, its current format, Trainees will continue to be required to complete the written components of the  MRCPsych Exam. In addition, they will be required to complete the College of PsychiatristsClinical Exam. The Clinical Exam will consist of the following: (A) CFME (Clinical Formulation and Management Examination) (B) OSCE (Objective Structured Clinical Examination) REGISTRATION REQUIREMENTS Candidates are required to have received an outcome 1 or 2 at the BST1 Annual Review of Progress (ARP) and must be registered BST Trainees in Psychiatry or have received a BST3 ARP Outcome 6 within the previous 2 years. 40 Candidates will be required to have obtained a pass in all written papers of the MRCPsych prior to sitting the College of Psychiatrists of Ireland Clinical Examination. APPLICATION PROCEDURE Examination dates together with application periods will be published on the BST Clinical Examination page of the College website at least 5 months prior to the following Examination. All applications must be received within the specified dates. Application forms can be obtained from the Clinical Examination page of the College website. Please note the following: • It is the candidate’s responsibility to ensure that applications sent are complete, and that all necessary documentation required is attached. NB - incomplete applications will be returned and must be resubmitted within the application period. • Applications must be received no later than 5:00pm on the published closing date, and, applicants are strongly advised to apply as early as possible within the application period. • Once a complete application has been received by the College this will be acknowledged. • The College cannot accept responsibility for postal delays or loss of documentation in the postal system or insufficient postage paid. EXAMINATION CENTRES Details of Examination dates and venues will be made available on the BST Clinical Examination page of our website which can be accessed by clicking here. Applications received are only valid for the specific date and venue that the candidate has applied for. Candidates must bring proof of identity to each Examination. Proof of identity must be an official document, such as a current passport or driver’s licence that includes the candidate’s name, signature and photograph. CONDUCT IN EXAMINATIONS It is strictly forbidden to take books, notes, aids, overcoats, handbags, cases, and any electronic, computer, recording or other equipment into the Clinical Examination rooms or test stations. Writing materials for use in the Examination will be provided and must be returned together with all notes made. It is strictly forbidden to remove Examination material from the Examination. This includes written questions and any material received at the OSCE stations. During the Examination, the use of telephones, computers, or any form of communication, messaging or electrical/electronic equipment, including recording devices by candidates is strictly prohibited. 41 Please note that failure to comply with these requirements will lead to disqualification from the Examination. Please also note that some participants in the clinical exam will be actors while others may be volunteers who have consented to participate with the understanding that confidentiality will be maintained. Candidates must respect confidentiality as in any clinical situation. Failure to do so may be considered as professional misconduct. Similarly, candidates’ behaviour towards participants must be consistent with the Medical Council’s guide to professional conduct. http://www.medicalcouncil.ie/News-and-Publications/Publications/Information-for-Doctors/Guideto-Professional-Conduct-and-Ethics-for-Registered-Medical-Practitioners.pdf PUBLICATION OF RESULTS Dates for publication of results will be published on the BST Clinical Examination page of the College website or are available from the Postgraduate Training Department. Results are sent by post to candidates on the predetermined dates as published on the college website. RESULTS WILL NOT BE GIVEN OVER THE TELEPHONE, BY FAX, OR E-MAIL. Candidates should not contact the Postgraduate Training Department to enquire about or discuss results. REQUESTS FOR FEEDBACK Feedback is available for the Clinical Examination. It is provided only for those who have been unsuccessful and submit a written request for feedback within 21 days of issue of the result letter. WITHDRAWALS a) Withdrawal Prior to an Examination It is the responsibility of candidates to satisfy themselves that they are fit to take the Examination(s). If the candidate is not fit, or if he / she thinks there may be other grounds for withdrawal - for example, illness / bereavement or personal problems of a very serious nature – he / she should inform the College of Psychiatrists in writing together with a GP’s letter (if applicable). b) Withdrawal during an Examination Candidates who attend the Examination Centre and are or become unwell on the day of the Examination should speak to a member of the Postgraduate Training Department present. If the candidate wishes to continue the Examination, the Examiners/Examinations Sub-Committee of PTC will not normally make allowances for adverse performance levels due to illness. Candidates should be aware that if they decide to continue under such circumstances their attempt will stand whatever the circumstances. It will not be possible to allocate another date outside of the biannual Examination schedule for candidates who withdraw. 42 SPECIAL NEEDS FOR CANDIDATES TAKING THE BST CLINICAL EXAMINATION Notification of Disability or state of health within an Examination centre Applicants should inform the Examinations contact in the Postgraduate Training Department of any disabilities or factors that may hinder their movements within an Examination centre within the application period. Supporting documentation from the applicant’s physician should also be submitted together with details of requirements. If a candidate is not able to supply the above documents within the application period, the candidate may choose to (i) withdraw, or (ii) proceed without special arrangements. In the event that a candidate requires special assistance at an Examinations centre outside of the application period due to unforeseen circumstances they should contact the Examinations contact in the Postgraduate Training Department immediately. COMPLAINTS PROCEDURE Trainees who wish to make a complaint regarding assessment of their eligibility to sit for any Examination should write to the Dean of Education. All such complaints will be discussed with the Dean of Education and the Examinations Sub-Committee of PTC if appropriate. Candidates who wish to make a complaint about the conduct of an exam/ Examiner at the Examination should in the first instance immediately ask to speak to a member of the Postgraduate Training Department, who will complete an incident report. In addition, the candidate should make a formal complaint in writing to the Dean of Education no later than FOUR DAYS after the date of the Examination. It is the responsibility of the candidate to comply within the stipulated timeframe. The Dean of Education will investigate the complaint and report to the Examinations Sub-Committee of PTC. APPEALS PROCEDURE Candidates who wish to appeal against the result of the BST Clinical Examination should apply on the official BST Clinical Examination Appeal Form and should follow the appeals procedure both of which can be obtained from the postgraduate training department (see also Appendix 1 to this document). HIGHER SPECIALIST TRAINING Trainees are expected to have achieved the outcomes for Basic Specialist Training outlined in the curriculum and the Examination is an objective benchmark which all Trainees must achieve to progress towards Basic Specialist Training completion. Sitting the BST Clinical Examination therefore is a foundation to progress towards higher training. 43 APPENDIX 1: THE COLLEGE OF PSYCHIATRISTS OF IRELAND - BST CLINICAL EXAMINATIONS APPEALS PROCEDURE (Drafted 12th May 2014) Candidates who wish to make representations with regard to the conduct of their BST Clinical Examination must initially submit them to the Postgraduate Training Department / Dean of Education within 14 days of the date of issue of feedback from the Examination (see paragraph 7 above). Representations will be dealt with according to this policy. Definitions “Days" "Examinations Appeal Panel" Calendar days A panel of five comprising of the Dean of Education or his/her nominee as Chair, and, four others jointly agreed by the Chair of the Postgraduate Training Committee and the Dean of Education. "Final Appeals Panel" An independent panel determined by the Council of the College. "Final Appeals Panel Hearing” The hearing of the final appeal comprising of the Final Appeals Panel and the candidate. "Application" An appeal submitted for consideration under these rules before acceptance. "Candidate" A Trainee who has attempted the BST Clinical Examination. "Postgraduate Training Committee" The Committee responsible for all matters regarding Examinations and Training. 44 GROUNDS FOR APPEAL An appeal will only be permitted to proceed provided the candidate has complied with all applicable procedures as set out in the Examination. One or more of the following shall constitute grounds for an appeal under the appeal procedure:- I. An Examination result is incorrect, for example, due to an administrative error. II. There is evidence of administrative irregularity or procedural failure and there are reasonable grounds to believe that, were it not for that irregularity or failure, the Examination result would have been different. III. There were circumstances affecting the candidate which were not known to the Examiners or to the Examinations Sub-Committee at the time it determined the Examination result and, had those circumstances been known to the Examiners or to the Examinations Sub-Committee, it is likely that the Examination result would have been different. WRITTEN APPLICATION I. The Application must be typed, signed and submitted to the Postgraduate Training Department by post only on the official College of Psychiatrists of Ireland BST Clinical Examination Appeal Form – this can be obtained from the Postgraduate Training Department. II. Where relevant to the appeal, all supporting documentation on the candidate’s medical condition at the time of the Examination including, where appropriate, a medical report from a suitably qualified medical practitioner written at about the time the candidate sat the exam the subject of the appeal. III. The current fee for an appeals application is: €600. If the candidate’s appeal is successful the administrative fee will be refunded in full. IV. The Dean of Education may request in writing further information from the candidate. The candidate must supply such further information within 14 days of the date on which the request for further information was sent. In the event of it not being supplied within that period the application will automatically be void. V. Providing that the applicant complies with the preceding provisions then, not later than 14 days after receipt of the application, the Dean of Education will contact the candidate in writing notifying them that the application for the appeal has been accepted and to whom it has been referred for consideration. 45 CONSIDERATION OF APPEALS I. The grounds for appeal will be considered by the Examinations Appeals Panel who will review all documentation submitted by the candidate, together with comments and mark sheets from the Examiners, and from the external observer if available and appropriate. The Dean of Education will advise the candidate of the panel's decision in writing as soon as reasonably possible. II. An anonymised report on the outcome of the appeals will be presented to the Postgraduate Training Committee and the Examinations Sub-Committee by way of information. FINAL APPEAL I. Candidates who remain dissatisfied following consideration of their appeal, can, within 14 days of issue of the result of such consideration, lodge a Notice of Final Appeal by hard copy in writing only with the Dean of Education. This will only be accepted within the given time frame. II. The Notice of Final Appeal must contain the information and documentation that was submitted with the original appeal and any further information requested. III. The President, Vice-President, or Chief Executive Officer shall convene a Final Appeals Panel and will endeavour to fix a date for the Final Appeals Panel hearing within 14 days of receipt of the Notice of Final Appeal and inform the candidate in writing of the date of the Final Appeals Panel Hearing. IV. The Final Appeals Panel will consider all written evidence submitted by the candidate and the Examination Appeals Panel. Not more than 7 days after the date of notification of the Final Appeals Panel Hearing, the candidate may request in writing all written evidence submitted on behalf of the Examination Appeals Panel. The Dean of Education will supply such documentation within 7 days of the date of receipt of the candidate's written request or as soon as reasonably practicable following submission on behalf of the Examination Appeals Panel. V. The candidate may attend the Final Appeals Panel hearing and present an oral submission. In addition, the candidate may wish to bring a representative or friend to the Final Appeals Panel hearing. It is not normally envisaged that such representative will be a lawyer, and if the candidate does intend to bring a lawyer representative at the candidate's own expense, then he/she must obtain the College's prior written agreement. In the event that the candidate is legally represented, the College reserves the right to have its own legal representation. If a candidate wishes to be accompanied by a lawyer, the Appeal Panel Chair should normally agree to the request. Legal representatives should be reminded that appeal hearings are not courts of law and that the panel governs its own procedure, including the questioning to be allowed of others by the legal representatives. VI. If it is not possible immediately to make a decision whether to uphold or reject the Appeal, the Final Appeals Panel may at its discretion adjourn the hearing and / or carry out further investigations. Once a decision has been made, the Final Appeals Panel will present its determination in writing to Dean of Education who will send the determination to the candidate forthwith. The appeal process described above is the final internal avenue of appeal 46 VII. An anonymised report on the outcome of the Final Appeal will be presented to Postgraduate Training Committee by way of information. A copy of the report on the outcome of the Final Appeal will be provided to the candidate.