Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0140Training Requirements forOld Age Psychiatrists in the UKSusan M. BenbowWolverhampton Health Care NHS Trust, Wolverhampton, UKIn the UK over the last 20 years, increasing numbers ofpsychiatrists have specialized in working with older adults.Various terms have been used to describe this area of work:‘‘psychogeriatrics’’, ‘‘geriatric psychiatry’’ and ‘‘old age psychiatry’’are probably the most common. In 1978 the Royal College ofPsychiatrists formed a Section (now Faculty) of Old AgePsychiatry and just over 10 years later, in 1989, old age psychiatrybecame recognized as a specialty by the Department of Health.The Royal Colleges of Physicians and Psychiatrists produced aJoint Report in 1989, which devoted a chapter to education andtraining in the psychiatry of old age 1 . At that time there was noaccepted training programme for psychiatrists aiming for a careerin the developing specialty. Things have changed considerablyover recent years.experience in old age psychiatry, as recommended by the JointReport. Gregson and Dening 6 surveyed teaching hospitalpsychiatrists and found that many teachers set no formal learningobjectives in old age psychiatry. Most respondents wanted theirteaching to impart enthusiasm for the subject, a sense of hope inworking with mentally ill older adults, and an awareness of issuesspecific to ageing and ageism.Although there are now chairs or readerships at a number ofmedical schools in the UK, gaps remain 7 and the second JointReport, published in 1998, recommends that the characteristics ofmental disorders among older people and the principles of goodquality care should be included in the core curricula of all schoolsof medicine and nursing.BACKGROUND: GROWTH OF THE SPECIALTYIn the early 1980s, two surveys of psychogeriatric services 2,3showed considerable growth in the developing specialty, suchthat over 200 consultants were identified by late 1983. At that timethe Joint Committee on Higher Psychiatric Training of the RoyalCollege of Psychiatrists required higher trainees to spend 12–18months in posts where the bulk of the work was in the subject; 28senior registrar placements were identified. The authors predictedongoing growth in old age psychiatry and a need to expandavailable training.By 1990 there were 360 consultants working mainly in old agepsychiatry and in 1993 the total had increased to 405 4 . Figurescollected by the Faculty of Old Age Psychiatry show that the totalhas continued to rise, although there is still a high vacancy rate ofapproximately 14%.UNDERGRADUATE EDUCATIONThe first Joint Report 1 recommended that each medical schoolshould have a senior academic in old age psychiatry and that allmedical undergraduates should receive training in the subject.Faire and Katona 5 surveyed undergraduate teaching in the UKand reported a considerable expansion of academic posts in thespecialty, but noted that more than half of all departments lackeda senior old age psychiatry academic. Almost all medical schoolsoffered formal lectures in the subject, but there was great variationin the amount of clinical experience on offer and the authors feltthat there was a strong case for all medical students having clinicalPOSTGRADUATE TRAININGThe total minimum duration of specialist training in old agepsychiatry is 6 years, of which 3 years will be in generalprofessional or basic specialist training and 3 years in highertraining (as a specialist registrar).Basic Specialist TrainingPart II of the Membership examination of the Royal College ofPsychiatrists (MRCPsych) can normally only be taken after 30months of training in psychiatry and is a requirement for entryinto higher training, so basic training normally lasts for about 3years. The first 12 months may include 6 months in old agepsychiatry, provided that the experience offered is broad andincludes the assessment and treatment of people with functionalmental illness. Experience in old age psychiatry during basictraining is regarded as important because of the increasing elderlypopulation and the high rate of mental illness in older people, butthe College Basic Specialist Training Handbook 8 states thattrainees should be exposed to acute and functional mentaldisorders in late life and not solely to organic brain diseases.Old age psychiatry placements can often offer good communityexperience for trainees and the opportunity to attract youngpsychiatrists into the specialty.Basic training concentrates on providing a range of experiencein the specialties and subspecialties of psychiatry, aiming todevelop history taking, formulation and case presentation skills,therapeutic skills and clinical judgement, relationships withPrinciples and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd