Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Yeah. Hm. Hello everyone. Thank you very much for joining. My name is Tina. I'm one of the specialty care for leads and I have my colleague, Doctor Patel here as well, which who is the specialty careers article lead. Um Thank you very much for doing these specialty care for B uh Doctor Dominique will talk to us about the career in for psychiatry. So just hand over to Dominique. Thank you. Thanks Adina and thanks to Kostov um for linking me with this um presentation. So, hi, everyone. I'm Dominic. I'm an ST four in Forensic Psychiatry. Um I work in Bristol under the Sever Diary under a WP uh mental health Partnership Trust. So, um I'm going to give an overview about um forensic psychiatry uh which I will delve into. Um So I've made an outline here. So again, just kind of defining what forensic psychiatry is, um what is recruitment like. And then I'll explain how services are delivered um in the healthcare system here in the UK. So you got just letters there, SW PC and ICB, which I will explain um later on. And then I'll briefly speak about um my NHS Trust and how we work with different organizations, um, in, in Bristol and, um, the Southwest region. Um, then I'll touch on my training, how, how I got here, how I got into the UK and into this, um, higher training program and also kind of just giving an idea of what the curriculum is like, um, for forensic Psychiatry asset by the Royal College. Um, and they will move on to life as a registrar. So what my work week is like. Um And also just to highlight that um there's so much variation with what a registrar um can or cannot do. So there, obviously, there's a med reg and there's a a psych reg. So I'll just focus on forensic psychiatry because um general adult psychiatrists, um cas psychiatrist, they have a completely different framework. So I'm not gonna touch on that and also just mentioning about special interests and why it is part of the curriculum. And yeah, I'll, I'll aim to leave some time for, for questions and I think um Adina will call me up on that if I'm um lagging on time and I'll leave my contact details if you have any questions about, about, you know, my talk tonight or if you're just curious about um considering forensic psychiatry as a career. So, um I would define forensic psychiatry as a multifaceted spec specialty in medicine. So, in simple terms, it's, it's the interface between psychiatry and the legal systems. Um So it's it's based on right, detailed knowledge of, of, of relevant law, criminal and civil justice systems, mental health systems and the relationship between mental disorder, antisocial behavior and offending. So, your role really is to assess treat and rehabilitate offenders who, um, have, sorry to interrupt. Yeah. I think people are unable to see the slide. I, oh, ok. Um, I'm on slide three. Ok. I think they can see now. Ok. Ok. Maybe it just takes a while because maybe I think it's kind of graphic head. Yeah, but let, let me know, let me know and then I um I'll try to like switch it up. OK. Um So, so yes, so it's an interface between two fields, basically mental mental health and law. But um I would say it, it's a lot more than that because you've got different systems. Again, legal systems, mental health systems and there's the relationship between um mental disorder, antisocial behavior and offending. So your role is mainly to assess uh treat and rehabilitate people who are involved with the criminal justice system um with mental disorder or have the potential to be, to be violent. So that means if somebody who committed crime is, is known to be to have ongoing mental illness, you treat them um under, under the under forensic services or if somebody in prison, if a prisoner is on remand and develops mental illness, then you treat them as well and under um the Mental Health Act you can transfer somebody from prison um to a forensic hospital. Um And that leads me to the next bit here, which is risk, which is really the core feature. Um I believe um in this specialty, you're always assessing risks. Um and in a range of settings and that you can, you can express this in many ways. Um You know, I in this, in this, in this work like where you, you are called by the court to provide um psychiatric reports, you can uh give oral evidence in court. Uh you're liaising and advising several professional agencies. Um So just like a for example, a general psychiatrist who can liaise with drug and alcohol services, social services. So in forensic psychiatry, it's, it involves. So it's, it's also there are similar um services you link up with, but at the same time, you are also providing your expertise again with legal bodies. So that's the Ministry of Justice um magistrate Court, Crown Court. Um And there's this um leg legislative framework um called MA A which stands for Multiagency public Protection arrangement panel. So I had to write this down because I can never remember. Um it's, and it's designed to protect the public from serious harm by sexual offenders, violent offenders and other dangerous offenders. So again, it's a partnership between police prison and probation services. And again, because these offenders have mental illness or a history of mental illness, then you are invited to attend um these meetings and they are um mandatory. Um but at the end of, at the end of the day, um you are a doctor, you're a psychiatrist. Um and this is why these other um these assortment of bodies are, are relying on your medical expertise in terms of the of patients, you know, who deteriorate in mental state leading to, to mental disorder. And as a psychiatrist, um you are still dealing with physical physical aspects, you know, given that psychiatric medication um present with so many physical side effects and complications. So you, you are so in my, in the hospital where I work, I still have, you know, an sho colleague and obviously there's a consultant. Um and there are, it, it, it's basically the same when you work with the nursing team, social worker ot. Um and you know, we still, we still r the med edge for advice, we still bring patients to the general hospital in case they develop physical health concerns. So I'm moving on to the fourth slide. So let me know if you can see it. Um So I've just included your screenshots from the um recruitment uh website um from NHS England. So as you can see, we're quite a small bunch. Um in 2022 there were 19 posts um that was completely filled. Um And it's a shame really because they started to cut down on the dual posts. So there was only one post for a forensic psychiatry and medical psychotherapy post. So that becomes, instead of a three year higher training program, um, that becomes four. So you do your core psychiatry training for three years, CT one to CT three, and then you become an ST four when you enter higher training. So if you're in a dual post, whether it's general adult plus old age or in this case, forensic plus medical psychotherapy, then you, um, you reach up to ST seven before you see CT um So last year, uh this was, there were about 30 posts, um 21 were filled. So I started in February and when I was applying for, for forensics around this time, last year, there was uh 26 posts across England, Scotland and Wales. Oh, and just um if anybody is interested to become a higher trainee in psychiatry, there is also a point system uh where you submit evidence. Um And there's also an interview. So um moving on to the system. Um So you've got here a picture on the right, which is um which tells you the different NHS trusts that work together under uh integrated care board. Um And um so integrated care board is, it's, it's a legal term. Um It's so it used to be called CCG the Clinical Commissioning Groups. Um And so as a legal entity, they, you know, they can develop plans on how to um to assess the healthcare needs of the population, especially with more um specialized or complex needs. They manage the NHS budget, they commission services. Um So they involve a provider collaborative. So because I'm in the Southwest, it's the Southwest provider, collaborative. Um Sorry guys, really boring stuff. But um I'm I'm gonna make a point here. So the reason is secure services is quite, you know, it's, it's complex needs. Um So the SW PC makes it possible um for more integrated and specialized healthcare. So um we provide uh the SW PC provides like ac tier for service. So just for Children with mental disorder that are more, that have more complex needs, adult eating disorders, mother and baby unit. Um and it spans really from Cornwall to Gloucester. So that's quite a uh wide geography there. Um And the, the aim is to let patients live as close to their, to their homes as possible. So for example, if there's a, so at this point in my training, I'm not really sure how, what the regulations of prison is with moving around prisoners. But let's say, for example, if there was a, if there was a prisoner in Devon, in a prison in Devon, and he developed mental illness and he, and he needs to be treated now in a, in a secure unit or a forensic hospital. If that prisoner lives in Bristol or has family in Bristol, then we are the assessing team. And if he gets admitted, the ideal situation is for him to be admitted in a forensic hospital in Bristol. So, so that's, so that's how it works. Um So sometimes in, in, in my, in my work when I, when I have to do, when I have to assess, let's say a prisoner or somebody in PQ. So for, in prison, for example, I've driven as far as in the Midlands, like a 2.5 hour drive and then assess the, assess the, the prisoner and then drive back to, to where I work and just hand over to the consultant, see what they think. So it's, it's really a whole day. It's, it's a whole day's work. So sometimes I there's one day in my schedule, if there's an urgent assessment of somebody in prison who and there's really concerns that they're really, really unwell, then, you know, I don't, I don't, I don't have to do my work in hospital. And obviously I need, I need to do the assess, I need to do my work outside of it. Um So, yeah, I hope that makes sense. Um why there's a, there's a need for the like provider, collaborative and different regions has it. So there's London provider, collaborative, there's also in the North. Um OK, so by definition, um so I've been mentioning secure services. So that just means, you know, obviously a service with, you know, with the level of security and in forensics, there's, it's three tiers. So there's low, secure and medium secure and high secure. So Broadmoor, um I'm sure some of you here might have heard of it is, is a high secure or I guess in America they call it like a maximum security um uh or maximum detention uh hospital. So the NHS England defines um patients um liability to be detained under the Mental Health Act and the risk of harm to others and risk of escape from hospital cannot be managed safely within other mental health settings. Um So again, I've just, you know, highlighted there the term. So if it's low secure, they present a significant risk of harm to others. Um their escape from hospitals should be impeded for medium secure. Um They present a serious risk of harm to others. And if they um you know, escape should be prevented. And finally, with high secure, they present a grave and immediate risk to public and who should not be able to escape from hospital. So I guess for example, if you, if you come in a low secure unit, um I haven't worked there but I believe, for example, you probably have to like surrender your, surrender your phone if you were visiting. Um But in a high secure, uh I'm aware that even if your staff because I did, I did, I did a shadowing there quite recently. Even if you're the consultant, you need to leave your phone in the car. Like you can't even, you can't even bring it inside because of the the security and you, you pass through like a like an airport security that you get the full body scan and there's, there's so much so the more, the more secure the hospital, the more restrictions and that goes definitely for, for patients as well. Ok. So moving on to locality. So, so my trust even in a wheelchair, it's the lead provider for of health care for people with serious mental illness, learning disability and autism. So it covers um quite a lot uh including bath in North East Somerset Swindon and wheelchair and the BN Ssg Bristol, North Somerset and South Gloucestershire. Um in August 22 Oxley's was Oxley's NHS Trust, the, the London Trust um was awarded the Southwest Prison healthcare contract for 10 prisons in the Southwest. So, and I'm going to talk more about that. Um ok, later on, but for now I'll just describe um my work site. So there's a picture, there's a picture there. Um Yeah, so it currently I'm in a medium secure which is 80 beds. Um It includes like an acute ward. So um somebody presents like higher risk or usually an admission comes through the ward that I currently work on. So usually if you're ST four, you're, you're placed there because it's a lot of learning like you can see the process from transferring somebody from AP PQ. Sorry PQ is psychiatric intensive care unit. Um So for people who are not from the UK or people who are um who haven't rotated in a PQ, it stands for psychiatric intensive care, not, not, not like a medical ICU. Um So if somebody is being transferred from a PQ to a um um secure hospital, um and then where was I? OK. So, so obviously, for example, we have a PQ um in Bristol and if somebody is being transferred there, then it depends whether it's low or medium secure. Um And then again, if somebody is being transferred from prison, depending if they are from Bristol, then I the ideal situation is for them to be transferred to us. But again, if there's no bed availability. Um so we do have, we do have 80 beds but you know, there's a, there's an acute ward, like I said, uh where we get the transfers from p in prison, there's a rehab ward. Um There's a female ward. Um And then with, with lo Secure, I think it's completely completely male wards. Um So yes, again, um the admission process is, is, is much slower compared to like somebody in a general hospital. Um and, and the oh, but um much slower as well compared to like physical health, physical health admissions. Ok, so yeah, so I mentioned prison. Um So my contract is with a WP but I have an honorary contract with Oxley because as mentioned before Oxley has kind of um is now the responsible trust for these prisons in the Southwest. So I do have an honorary contract with them and I do, I work uh once a week under a clinical special interest as per the, you know, training scheme of the deanery. And I will touch on that later on. Um So having training in prison and having experience in prison for a year um is the recommended um training competency to be achieved um whilst you're in your registrar years. So I'm just, I'm just put there um you know, bits from the curriculum saying that you must practice psychiatry in prison, you know, including in the key capabilities. You know, you must have an understanding of the nature of the environment, adapting the skills, recognizing what, what you can and cannot do. Because again, as I've mentioned, you're working with legal systems. Um and it's not always straightforward. Um you must have an advanced knowledge of the prison estate structure, you know, the wider criminal justice system in the in, in the UK. And again, you must provide effective clinical leadership because again, you are working with prisoners and the prison mental health team, but again, you are also working with non healthcare agencies. So just thinking about if somebody, if somebody is um has been ment has been treated for their mental illness and you know, they serve their sentence and they are, they are actually going to be released and you know, discharged to the community. What, what does that mean? Like which agencies do you need to inform about, you know, this, this, this patient slash prisoner? Um So it's a lot, it's a lot of, again just letting people know about the risks and in forensic psychiatry, um any added information is, is always welcome. Like the more information we have the better even if it's repetitive. Um Yeah, we never, we never turn down um information about, about the patient. So that's a picture of um the mail prison where I work. Um So again, I just put the logo there because it's under um yeah, it's under oxy and that's just a uh a picture on the right, just what the, what the prison ward is like. So I work, I work with the um I work with the psychiatrist. Um I never see a, I never assess a prisoner by myself. I always need to be with a mental health nurse or the psychiatrist. Um II do have some, some influence on making decisions. Um But again, it's an honorary contract. So again, there's just kind of just that boundary between, you know, between what you can do. So my journey um to getting to, to where I am. So I, I'm an I MGI I moved here from the Philippines in 2020. My first job was a, I was a trust doctor in a um mental health services for older people. Um And then I just, you know, I just jumped straight into training uh in 2021 of January. So I'm, I'm here for about four years now. Um And then I stayed in that dry for a whole three years. And then last year I, uh gained my membership to the Royal College. So II transferred, I transferred dries uh because I wanted a change of environment. Um And I personally, I like, I like Bristol as a city. OK. So I've, I've just, um, copied some bits here fro from the, from the Royal college curriculum about what is expected of a registrar. So um to simply describe it, the higher you go, the more independent you are. So in your portfolio, you know, when you start logging in your, your workplace based assessments or your cases. So, you know, sometimes you get assessed for, um I don't, I can't speak for other specialties, but let's say if you were to assess a patient, usually a consultant is there to observe you how, how you, you know how you assess and how you diagnose and how you speak to the patient about management. But because as a registrar in, in forensics, so for example, if you go to prison, let's say, as far as Devin and you, you assess somebody, you're the, you're, you're the senior member of staff. So there's no consultant to observe you. So our portfolio is more of case based discussions rather than, rather than like real time um observed assessments. Um because there's expectation that that you can make these decisions. And there is, I would say that you, you have a lot of influence, you have a lot of power um as to the movement of patients um and offenders um in the country. So, so yeah, II really like have developed an appreciation of that. Um And yeah, and the consultants trust you more. But again, there's always that support. So you're kind of in the middle, you, you have a, you have a um a resident doctor who's like covering the ward, like with the physical health bits, um which you are expected less, less expectations for you to do, but I wouldn't say you're exempt from it. Um And yes, you have a, so you still have a supervising consultant. So as an ST four, you, it says here you bring evidence base regularly into clinical decisions in line with best practices and you plan the research activity and you show evidence in, in super in supervision. Um So planning the research activity. So you're expected to do research at least once in your specialty training. Um And again, you can do this in the form of AQ I, you know, you can do, you can do um uh a systematic review meta analysis with a team. It really depends on you. You're not gonna be spoon fed or told what you can do. Um But you will be given time for this and I'll, and I'll tell you how because the the Royal College makes makes sure that, that um there is time to do all these uh nonclinical development competencies. So when you're an ST five, you're able to grow reco recognize the limit of the evidence base and you're able to work safely beyond that. So that just simply means if you have an assessment about somebody or I don't know, you, you have to make a decision for, for a team, you know, the limit of, of your role and you know, the limit of the the medical team in the wider forensic system, like in the wider interface of medicine and law. So, you know what you cannot do. So you know who to speak to when there's when there's a certain issue. Um and also, yeah, just says here shows progress being made in the plant research activity and she has outcome of research. So again, just, you know, just kind of being more independent and finally, in your last year, um you pursue your own area of academic interest. So I know some registrars who managed to do AP APG cert APG dip a part time masters. Um you know, they've gone on to like um taking management roles or like finding jobs for themselves, like securing themselves a consultant post when they reach ST six, they're able to disseminate research outcomes in appropriate ways and forums. So again, once you finish your research, you know, you're free to um I don't know, do an oral presentation overseas. Um Ask the senior member of the team, um You collaborate with different trusts, different organizations. Um And yeah, obviously, the goal is to use that research, whatever you've learned in your training to influence MDT S and guide service development. OK, so you're ready now, what? Um so I already touched on this. Um So you, you're a senior role, you have a senior role working more closely with the consultant. Um I would say you're coca of the ship, you're not quite captain of the ship yet, which to me gives um you know, a nice kind of feeling of relief and security. But then you are also encouraged to like make, make decisions. So if, if, if you have an admission, the consultant says, um you know, he's under your or she's under your case load, like, II have more decisions about, you know, choice of medication switching. Um trying this, trying that. Um and then, um and obviously knowing my limitations um to what I to what I can or cannot do. So, for example, um if somebody's in so in a psychiatric hospital, in a, in a, in a general psychiatric hospital, uh obviously where you're not where you're not under the criminal justice system, consultants can prescribe leave. So that just means you can, you can tell that you can tell the patient you can go out of hospital, you can have a cigarette break by the grounds, ok? And we'll have like a member of a member of nursing staff, like walk with you or you wanna go to the shop, you wanna buy something. Um That's fine. E like easy, like fill out the form like easy in like 55, 10 minutes. So because it's forensic psychiatry and this is what I've been trying to um, to like uh reiterate in the last several minutes. There's more risks, there's more nuances, there's more steps. So you cannot just prescribe, leave. Uh You need to be writing a report that needs to be submitted to the Ministry of Justice and that can take, you know, days, weeks, months, depending on the complexity and the dangerousness of the, of, of what that patient presents. So obviously, if you, if you believe that this patient has um reached a level of stability um and good therapeutic response, you know, to medication to, to psychology, o occupational therapy and whatnot. Then that then that's what you write in your report. You can say that they've been working well on the ward. They're like they're settled, they're, they're incident free, they're taking their medication regularly. My recommendation is that, you know, we take positive risk taking and we can actually let this, let our patient go, go to the shop or go to town. So if you think about it, it's, you know, it's something that, yeah, I think being in forensics just kind of makes me appreciate the things that we we, we can do like it's freedom basically. And if you're in this field, you're, you're deciding like the level of freedom that you want, that you wish to give this person. But at the same time, you have to protect the public. But then again, it's also a balance where you cannot keep somebody in hospital forever. So that's there's that element of positive risk taking. Um So yeah, it's always constant risk assessment, constant like, you know, it's a delicate balance, all those bits. So I've put here a picture of a sample work week and you can just read through that. Um And whilst you do, I can just briefly explain my work week. Um So on Monday, I do a handover from one of the wards I get um it, it's, it's online so, you know, so I can attend that from, from home and then I pop into work later on or I can just show up if it's urgent, obviously, then I have to come in. Um And then in the morning, I tend to finish reports. I go through emails, finish the reports. So if I'm writing a court report, if I'm writing a, a report about granting somebody leave and basically it's different kinds of reports. Uh II leave that in the morning in the afternoon, there's another handover from another ward and that's face to face. Um In the afternoon, there could be, it could be anything really like um writing medical recommendations. Um Yeah, it's all gonna sound really boring now, but it's, it's a lot of writing, it's a lot of writing throughout the day um for Tuesday. Um That's where I go to the prison where I work for my clinical special interest on Wednesday. So if you remember the, the me, the, the terminologies I mentioned um to you guys the um the SW PC, the Southwest provider collaborative. So there is a meeting that occurs once weekly and that's where like consultants award managers. Um uh and the panel, the SW PC panel they, they pretty much discuss. And if you remember that picture where there's all those like trusts like from Gloster, like from Cornwall to Gloucester. So they, they do discuss like they a lot like a few hours for, for this day to talk about referrals, admissions transfers who needs to be assessed urgently. Um I'm not required to join that, but II did just for my learning like a few times. Um because obviously the outcome of that, of that meeting, let's say, oh, somebody needs to be assessed really urgently. Um The prison mental health team is concerned and again, if they're local, if they're from like Bristol Bath, Swindon wheelchair, then I get an email from my consultant saying, can you do this assessment? It's quite urgent. Um Wednesday is also um is uh it's, it's time for um like a case consultation. So if you're a friend, if you're a consultant and you're having, if you want to seek advice from your colleagues on how to manage a patient cause patients can be really complex. Um And again, it takes, it takes ages. Um I just had a, a manager's hearing today where about, about a patient who's been in hospital for for a long time and I can, I can give you a range, people in hospitals in forensic hospital can stay from for about maybe two years and sometimes people spanning up to 20 years. Um Yeah, so it's, it's, it's, it's so variable. Um So sometimes you can attend these meetings. Oh, as well. Um You can attend a tribunal. Um If somebody, if people here are familiar with a medical tribunal, you attend that you're, you're the person who gives oral evidence. So again, usually it's the consultant but because it is part of your training to become more independent, sometimes they just let you give oral evidence and, and they're not, they're not there anymore. You just kind of um in your next supervision, you just talk to them about it and you know, discuss it. But obviously, again, if you have difficulty with the process at any point, you just, you just speak to them. They're always around, they're always around. Um Thursday is ward round. Um So again, if the consultant is not around, then the registrar leads the ward round and that, that's quite a whole day affair that gets um pretty tiring. And for Friday, um at least for my Friday, it's my nonclinical special interest. So there's a, so again, just mentioning in the curriculum, there's a clinical special interest and there's a nonclinical interest, special interest and I'll tell you later on what, what that involves. So, again, on Friday, I'm not, I'm not in the office because of the nonclinical special interests. Ok. So for the clinical bit, so in the curriculum you are, I think it's, uh as far as I'm aware, it's, I think it's the only dry that gives you two days for a special interest. So one clinical and one nonclinical for clinical you can, um, so it's basically like it's like an elective where obviously it's still, it's still a, it's, it's still a working contract. Um So you can, you can um pursue it in a forensic services for women. You can go to an elderly um forensic unit. Uh You can work with consultants who manage, you know, really complex schizophrenia or treatment resistant schizophrenia who are, you know, again offenders. And under the criminal justice system, you can do an adult AD HD clinic. So that's my, that's going to be my next um, special interest. Um I'll be shadowing one of the, um, the Bristol or not just shadowing but working uh for the adult AD HD clinic in Bristol, there's a memory clinic, uh eating disorders unit, um, and find which uh stands for forensic intellectual and neurodevelopmental disability. Uh yeah, so that's people with um, yeah, again, learning disability, um, severe autism. Um again, really complex patients but they are offenders. So, and there's a whole, like if you just do a quick Google, there's a whole, um there's a whole field separately for, you know, people with autism and ad HD offending. So for example, in prison, 30% of the population have ad HD. Um and again, that calls for, you know, that kind of psycho the Royal College has been calling for um you know, the government to, to so to, to give more um funding, you know, for AD HD services and knowing that there's such a such a long waiting list, I think it's seven years now. But again, obviously, we have there needs to be more support for people with um neuro diverse conditions, OK? For non cinical. So this is quite a mixed bag. This is your time to do research. If you want to do a quality improvement, you want to do some teaching, you want to get involved in a leadership role. It's, it's pretty much um it's whatever you want to do. Um So at the moment, uh I just recently finished a uh a certification course in public mental health. So it was the first, it was the first cohort um by the Royal College of Psychiatrists and I rec I recently finished that um if, if anyone's keen, um just let me know, I can pop it in the chat um for my next non clinical special interest. I recently joined the um the leadership and management um fellowship scheme also by the Royal College. But again, this is really like flexible and you can choose use the day where you want to assign it in your work. Again, if you want to pursue a master's degree, another, you know, educational degree, like by all means, as long as you just, you know, inform your line manager and make sure that obviously your, your competencies in for things like, hi, you are not being compromised. Um Yeah, I think that's, that's pretty much it. So I'll just put here, put in here the resources. Um Obviously there's a, there's a faculty of Forensic Psychiatry in the Royal College website. So all the news in terms of like recruitment, you know, numbers uh number of, I mean, number of vacancies, um events, conferences, um awards. Uh Yeah, I mean, get involved if you're interested in it. Um If you're a, if you're keen to get into psychiatry training or if you're a psychia trainee, um there's a, there's a Twitter or slash X um account. Um they're pretty responsive on there um from the and there's also the NHS England higher Training recruitment where I got the, the, the, the pictures from and I put the email there as well if, if you just want to know more information. So they're quite responsive to um and, yeah, if you are a, if you, if you like books, reading books, um, forensic psychiatrist, a few of them end up becoming authors. Um, so on the left, um, it's by Gwen Adhe who is a psychiatrist in Broadmoor. Um, I've met her a couple of times um, in conferences. Uh, and I've read that book as well. It's, um, it's, it's a story, uh, it's a book, um, where she kind of tells the story of the patients she's um interacted with through medical psychotherapy. So I think she's a dual forensic psychiatrist and medical psychotherapist. Um They got dangerous minds by Taj Nathan. I'm currently reading that um quite similar and can they, they kind of, he kind of explains the patients he's seen, you know, under his case low throughout the years and kind of explaining violence and dangerousness. Um But I think what's important with these novels is that cause I think it's, it's so easy for us to like to, to condemn, to condemn offenders because obviously what they've done like to society. It, it's not, it's not great, it's not good. And there, there are victims and families of victims. Um But at the same time, I do acknowledge that no, nobody's born an offender, nobody's born with in intent to, to take somebody's life or to kill somebody. So that's, that's what I appreciate about like forensic psychiatry the most. Like you're not just a medical doctor, you're almost like a a APA public health um advocate as well because you need to be studying from the beginning just like the um the childhood history. Like, what, what led this person to, to resort to violence as a, as a coping behavior? Like, why is their first intention is to like to punch people instead of like just having a conversation? You know, how did he get? Point A to point B and I think if you're just eternally curious about those things, then, you know, I'd say maybe it's worth considering um pursuing also if you like thoroughness and spending at least six months with a patient. Um Then yeah, it might be um yeah, it might be worth pursuing. Um the last book I haven't quite read on it, but it's, it's got more of like a, there's a bit of dark humor in it, I'd say it's lighter. Um But yeah, um I'd encourage you to look into these books if you, if you're curious about the field. Yeah. Um Thank you very much. Um I probably the last thing I'd probably say is that at the end of the day, you know, you offer all these like risk assessments. I think being a doctor, your ultimate goal is to help people. Um And that really involves a lot of compassion um with the way you deliver your care um for forensics. So, yeah, that's me. Thanks. Thanks very much. I've left my um contact details there for anybody who has any burning questions? Maybe not now, but later on, thank you very much for this fantastic talk to me and it was really great. Um I just have one question for you. So you mentioned that you joined as an SD four trainee. Do you have any piece of advice for people that are looking to join at ST four level in order to make themselves more competitive for the application process? Ok. Um I feel like I'm gonna answer this question with, um, expressing my, um, dislike for the process because, uh, so in, in a similarly, it's kind of in surgery, you have a point system, right? So in ST four, there's also a point system and I, some of those things are not quite constructive. So for example, if you, if you completed another specialty, like if you were a radiologist who jumped into psychiatry, because you have another because you have an ex extra degree, you have more points. So I feel like that's not, that's not quite fair. Um, but if you happen to be that, then that's to your advantage. Um, uh, if you have any publication, that's, that's really something you wanna work on early. So when I was Act two, I just kind of briefly went through the point system. So I told my supervisor I wanna work on a publication, like because, you know, it could determine the, you know, the one point that sets you above um the other applicants um if you have an award at, at some point, uh if you have presented in a um and a regional or a national conference, so the, the Royal College International Congress, it's, it's a really good opportunity because if you just get, if you get to present a poster, you don't even have to speak orally. If you just get accepted to it because it's an International Congress, then that already, you know, falls under like the, you know, the international um presentation. Um The interview is probably around 15 to 20 minutes long. Um They do it online now, I think because of the pandemic and they haven't really reverted back to face, to face. The two questions will be given to you guys in advance. It's gonna be on the, the hee website, I think they give it about 23 weeks before. But to me that makes it even more difficult because everybody knows the question before the interview. Um And they, they tell you, um we discourage um rehearsed answers or we discourage you memorizing your answer. But then at the same time, like who wouldn't, who wouldn't try to memorize a little bit? Right? So I think it's like balance, just practice with somebody. Um Again, because if they feel like it's rehearsed, then I guess you lose a bit of points. So it's just finding that balance between, you know, you have a, you have a outline in your mind. But again, you're like kind of confident for like the followup questions that come. Uh Also it does come in waves because I think in, in higher training in psychiatry, most people take it as a chance to get pregnant, have a family. So it's these numbers because um it's a shame they're not increasing the numbers, but obviously there's more demand for core training. So it kind of bottlenecks. Uh So yeah, it comes in the wave. There are times when sometimes the February intake is more than the August for certain um subspecialties. Yeah, so I'll just say if, if you're, if you've decided on what higher training you want to get into, just keep an eye out for the news and try to see the trends if February or August is more, is more feasible. So, yeah, lovely. Thank you very much for that answer. That was really great and a lot of details in there. Um I have a question in the chat. Um uh Can I just check it as far as the psychiatry, let them full time training friendly? I can imagine that uh if that would affect the schedule planning. Uh So psychiatry I think is one of the LT FD friendliest specialties. Um in my in sever dry, we have an LT FD champion. Um There's even a whatsapp group for like um sever trainees like family matters. Um So it's so specific, I feel like there's such solid support and they even conduct these um like support sessions for LT FT trainees. So what happens is, so for example, if you're already doing um a clinical and a nonclinical special interest, technically, you only have three working days left. So if you're gonna go down LT FD, you, you have to prioritize your training as a frantic psychiatrist. So, um adjustments could be made where you could do just half a day of your clinical special interest. Um And then you still do like half the clinical work. Um But obviously the the workload is still, you know, it still reduces obviously, but just in terms of ensuring that you still have your special interests in. So again, this is very flexible. Um Yeah, great. I don't, I don't, I don't think there are any more questions at the moment. Um Yeah, it's somebody has asked, can't believe there's only one post in the whole country though. I don't think there was. Oh no, it's one, it's one post. So for Bristol, it was one post but it's not, it's not. So um in 2022 it was 30. No, tw 1920 23 was 30. And from the, for the February 2024 intake this year it was 26. But that's for England, Wales Scotland. I can't speak for Ireland, but I really think they should be increasing it. Um Yeah, it's a shame. Um Do you, so you don't, you don't have to do like ward rounds every day. So ward round is uh once a week. Um but again, the for example, my my consultant, her approach is Thursday is ward round day, but she sets another day throughout the week to just kind of like do like a mini ward round because that's how you establish um relationship with the with the patients because we're talking about patients who are in hospital for six months to a year. So it's almost like if you do a ward round like every day. Yeah. Yeah. It's almost like, yeah, what's the, what's your ultimate goal with it? Almost like you're just tiring yourself out. So it's more like timing it strategically and what are the urgent issues that arise for that for that week? Um And there's handover as well, but war ground wise. Yes, it's, it's not as often compared to a medical job. Mm. Um Do you generally finish on time? Uh Me? Yes, I II finish on time. Um I do have my lunch breaks. Um There are probably the days where I don't get to have a lunch break is when for example, there's a meeting at lunch time like literally I cannot, I cannot um go and have a break because there's, there's a tribunal, a manager's hearing basically a a really serious meeting that you just have to attend. But the thing with um I don't know, maybe, maybe I'm, I'm just gonna talk about the, the trust that I'm in but the consultants are extremely um supportive. I think there's a level of trust that you established with them and for them it's about like, they're not gonna police you. Like, I remember my TPD telling me my training program director telling me if you didn't come to work for like, two days in a row, like, I wouldn't, I wouldn't think that you were, you know, trying to avoid where I would be worried like where you are, like, what's happened to you? I don't know if it's the nature of the job, but that's, it's almost like it's really like the team looking out for each other. Um And it's flexible, like if there's a, if there's a, if there's a handover and for example, you, you, you have to only attend online, then you can do it. That's why a lot of people find it feasible for like for child care. And um, and if you have to leave early, for example, so the, the, the prison consultant that I work with, he's a general adult psychiatrist. So she has childcare and all that. So what she tends to do is on Tuesday, she works from 9 to 7 p.m. but then on Friday she leaves at 3 p.m. So it's almost like you kind of just as long as you achieve your 40 hour work week, as long as you ensure that you're meeting your training competencies, you're getting the work done. Um Yeah. And do you have to be on call? Oh, yes. Oh, yeah, I forgot, I forgot to mention that. Good question. So, in, in, um, if you're a forensic reg, so we're quite, we're quite isolated. I don't know why, but I have my induction, II didn't have any, like, first day induction. I was quite separated from all the rest of the psychiatry regs. Um, um, sorry, what was your question again? Do you have to do on call? Yes. So for, for the on call, uh we are on a separate forensic on Colora. Um So it's one every 15 days. Um So you're expected to be on call from, um it's a 24 hour on call now. So it's 9 a.m. to 9 a.m. the next day. But again, it's nonresidential. So after you finish your five, when it, when the clock hits 5 p.m. and there's no pressing issues and you can come home. And the reason I think the reasons that you just need to come in is if somebody is sent, is sent into seclusion because you have to do. And here's the thing if you're, if you're an sho if you're a junior resident doctor, if you're a core trainee, you have to see the patient within one hour. But if you're a reg or you're the consultant on call, you allow for like 6 to 8 hours. So there's a lot more flexibility there because again, you're kind of, you're not on the ground, but you're also making some decisions. So if somebody was sent into seclusion at 2 a.m. you know, the sho can ring you, but you're not really obligated to come in in the wee hours of the morning, you can leave it for the next, for the next day and you can do swabs uh on the weekend. We do every six months, we do have a 48 hour weekend on call. So it's basically from 9 a.m. Saturday to 9 a.m. nine AM Monday. Again, it's non-residential and we do get Monday and Tuesday off. So even if it's not, so you get, you get, you get your time back and for, for a time that you were in like, literally like working like, you know, like you're not running around like a headless chicken for the 48 hours. But again, it's more complex because we get calls from, from the police station, we get calls from prison. There are emergency transfers and I've seen a consultant on call, work like six hours on her desk on a weekend because it was just such a serious. Um I think something serious really happened. So it's quite variable, but I would say that is not as common as a usual onco Great. That's really interesting. Uh quite different to the medical uncle. Yeah. Yeah. Absolutely. Yeah. Absolutely. Yeah. Yeah. Yeah. That's why I have so much respect for like the medical, I would say I don't know what I, what I describe as busy now isn't quite, yeah. Isn't quite, quite careful. Yeah, that, I think that's a factor that, um, everybody should consider when they apply for training. And I think also as well with, for, it's more of a because II did, like, highlight you have power with, with people's freedom and I feel like even if, even if you are not physically exhausted but, but the process to make these decisions and when you write your reports, because the judges read your reports, they make decisions in court. They actually they do rely and listen and read and accept your recommendations. So it's almost like you do have you, you really have to know what you're, what you're talking about. And again, this is a slow process. Like I feel like in my ST four, I'm, I'm barely like every of the consultants need to read my report completely um before, you know, before and um they do tend, they do, they do tend to like make revisions and amendments. Um Again, it's a process. Uh Yeah, I feel like even if you're already in your early consultant, you're just not gonna be that, you know, it doesn't mean you already know everything. Uh but yeah, s slowly but surely and safely, I think that's it. Ok. We've got a couple of more questions in the chart. Uh One of them is if you have any ideas about the seizure training in for psychology psychiatry, sorry. Uh, seizure for forensic psychiatry. I haven't encountered somebody who has done that. Um, I think it's possible uh I might be wrong but I think with every CCT you can apply for seizure. Um, unfortunately, I do not know anybody yet on the forensic pathway towards uh Caesar. No, thank you. And the next question is the trainees have to attend court for proceeding proceedings. Um If you are the So no, because it has to be the responsible clinician who is the consultant. So um if there's for example, a sentencing, a patient who is in hospital is going to be sentenced and the court has asked for oral evidence, then it's going to be the consult, the responsible consultant. But if you are a trainee who has accepted to write a court report for somebody in prison, so it's almost like if you're a, if, if you're a wre if you're a forensic w you're doing some independent work. Um So and so for example, if I write a court report that's um that's being and the payment is sent, for example, you're being paid by the solicitor, um it doesn't get taxed in your, in your pay slip. So, and I recently realized it. So now I have to declare it now as a self assessment on the HMRC website because you, you're doing independent work, it's almost like you're, you're a sole trader because you're providing services for somebody outside your work contract. Um Yeah, I'm sorry, I forgot your question. I feel like being congenial. The question was if the trainees need to attend court. Yes. So, so for example, if you wrote a court report, um and if they want like additional evidence or you might need to come in for oral, usually if you, if you provide a written court report, they don't. But I think if it's more complex, if they would prefer oral evidence instead of a written court report evidence, then you might be asked to come in. Thank you. I think that's all of our questions. Thank you very much for your talking and for the, for your time this evening, it was very informative. There's a lot of thank you coming through in the chat. OK. Thank you very much. I hope it wasn't too boring with the, the terminologies. But yeah, something to consider. It's really interesting field. Thank you. Thank you very much and uh have a good evening everyone and don't forget to fill in the feedback form in order to receive your certificate. I put the feedback link in the chart and you'll also receive an email from medo. Thank you very much for joining us. Thank you.