Further information about LD Posts
Training available in the core clinical experience consists of the assessment, diagnosis and treatment of people with a learning disability and mental illness, challenging behaviour, complex medical conditions including autism, epilepsy, genetic syndromes and people with profound, multiple learning disabilities. It also includes the increasing issue of Substance misuse/dependence in people with Learning disability and the interface with the criminal justice system and forensic issues. Training in a lifespan service is available.
The established services offer opportunity for clinical experience in the following situations:
• In-patient Units: Acute mental illness with access to general psychiatric beds, specialist dual diagnosis and challenging behaviour units provide excellent experience of the multidisciplinary assessment and management of people presenting with complex needs including those of a forensic nature.
• Residential services: There are a vast number of registered nursing and residential homes throughout the area of this joint rotation (with a particularly large number in Gloucestershire) These establishments are in both private and voluntary sectors. Supported Living placements are increasingly being set up which can present its own challenges. The multidisciplinary teams frequently provide input to people living in these homes with varied philosophies and methods of service provision
• Out-patient Services: There is a good working relationship between General Adult Psychiatric Services (including the dementia wellbeing service in Bristol), Forensic Intellectual Neurodevelopmental Disorder (FIND) team, Forensic services, Child and Adolescent Mental Health Teams, Community Paediatrics and the Learning Disability Services. Links are well established with General Practitioners throughout Gloucestershire and Bristol plus surrounding areas with increasingly innovative joint working and shared care in some private sector homes. Strong working relationships exist with third sector agencies.
Emphasis on the successful management (following appropriate risk assessment) of clients with complex needs, including mental illness and challenging behaviour, within their community is an essential part of training.
The transition from education to social provision (with further educational input) is often a difficult period of change. Liaison with a wide variety of educational facilities occurs frequently. Education in the form of training courses for staff and carers are regularly held with input being provided by the medical staff.
A Forensic/LD training post has been developed on this rotation in Bristol with the FIND team in Fromeside Medium Secure Unit. In the Gloucester rotation forensic work is available with the Court Diversion Team and with Dr Jim Laidlaw, the consultant for low secure services. In Bristol specialised forensic learning disabilities experience is available through working with the Avon Forensic Learning Disability Team based in Petherton Resource Centre in Hengrove and the FIND team in Fromeside Medium Secure Unit in Bristol. All posts provide experience in the writing of Court reports and Out of Programme Training (OOPT) can be arranged at Special Hospitals or other secure facilities.
AWP also work within the criminal justice system delivering substance misuse care coordination and treatment interventions across Bristol City and South Gloucestershire. There are therefore opportunities for trainees to gain experience of the substance misuse/dependence interface with forensic psychiatry.
Special experience is available in the management of Autistic Spectrum Disorder, Asperger’s Syndrome in children and adults (with specialist teams as outlined below) plus assessment of elderly people with learning disabilities and family/systemic therapies. The management of epilepsy in people with learning disability is an area in which trainees can develop an interest whilst in any post with close links with the Burden Centre and with the Epilepsy Unit in Cardiff.
Experience in the assessment and treatment of children with a learning disability is gained in Gloucester by sessional work with the CAMHS service in that area. In Bristol the trainee can get this experience with the Bristol CAMHS-LD Service or with the South Gloucestershire CAMHS-LD service. There are also opportunities for a CAMHS-LD placement in Swindon.
Training in the management of a service is provided in all placements where service provision is constantly developing with ongoing review. Trainees may attend and participate in County Joint Planning Groups, Medical Advisory Group meetings, Executive Management meetings etc. There are regional management courses run by the South West Development and Training organization as well as The Severn Deanery and trainees may choose to attend national courses. Health Education England – working across the South West, and the Universities of Plymouth & Bristol Medical Schools also deliver the Professional and Generic Skills Programme for Doctors in Training.
In Bristol there are opportunities for trainees to take on management roles including:
• Chair of Specialty Registrar Group
• Organiser of Trainee Support Group
Trainee representative for:
• Academic programme
• Avon Learning Difficulties Education and Research Network (ALDERN)
• Audit Committee
• Medical Advisory Group
• Psychotherapy Committee
• Research Committee
• Severn Deanery Advanced Specialty Steering Group for Learning Disability
Education and Research
All placements offer the trainee access to well stocked library facilities with on-line searches and CD ROM Databases and inter-library loans. There are additional specialist libraries available at General Psychiatric Units (eg Blackberry Hill Hospital or Callington Road in Bristol, Wotton Lawn in Gloucester) and in the learning disability administrative bases. All medical staff have access to Bristol University Medical Library. There is also a service from the general medical library of the North Bristol Trust.
Trainees are encouraged to join in existing research, multidisciplinary projects and develop their own interests. There is now a strong connection with the Department of Psychiatry at Bristol University following the appointment of the Academic Clinical Lecturer in Learning Disability (unique in the UK), and the Department can provide research supervision where necessary. Within the scheme, Dr Mark Scheepers (Glos) and Dr Dheeraj Rai (Dept of Psychiatry) provide research supervision over and above direct supervision available from clinical supervisors. There is also the Deanery wide SpR Research Involvement Course (SPRRIC) which was set up to link post MRCPsych Trainees and Specialty Doctors to relevant and established research projects. It includes 6 weekly supervision and a teaching programme about Research. Two sessions for research and development are protected within the timetable.
Psychotherapy training is encouraged at all stages of training with expert supervision available if a trainee takes an individual case. In Bristol the trainees run their own Trainee Support Group twice per month for trainees only. In addition trainees have undertaken specialist training in psychotherapy for application in learning disability.
Trainees are expected to take part in local journal and continuing professional development meetings. They are strongly encouraged to attend the Deanery-wide Learning Disability training programme - this includes journal club, audit, case presentation and topic review on the second Wednesday in the month and a separate multidisciplinary conference on the fourth Wednesday every month on topics that follow the LD curriculum. Academic meetings are well attended by all staff including consultants and provide an intellectually stimulating programme. All academic activities are coordinated through the Avon Learning Disability Education and Research Network (ALDERN). This is an exciting project that is promoting the development of academic excellence in learning disability and over the last three years has hosted an annual Learning Disabilities Conference. Trainees can also attend the Gloucestershire and the Bristol academic programmes. In addition there are strong links with the Norah Fry Research Centre (Bristol University) which has a focus on improving services for people with a learning disability.
Trainees are expected to attend Royal College of Psychiatry Learning Disability Section Meetings and the Southwest Consultants and Specialty Registrars in Learning Disability meetings as well as other appropriate courses for which study leave is available.
The South West Division Training (SWDT) is part of the South West Division of The Royal College of Psychiatrists. It aims to provide a coordinated training programme for all psychiatrists in the South West, particularly trainees, in the areas of teaching skills, health service management, critical appraisal, appraisal and supervision, personal development, team leadership, and litigation in the NHS.
Trainees are encouraged to attend conferences in a wide variety of subjects including topics in psychiatry, autism and epilepsy with the emphasis on continuing education. A number of special interest meetings are sponsored at a local level within the trusts and in the South-West Region.
Progress during training is reviewed through the ARCP process run by the Severn Deanery School of Psychiatry.
Locally and within the Region there are a number of specialist services in which the trainee can have sessions including: -
• Child and Adolescent Psychiatry including the LD CAMHS service
• Neuropsychiatry - Burden Centre or University Hospital of Wales
• Brain Injury - Frenchay (BIRU)
• Autism-Bristol Autism Assessment Service
• Autism Spectrum Condition Diagnostic Service in Gloucester
• Forensic Psychiatry – Bristol Forensic Team, Leander Unit, Fromeside, Llanarth Court, Rampton Hospital, secure LD units in Norfolk
• Genetics - Bristol
• Community and Developmental Paediatrics
• Complimentary Therapies (Art, Music, Drama)
Two sessions are protected within the timetable for these and other appropriate special interest topics, which must be agreed with the educational supervisor in the job plan.
Audit/Quality Improvement Projects
There are active audit and quality improvement programmes (some through Medical Education Departments) and best practice committees providing a focus for multidisciplinary, clinical and professional audits. Clinical audit/QIP informs Clinical Governance and trainees will be encouraged to engage in developing evidence-based practice within the services.
Trainees are expected to take an active part in audit and quality improvement projects. There will be opportunities to audit and develop their own practice but there will be encouragement to supervise other audit/QIP projects.
Specialty Trainees in learning disability are expected to take part in the teaching of: -
• Medical students at Bristol University and on placements in Bristol and Gloucestershire.
• Service research and development meetings
• Local Certificate in LD courses for Health and Social Care Workers in Gloucestershire
• Training for core trainees during their first placement in A&E in Gloucestershire
• Trainees on the General Psychiatric Rotation in Gloucestershire
• Induction training for the core trainees starting their six month LD placements in Bristol.
• MRCPsych programme
There are also opportunities to take on the role of Associate Undergraduate Tutor who works alongside the Undergraduate Tutor for each Academy to coordinate and improve the educational experience of all the medical students across AWP. This is a year long role.
There are also opportunities to apply for an Educational Fellowship with the Severn Postgraduate School of Psychiatry. http://psychiatry.severndeanery.nhs.uk/about-us/advanced-specialist-training/educational-fellowships-project/
The timetable will be structured to meet the identified training needs of the individual Specialty Registrar providing a coherent pattern of clinical work reflecting the changing needs throughout higher professional training.
There are two timetabled sessions for special interest work and two for research and development, with learning objectives approved by the educational supervisor.
Consultant supervision will be timetabled reflecting the stage in training and the needs of the trainee, but will always occur on at least a weekly basis for one hour.
Duties of Post Holder
• To provide psychiatric care for people with learning disability as specified by the supervising Consultant, under the supervision of that Consultant
• To work constructively as a member of the multi-disciplinary teams in the Community Learning Difficulties Teams
• To liaise with others, where necessary, to ensure good care of the people for whom the post holder is caring
• When appropriate for either clinical care or training, to attend case conferences, CPA meetings, outpatient clinics, day centres, homes and other sites
• To maintain an appropriate level of confidentiality of client information
• To take an active part in clinical audit and quality improvement project
• To take part in the senior on-call system, as first on-call working under the supervision of a named learning disability consultant. In Bristol the rota is a 1:10 with prospective cover, in Gloucester the rota is also 1:10.On call will require the trainee to travel.
• To contact the supervising consultant, if clinical difficulties arise.
All trainees will be provided with a lockable cabinet, desk and computer and full secretarial support. In some bases, the available desks are in open plan offices but trainees do not have a problem accessing desk space in these situations.
There are a total of twelve potential placements on this rotation scheme, with further posts in development, offering a rich and valuable experience for specialist training in both Learning Disability Psychiatry and associated psychiatric specialist areas, Forensic Psychiatry, Neuropsychiatry, Child and Adolescent Mental Health.